Download Tri-County Health Department

A Successful Regional Health
Department in Colorado
Richard L. Vogt, M.D.
Executive Director
CCI Conference, June 10, 2009
Composition
• Tri-County Health Department (TCHD)
serves Adams, Arapahoe and Douglas
Counties
• We serve 1¼ million residents, ¼ of
Colorado’s population
• Our Board of Health has three appointed
representatives from each county, for a
total of nine members
History
• TCHD was formed in 1948 to include
Adams, Arapahoe and Jefferson Counties
History
• In 1958, Jefferson County formed its own
Health Department, so TCHD served only
two counties until 1966
• In 1966, Douglas County
decided to join TCHD
after they received mutual
aid in response to the
South Platte River floods
Approach as a
Regional Health Department
• Delicate balance functioning as one health
department serving the needs of three
diverse counties
• TCHD needs to keep consistent
approaches for all of our three counties
• However, each county has special needs
and interests that also need to be
addressed
Regional Health Department
• Provide core services to all three
of our counties
• Provide some individualized services
for each of our counties
Core Services Offered to
Each County
• Nursing
– Adult and child immunizations
– Family planning
– Women’s cancer screenings
– Maternal child health programs
– Access to care programs
– HIV/AIDS, sexually-transmitted disease
and TB outreach programs
– Chronic disease prevention
Core Services
• Environmental Health
– Restaurant inspection program
– Child care inspection program
– Pool/spa inspection program
– Onsite-wastewater program
– Hazardous chemicals in schools
– Land use reviews
– Vector control
Core Services
• Nutrition
– WIC program
– Community nutrition
– Early childhood obesity
and prevention
– Dietetic internship
– Breast-feeding support program
Core Services
• Epidemiology, Planning
and Communication
– Infectious disease investigation
– Outbreak control
– Public information
– Tobacco prevention
– Statewide older adult fall prevention program
– Health planning
– Geographic Information Systems (GIS)
Core Services
• Emergency Preparedness
– Developed emergency
response plans in coordination
with external and internal partners
– Coordinated agency responses
to public health emergencies
– Coordinated the strategic national stockpile
and mass prophylaxis
– Developed agency continuing operation plans
(COOP)
Core Support Services
• Administration
– Purchasing
– Payroll
– Human resources
– Information technology
– Facility management
Individual County Interests
and Programs
Adams County
• Major interest in protective
measures with oversight
of landfills and the Rocky
Mountain Arsenal cleanup project
• Developed an innovative mutual agreement with
Adams County Human Services to provide
selected nursing services for human service
clients using Temporary Assistance for Needy
Families (TANF) funds
• Household hazardous waste disposal
Arapahoe County
• Largest populated county in
our jurisdiction
• We have special funding to help provide dental
services for Arapahoe County senior citizens
• Developing a similar program with social
services again using TANF funds
• Arapahoe County has shown a special interest
in outbreaks of illness that require planning
– West Nile Virus
– H1N1 influenza infections
Douglas County
• Has a special interest
in water
– Quantity
– Quality
• TCHD conducted a special study of the
quality of well water in homes that have
septic systems, finding little contamination
in households with submitted samples
• Household hazardous waste disposal
Three-County Agreement
• In 1988, all three sets of County Commissioners
entered into an agreement to provide the same
level of county per capita funding
• The advantage is that there is a common
contribution for all of the three counties
• A disadvantage is that we are funded at a level
that the most financially challenged county can
afford each year
• We also have individual contracts for
county-specific activities
Benefits of Regional Health
Department
• Provide more uniform services across counties
• Provide enough depth to shift resources
depending upon the public health need
• Can provide a significant nursing workforce for
public health activities in the area
• Able to undertake large campaigns
– In 1992, administered IG to 15,000 residents
– In 1993, coordinated activities for the Pope’s visit
– In 2009, administered 1,300 doses of IG and hepatitis
A vaccine
Benefits
• Receive financial support from three
counties which enables us to have
professionals and programs that would
otherwise be unavailable
• We have economies of scale with one
office of administrative services for three
counties
Challenges
• A presence in each of our three counties
• Staff liaison in an office located in each
county
• Attendance at each of the many county
functions
– Volunteer appreciation receptions
– Ground-breaking and dedication ceremonies
– Presentations of our proposed budget to each
county
Challenges
• Campaign with Commissioners
over the years with the theme that
“TCHD is your local health department”
• Lack of recognition as a “department”
similar to those housed within the county
structure
• Lack of awareness by county residents
that TCHD is their county health
department
Challenges
• Some difficulty in managing
11 offices in our jurisdiction
– Four full service offices
– Two partial service offices
– Four WIC offices
– One administrative office
• Currently have an “office director”
for each office
Challenges
• Arrange for courier services between
offices
• Negotiate multiple leases for properties
not supported by counties
• Strive to be “equal and fair” to employees
in 11 different offices
• Strive to provide uniform services between
the different offices
Space Challenge
• At present, each county provides at least
one office for TCHD free-of-charge
• However, one county has provided all of
our office space at no charge
• TCHD contracted with a consulting firm to
evaluate the current county space support
• The results will be presented to our three
sets of County Commissioners
Douglas County Study
• In 2003, Douglas County formed a committee to
review the possibility of forming their own LHD
• At that time, Colorado Statutes allowed this to
happen, giving 12 months notice to the LHD
• TCHD convinced Douglas County of the worth of
our agency to provide services to residents
• In the end, Douglas County decided to stay with
TCHD because of “economies of scale” and
demonstration of vision and strong leadership
Activities
• Undertaken a campaign to be
included in all written county
reports that list county
departments
• Attempted to attend all
county functions recognizing
county departments
• Attempted to send a TCHD staff
representative for regular county
management meetings
Summary
• There are many advantages to
establishing a regional health department
• However, the process is not without
challenges
• At present, each of our three counties feel
that we are providing cost-effective, highquality public health services to our
residents and are attentive to individual
county needs
Thank you!