Download 2016 Regional School and Public Health Nurse Meeting

2016 Regional School and Public
Health Nurse Meeting
CDPHE update
CDPHE Update
• Communicable Disease Updates
• Suicide Prevention
• Substance Use - Narcan
Tuberculosis
What is tuberculosis?
• A bacterial infection that spreads from person to person through the air.
How is it spread?
• When a person with TB disease coughs, sneezes, speaks or sings, the
bacteria can remain in the air for several hours.
Latent TB Infection
• People who have become infected but do not yet have TB disease are not
infectious, do not have any signs or symptoms of disease, and can be
treated before they develop TB disease
Tuberculosis (cont)
TB Disease
• People who are not treated when they have latent TB
infection are at risk of developing TB disease and
spreading tuberculosis
PREVENTION
• People who have come into contact with an infectious
person are tested and treated to prevent them from
developing infectious TB disease later in life.
Source:
http://www.cdc.gov/tb/publications/factsheets/gener
al/tb.htm
Infectious TB Disease Symptoms
TB bacteria most commonly grow in the lungs, and can cause
symptoms such as:
• A bad cough that lasts 3 weeks or longer
• Pain in the chest
• Coughing up blood or sputum (mucus from deep inside the lungs)
Other symptoms of TB disease may include:
• Weakness or fatigue
• Weight loss
• No appetite
• Chills
• Fever
• Sweating at night
Source: http://www.cdc.gov/Features/TBsymptoms/index.html
2011-2012 School-Based
Tuberculosis Contact Investigation
• Index patient had infectious TB disease, with
cough, fever, and night sweats for two months.
School contact investigation
– Medically evaluated/sought:
– TB disease:
– LTBI:
1,249/1,381
1
162
• Partnerships for public health: 81 people from
health departments and schools were mobilized
for screening (885 person-hours) and LTBI
treatment (890 person-hours).
Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6239a1.htm
Please Notify CDPHE
• Suspected cases of TB are reportable to
CDPHE, please call (303) 692-2638 for more
information.
• Ann Scarpita, TB Nurse Consultant, RN, can
consult with you at (303) 692-2656 or
[email protected].
• Melissa Broudy, TB Training Coordinator, can
provide education (303) 692-2638 or
[email protected].
Reporting Chickenpox Cases to Public
Health
• CDPHE will be making minor updates to the case report
form in the coming months and will notify schools when the
new form is available.
• Please use CDPHE’s “Report a Disease” page to find the
most recent version:
https://www.colorado.gov/cdphe/report-a-disease
• CDPHE is involved in a new project that more closely tracks
outbreaks of chickenpox so schools may be contacted more
frequently with additional questions on reports.
• Contact your local PH epidemiologist or Breanna Kawasaki
(303-692-6235) at CDPHE with questions or if you think you
have an outbreak in your school.
Animals in school and child care
settings
• New health and sanitary regulations for child
care centers and schools
• Reptiles, amphibians and live poultry (e.g.
chicks and ducklings) are prohibited in
classrooms with children who are
kindergarten age or younger
• This includes hatching eggs in an incubator
Live poultry in schools
• Live poultry (e.g. chicks, ducks, incubating
eggs) prohibited from
– classrooms with kids kindergarten age or younger
– communal areas (like offices, halls, gyms) that kids
kindergarten age or younger use
• Discouraged in other classrooms where
children engage in frequent hand to mouth
behavior (special needs)
Live poultry in child care centers
• In settings where all kids are < 5 yrs:
– live poultry (e.g. chicks, ducks, incubating eggs)
prohibited
• In settings that also have kids ≥ 5, live poultry are
prohibited in:
– classrooms with kids kindergarten age or younger
– communal areas (like offices, halls, gyms) that kids
kindergarten age or younger use
– discouraged in other classrooms where children
engage in frequent hand to mouth behavior (special
needs)
Helpful Communicable Disease Branch
Website Links
• Main CDPHE website: https://www.colorado.gov/cdphe
• Report a Disease (lists of reportable conditions and information on how to
report cases): https://www.colorado.gov/pacific/cdphe/report-a-disease
• Communicable Disease Manual (disease-specific chapters, case
investigation forms, and guidance and timelines for investigation):
https://www.colorado.gov/pacific/cdphe/communicable-disease-manual
• Infectious Disease Guidelines (includes guidance for special settings such
as schools, child care, and health care facilities):
https://www.colorado.gov/pacific/cdphe/infectious-disease-guidelines
• Outbreak Investigations Page (guidelines, resources and forms for
outbreak investigation):
https://www.colorado.gov/pacific/cdphe/outbreak-investigationguidelines
• Reportable Disease Data (counts of reportable conditions by age, county
and report month): https://www.colorado.gov/pacific/cdphe/coloradoreportable-disease-data
Data
“Statistics are merely
aggregations of numbers with
the tears wiped away.”
- Dr. Irving Schikoff
Sources of information/data
National
National Violent Death Reporting System (NVDRS)
http://www.cdc.gov/injury/wisqars
State
Colorado Violent Death Reporting System (COVDRS)
Colorado Health Information Dataset
http://www.chd.dphe.state.co.us/topics.aspx?q=Mortality_Data
http://www.chd.dphe.state.co.us/cohid/Default.aspx
Colorado Child Fatality Review System
https://www.colorado.gov/pacific/cdphe/cfps-data-and-information
Healthy Kids Colorado Survey
http://www.chd.dphe.state.co.us/topics.aspx?q=Adolescent_Health_Data
Value of Data
Inform programming
Target limited resources to certain populations
Inform access points
Measure efficacy and outcomes
Leading Causes of Death: United States
Residents, 2011‐2013
173.7
169.8
169
163.2
Heart disease
Cancer
Chronic lower respiratory…
Stroke
Unintentional injuries
Alzheimer's disease
Diabetes
Influenza and pneumonia
Kidney disease
Suicide
0
42.5
42.1
37.9
36.2
39.1
39.4
24.7
23.5
21.6
21.2
15.7
15.9
13.4
13.2
12.3
12.6
40
80
120
160
Age‐adjusted death rate per 100,000 population
2011
2012
2013
200
Source: National Center for Health Statistics, Centers for Disease Control
Suicide in Colorado
In 2014, there were:
52 HIV deaths
172 Homicides
486 Motor vehicle deaths
553 Breast cancer deaths
668 Influenza & Pneumonia deaths
826 Diabetes deaths
1,058 deaths by Suicide
Suicide is the 7th Leading cause of death in CO for
all ages
Source: Vital Statistics Program, Colorado Department of Public Health and Environment
Leading Causes of Death, Ages 10‐18
In 2014:
3 Drowning deaths
9 Poisoning deaths (unintentional)
16 Homicides
18 Cancer deaths (all types)
35 Motor Vehicle deaths
50 Suicides
Suicide is the 2nd leading cause of death for those ages
10‐24
Source: COHID
CO Suicide deaths and rates ages 10‐18, 2009‐2014
Year
n
Rate*
2009
48
8.0
2010
40
6.8
2011
39
6.4
2012
42
6.8
2013
48
7.6
2014
50
7.8
*per 100,000 population
Source: COHID
Suicide deaths by age and gender,
2010‐2014
900
792
800
Number of Suicides
700
656
614
629
600
484
500
400
291
300
185
200
100
279
202
177
128
178
88
4520
80
31
12
0
0‐14
15‐24
25‐34
35‐44
45‐54
55‐64
65‐74
75‐84
85+
Age Group (years)
Males
Females
Source: Vital Statistics Program, Colorado Department of Public Health and Environment
Age‐Specific Rate (per 100,000 population)
Age‐specific suicide rate, 2010‐2014
32
30
28
26
24
22
20
10‐17
18
16
14
12
10
8
6
4
2
0
18‐24
25‐44
45‐64
65+
2010
2011
2012
Year
2013
2014
Source: Vital Statistics Program, Colorado Department of Public Health and Environment
Suicide Deaths in Colorado
Ages 10‐14 (2010‐2014)
• Overall suicide rate 3.7/100,000
– 65 total suicide deaths
– 69% male
– 29% by firearm
• Overall U.S. suicide rate –1.5/100,000 ( 1,241 deaths)
Source: COHID
Suicide Deaths in Colorado
Ages 15‐18 (2010‐2014)
• Overall suicide rate 11.3/100,000
– 154 total suicide deaths
– 72% male
– 41% by firearm
• Overall U.S. suicide rate – 7.3/100,000 ( 4,992 deaths)
Source: COHID
Percent of suicides by age group
Suicide methods by age group,
Colorado residents (2009‐2013)
80.0
70.0
60.0
50.0
Poisoning
40.0
Hanging
30.0
Firearms
20.0
Other
10.0
0.0
0‐14
15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84
85+
Age group (years)
Source: Violent Death Reporting System, Colorado Department of Public Health and Environment
Percent of suicides by age group
Suicide methods by age group,
Colorado residents (2009-2013)
80.0
70.0
60.0
50.0
Poisoning
40.0
Hanging
30.0
Firearms
Other
20.0
10.0
0.0
0-14
15-24 25-34
35-44
45-54
55-64
Age group (years)
65-74 75-84
85+
Age‐adjusted suicide rates by county of residence
classification, Colorado residents (2009‐2013)
County Classification
Number
Urban
Rural
Frontier
3,943
581
129
Age‐adjusted rate
(95% CI)
17.5 (16.9‐18.0)
19.8 (18.1‐21.4)
19.0 (15.6‐22.4)
Source: Violent Death Reporting System, Colorado Department of Public Health and Environment
Suicide Attempts in
Colorado
In the US, for each death by suicide an
estimated 25 attempts are made
For those surviving an attempt, the vast
majority do not later die by suicide
2000
160
1500
120
1000
80
500
40
0
0
10‐14 15‐19 20‐24 25‐44 45‐64 65‐84
Age Group in Years
Males
Males
Females
Data Source: Hospital discharges from the Colorado Hospital Association
* excluding persons who died or were discharged to hospice
85+
Females
Rate per 100,000 population
Number of discharges in 3 years
Hospitalizations for Suicide Attempts* by age group and
gender: Colorado residents, 2010‐2012
Suicide Hospitalization in Colorado
Ages 10-14 (2009-2013)
• Overall hospitalization rate 32.2/100,000
– 545 total hospitalizations
– 80% female
– 73% by solid/liquid drug overdose
Source: COHID
Suicide Hospitalization in Colorado
Ages 15-18 (2009-2013)
• Overall hospitalization rate 121.4/100,000
– 1,649 total hospitalizations
– 66% female
– 79% by solid/liquid drug overdose
Source: COHID
2013 Healthy Kids CO Survey
Completed by 9th through 12th graders in public high
schools in Colorado
• 24.3 percent reported feeling so sad or hopeless almost
every day for two weeks or more in a row that they stopped
doing some usual activities during the past 12 months (LGB –
59.4%; Hispanic Female – 38.7%).
• 14.5 percent reported seriously considering attempting suicide
during the past 12 months (LGB – 48.5%; Native
Hawaiian/other Pacific Islander Male – 26.5%; Black female –
24.6%).
• 6.6 percent attempted suicide one or more times during the
past 12 months (LGB ‐ 28.2%; Native Hawaiian/other Pacific
Islander Male – 15.7%; American Indian/Alaska Native –
14.5%).
Office of Suicide Prevention
www.coosp.org
• Mission – To serve as the lead entity for statewide suicide prevention and
intervention efforts, collaborating with Colorado communities to reduce the
number of suicide deaths and attempts in the state.
• OSP Activities
– Suicide Prevention Commission (SB 2014‐088)
– Hospital Initiative (HB 2012‐1140)
– Man Therapy – www.mantherapy.org
– Bridging the Divide: Suicide Prevention and Awareness Summit
– Public information and education campaigns, clearinghouse, &
presentations
– Community grant making
– Children’s Hospital Means Restriction Education
– CO Gun Shop Project Pilot
High Risk Populations & Communities
• LGBTQ Youth
• Hispanic/Latino Youth
(Females)
• Active Duty Military & Veterans
• Working‐age Men
• Older Adults
Sources of Strength
School‐based suicide prevention through promotion
of protective factors and development of resiliency
ED‐CALM
CALM
Center on Access to Lethal Means at
Dartmouth
ED‐CALM
Firearm Deaths in Colorado, 2005‐2013
Source: Violent Death Reporting System, Colorado Department of Public Health and Environment
CO House Bill 2012 ‐ 1140
•88 CDPHE licensed short‐term, critical access,
licensed general, and Psych hospitals in CO
•Information and materials at time of discharge for
patients and families
• Assessment of hospitals to identify current
practices, gaps and needs
Suicide Prevention
Commission of Colorado
Initial Priorities
❖Expanding and streamlining efforts to provide effective
follow up care after emergency department discharge
❖Expanding efforts to provide effective follow up care after
inpatient discharge
❖Promoting practices for reducing suicide risk among primary
care patients
❖Improving and integrating training for members of specific
professional groups
Colorado Crisis Services
-
24/7 Walk In Clinics
Respite Care facilities
Acute Care Units
Mobile Crisis Teams
Crisis Line with Peer Support and follow up
1-844-493-TALK
- Services available regardless of county, region,
or insurance
Education
Community
Who:
K-12 Education
What: (in an ideal world)
Full Spectrum Prevention Programming and
Protocols:
Toolkit with formal protocols for schools to follow
All staff trained in Mental Health First Aid and Suicide Prevention specific course
Schools to have evidence-based program and compliments
Increase funding for behavioral health staff in school/available Primary
Prevention- Social/Emotional Learning in elementary schools
How:
Start with Top Level Buy in from Administration, Superintendents, Principals
Why:
Suicide is the second leading cause of death among our youth
Colorado age-specific rate is considerably higher than the national average
Healthy Kids Colorado survey provides notable data to support need
Trainings
Applied Suicide Intervention Skills Training (ASIST)
www.livingworks.net
safeTALK
www.livingworks.net
Question, Persuade, Refer (QPR)
www.qprinstitute.com
The Yellow Ribbon Program
www.yellowribbon.org
Kognito Online Trainings
www.kognito.com
Colorado Mental Health First Aid
www.mhfaco.org
See more at sprc.org/bpr
Colorado Statewide Resources
Office of Suicide Prevention
www.coosp.org
Suicide Prevention Coalition of Colorado
www.suicidepreventioncolorado.org
Carson J Spencer Foundation
www.carsonjspencer.org
Sources of Strength
www.sourcesofstrength.org
Yellow Ribbon Suicide Prevention
www.yellowribbon.org
National Resources
Suicide Prevention Resource Center
www.Sprc.org/bpr
American Foundation for Suicide Prevention
www.Afps.org
American Association of Suicidology
www.Suicidology.org
National Action Alliance for Suicide Prevention
www.Actionallianceforsuicideprevention.org
Zero Suicide Initiative
www.Zerosuicide.com
Prescription Drug
Surveillance
School Nurse Leadership Meeting 1/13/16
Rebecca Hebner, MPH
Substance Abuse Prevention Systems Coordinator
Prescription Drugs: Every Day
MISUSE=700
INJURIES=12
DEATHS=2
In 2014, there were 870 prescription drug overdose
deaths in Colorado. Eighty deaths were among 15-25
year olds.
Almost 5,000 people were hospitalized, more than
MVA, homicides or firearms.
This is just a fraction of the harms to the 6% of
Coloradans age 12+ who misuse prescription drugs.
Prescription Drugs: A Growing
Problem
Number of drug overdose deaths involving opioid pain relievers
and other drugs, Colorado residents, 1999-2014
Prescription Drugs: Focus on
Opioids
39%
Opioid pain relievers
contributed to at least
338 of the 870
drug overdose deaths
in 2014.
Source: Colorado death certificate data 2014, Health Statistics Section
4. Health Statistics Section, Colorado Department of Public Health and Environment. Definition used based on W
M, Chen LH, Makue DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008 NCHS d
brief, no. 81. Hyattsville, MD: National Center for Health Statistics, 2011.
Local Prescription Drug Abuse Data
INJURY
MISUSE
1
1
1
2
5
2
5
DEATHS
2
5
3
3
4
4
Opioid Mortality
(rate per 100,000 population, 2013)
Opioid ED Visits
(rate per 100,000 population, 2013)
Nonmedical Use of Rx
(percent of population age 12+, 2010-12)
3
4
Region 1
Region 2
Region 3
Region 4
Region 5
Colorado
5.4
6.1
4.8
9.3
2.8
5.6
10.8
15.9
17.1
24.1
10.4
15.2
5.9
5.7
5.2
4.9
5.2
5.6
What is an Opioid?
• Any natural, synthetic or semi-synthetic narcotic drug that
acts like opium in the body.
methadone,
Examples: oxycodone, hydrocodone,
and fentanyl.
• Highly addictive, and misuse can be life threatening.
• “Other opioids” refer to opioids other than heroin and are
not available over the counter.
Boyer EW. Management of opioid analgesic overdose. N Engl J Med 367:2: 146-155.
International Classification of Diseases, 9th Revision, Clinical Modification.
SCHOOL NURSES
But what about youth?
National Survey On Drug Use And Health
Healthy Kids Colorado Survey
Prescription Drug Misuse
Surveillance
A couple of definitions:
• Medical use but not as the prescription directs1
• Nonmedical or recreational use2
• Taking someone else’s prescription drug, even for medical use
1. http://www.colorado.gov/cs/Satellite/CDHS-BehavioralHealth/CBON/1251581819035 accessed on 11/15/2012
2. NIDA http://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction accessed on 2/21/13
Substance Abuse Mental Health Services Administration
(SAMHSA)
National Survey on Drug
Use and Health
“On how many days in the last 12 months did you use any
prescription pain reliever that was not prescribed for you or
that you only took for the experience or feeling it caused?”
NSDUH: Youth Misuse Trends
Nonmedical Use of Pain Relievers in the Past Year, by Age
Group 12-17, 2009-2014 trends
NSDUH: by Sub-state Regions
Nonmedical Use of Pain Relievers in the Past Year, by Age
Group 12-17 and Sub-state Region: based on 2010, 2011,
and 2012 NSDUHs
Colorado Substate Region
% (CI) = 7.10%
(5.76 - 8.73)
Region 1
6.89% (4.77 - 9.86)
Region 2 & 7
7.36 % (5.59 - 9.62)
Region 3
7.04% (5.03 - 9.78)
Region 4
6.83% (4.69 - 9.86)
Region 5 & 6
6.45% (4.33 - 8.91)
5&6
1
2&7
3
4
NSDUH: source of misused Rx
72%
of people who
misuse drugs get them
from friends or
relatives.
Colorado Department of Public Health and Environment
Healthy Kids Colorado
Survey: High School Students
“During your life, how many times have you taken a
prescription drug (such as OxyContin, Percocet, Vicodin,
codein, Adderall, Ritalin, or Xanax) without a doctor’s
prescription?
Colorado Average = 13.6%
HKCS: by Health Statistics Regions
Nonmedical Use of Pain Relievers, Ever Use, 2013 High
School Students
Health Statistics Region
HSR 1: Logan, Morgan, Phillips,
Sedgwick, Washington and Yuma
HSR 2: Larimer County
HSR 3:Douglas County
HSR 4:El Paso County
HSR 5:Cheyenne, Elbert, Kit Carson
and Lincoln
HSR 6:Baca, Bent, Crowley, Huerfano,
Kiowa, Las Animas, Otero and Prowers
HSR 7:Pueblo County
HSR 8:Alamosa, Conejos, Costilla,
Mineral, Rio Grande and Saguache
HSR 9:Archuleta, Dolores, La Plata,
Montezuma and San Juan
HSR 10:Delta, Gunnison, Hinsdale,
Montrose, Ouray and San Miguel
Rx Misuse
by HS
9.5%
Health Statistics Region
Rx Misuse
by HS
HSR 11: Jackson, Moffat, Rio Blanco and
Routt
9.9%
13.6%
HSR 12:Eagle, Garfield, Grand, Pitkin
and Summit
12.4%
12.8%
HSR 13:Chaffee, Custer, Fremont and
Lake
19.2%
14.6%
9.0%
15.4%
18.5%
14.9%
HSR 14:Adams County
19.5%
HSR 15:Arapahoe County
12.7%
HSR 16:Boulder and Broomfield
11.5%
HSR 17:Clear Creek, Gilpin, Park and
Teller
19.8%
HSR 18:Weld County
14.2%
HSR 19:Mesa County
13.9%
15.2%
15.9%
HSR 20:Denver County
HSR 21:Jefferson County
11.1%
n/a
HKCS: by Health Statistics Regions
Nonmedical Use of Pain Relievers, Ever Use, 2013 High
School Students
STRATEGIES FOR SCHOOL NURSES
What can we do for youth?
Colorado Plan to Reduce
Prescription Drug Abuse
Strategies:
1) Improve surveillance data
2) Strengthen prescription drug monitoring program (PDMP)
3) Educate prescribers and providers
4) Increase safe disposal
5) Raise public awareness
6) Enhance access to treatment
7) Expand access to naloxone
Improve Surveillance Data
✓Keep participating in Healthy Kids Colorado Survey!
✓ 2015 HKCS has more questions about prescription
drug misuse:
✓Ever Use
✓Current Use (past 30 days)
✓How easy to access?
✓How wrong for someone your age?
Increase Safe Disposal
✓ Most teenagers who abuse prescription drugs are given
them for free by a friend or relative.1
✓ Find a safe disposal box
near your school: Google
“Colorado Drug Disposal”
Encourage parents, guardians
and staff to safely dispose of
unwanted or unused medication.
✓ Sites to expand statewide
1. National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and
Human Services.
Raise Public Awareness
✓ Speak Now: Office of Behavioral Health’s resource for
parents and teachers to talk to youth about drug use
✓ TakeMedsSeriously.com: safe use, safe storage, safe
disposal of prescription drugs
✓ Smart Choices, Safe Kids: family and community information to
protect children around substances
✓ Other resources to promote
✓ Rocky Mountain Poison and Drug Center: 1 (800) 2221222
✓ Good Samaritan Law: 911 immunity and naloxone
administration
✓ OBH’s Treatment Directory: >600 facilities, treatment
often successful with younger audiences
Expand access to Naloxone
✓ Your school can request standing orders for Naloxone
from CDPHE
as
aka Narcan, the opioid reversal drug, available
injectable or nasal spray
✓ Relatively cheap (<$50 a dose), long shelf life, heat/cold
stable
✓ “No down side” –Naloxone Workgroup of Colorado
Consortium for Prescription Drug Abuse Prevention
✓ Trainings available: Harm Reduction Action Center, among
others, including online.
Questions?
[email protected]
What about heroin?
Not currently a major issue among Colorado high school
students