Local Board of Health Training in Montana Presented to MLC-3 Open Forum Roundtable discussion group by Sue Miller Director, Montana Learning Collaborative Public Health & Safety Division Montana Department of Public Health & Human Services Sept 17, 2009

C O N T E N T  Why Public Health is Important  County-specific Information  Montana Public Health Law: Responsibilities and Authorities of Local Boards of Health and Local Public Health Officials  Case Study  Upcoming Voluntary National Accreditation Program

Why Public Health is Important Set the stage with data from a Montana-specific survey : A majority of Montana respondents could not accurately describe what PH does However, a majority perceived public health services as very important to protecting the public’s health Opportunities exist to improve the PH system

Why Public Health is Important Reviewed key characteristics of public health: Mission, 10 Essential Public Health Services (convey that these are now in Montana law as the purpose of the PH system, tied to developing voluntary accreditation program) Focus on prevention Broad definition and determinants of health Population focus of PH contrasted with individual health care

Why Public Health is Important Reviewed key characteristics of public health (cont’d): Epidemiologic shift – from communicable disease as leading cause of death and disease in 1900 to chronic disease in 2000 Emphasized the need for the PH system to stay current in meeting contemporary PH challenges Documented national and Montana-specific public health successes

County-specific Information  County Health Profiles  County funding from federal and state sources

Montana Public Health Law  Training opportunity: updates to PH statutes enacted by 2007 Montana Legislature (biennial sessions)  Updates were made to basic powers and authorities of Local Boards of Health and Health Officers  Most of these foundational provisions had not been changed in MT law for years  Updates were based on the Turning Point Model Public Health Act and Model Emergency Health Powers Act

Montana Public Health Law  Local Board of Health Covered composition, appointments, administrative duties, responsibilities and authorities  Health Officer Covered education and experience required, appointments, administrative duties, responsibilities and authorities

Montana Public Health Law Emphasized three key statutory updates: Essential Services as the purpose of the public health system  This provision establishes that having a public health system in our state is important  Previously there was no reference to a public health “system” and public health and health care concepts were used interchangeably in Montana law  Emphasized in the training that this is the framework for the developing voluntary national accreditation program

Montana Public Health Law 2. State and local public health agencies shall address “conditions of public health importance” using “contemporary public health practices, such as…” Montana’s statutes previously focused on communicable disease, health inspection and sanitation services, with miscellaneous disease and issue specific provisions added through the years. This brought Montana statutes into alignment with practices in the field. Emphasizes that PH must continue to address contemporary challenges such as chronic disease, injury, etc.

Montana Public Health Law 3. Greater collaboration is now encouraged among/between state, local and tribal public health agencies in statute Montana’s statutes previously allowed for county, city, city-county and district boards of health Updates encourage agreements for shared services with non-adjacent jurisdictions, tribal nations and jurisdictions in other states that border Montana This was spurred by emergency preparedness discussions, but may be beneficial for jurisdictions as they attempt to meet standards for voluntary accreditation

Case Study  Multi-drug resistant TB, foreign-born student  Student wanted to travel out of state and eventually return to home country  Involved two counties – smaller and large – helped make it relevant to all  Case provided an opportunity for Local Boards of Health and staff to tie their actions to statutory responsibilities and authorities

Case Study (cont’d)  Discussion touched on: Need for coordination between federal, state and local agencies 24/7 systems for contact Screening, diagnosis, treatment and resolution of case Issuance of written orders and no fly order  This event occurred within weeks of a national story related to an XDR TB case that involved international travel

Preparing for Accreditation  Tied accreditation to EPHS framework at every opportunity  Draft standards were not yet available, but provided supportive materials: NACCHO Operational Definition of a functional local health department NALBOH Guide to Appointing Local Board of Health Members NALBOH brochure: Being an Effective Local Board of Health Member Later sessions included slides from PHAB on the development of the program

P R O C E S S  Trainers  Statewide coordination  Local coordination  Evaluation

Trainers  Administrator, Public Health & Safety Division  State Medical Officer  Supervisor, Office of Public Health Emergency Preparedness & Training  Chief, Family/Community Health Bureau  Chief, Chronic Disease Prevention & Health Promotion Bureau  Chief, Laboratory Services Bureau

Statewide Coordination  Determined geographic areas  Contacted Lead PH Officials to orchestrate local BOH meetings to fit the specific geographic area, timing and sequence

Local Coordination  Lead PH Officials coordinated training with regular BOH meeting or arranged special BOH meeting  Provided or arranged for meeting place  Provided or arranged for refreshments or meal (depending on time of meeting)  Invited BOH members, County Commissioners, County Attorney, staff members and other community partners

Evaluation  49 Local Boards of Health received training (April 15—December 15, 2008)  Approximately 450 participants across the state  Overwhelmingly positive response Follow-up evaluation survey by the UM MPH program Positive comments on information/materials, presentations and case study 97% of responders felt the training was helpful 91% suggested that training be repeated