Oregon City School Board Increases Access to Reproductive Health Services
February 2020
Oregon City has one of the longest-standing school based health centers (SBHC) in Oregon. Students can go to their school based health center (SBHC) for routine services, such as comprehensive physical exams, vision screenings, immunizations, and mental health support, and other types of preventive health care. No one is denied services, and students and families aren’t charged for their visits to the clinic. However, not all SBHCs provide the same breadth of services.
Oregon City School District, Clackamas County Public Health Division (CCPHD), and Clackamas County Health Centers (CCHC) oversee the local SBHC. Since its existence, the SBHC in Oregon City High School has not distributed birth control measures to students, and was one of only two centers in the county that prohibits dispensing contraceptives to students – until now.
On January 13, 2020, the Oregon City School Board voted unanimously to change their contracts with CCHC, and CCPHD, and begin dispensing contraceptives at their SBHC. Local public health officials reported that data on the rising rates of sexually transmitted infections (STIs) informed the school board’s decision-making, and moved the school board to take action in providing comprehensive reproductive health services.
Kim La Croix, MPH, RD, Access to Care Program Manager at CCPHD, applauded the school board members, the Clackamas County Sexual and Reproductive Health (SRH) Coalition, and her public health colleagues for their work in advancing the policy change.
Deschutes County Reflects on Modern Approaches to Suicide Prevention
January 2020
Suicide is the second leading cause of death among young people, ages 10-24, in Oregon (1). Similar to statewide trends, Deschutes County has witnessed an increase in the rates of suicide over the last decade. During the past year, Deschutes County public health officials have implemented compassionate, modern, and trauma-informed approaches in how they respond to every suicide loss in their community.
When asked about the data related to suicide rates specifically for Deschutes County, Whitney Schumacher’s first response exemplified her tempered and empathic approach to the issue. Speaking about the data, Schumacher first says, “Suicide is an alarming and complex public health issue that no single entity nor single solution can solve, which is why we take a comprehensive, collaborative approach to suicide prevention in Deschutes County. We all know that one death by suicide is too many.” Schumacher also shared that Deschutes County loses about 54 people to suicide every year.
Schumacher is the Suicide Prevention Coordinator for Deschutes County Health Services, and has elevated the county to become a leader in suicide prevention in Oregon. Deschutes County’s compassionate suicide prevention work also pays close attention to evidence based practices and continuous quality improvement. Schumacher and other local public health officials weaved together what it means to be a modern health department that synergizes technical capabilities and caring for communities.
Suicide prevention is a young field in public health, and the innovative progress in Deschutes County started shortly after the Oregon Legislature passed Senate Bill 561 in 2015. “The purpose of SB 561 is to prepare communities to respond to suicides in order to reduce the risk of more suicide among those left behind after the death” (OHA). Each county has an informally dubbed “SB 561 Reporter” that must report suicides by anyone age 24 and younger to OHA so that local and state jurisdictions can coordinate their responses, commonly referred to as the postvention. Deschutes County took these first-in-the-nation requirements to a new, comprehensive level in January 2019 by expanding their services.
Multnomah County Health Department responds to HIV-syphilis syndemic
The Multnomah County Health Department (MCHD) continues to respond to complex communicable disease outbreaks alongside Portland Metro Area public health partners.
In June 2019, Multnomah County activated their emergency response incident command structures to respond to an increase in HIV cases among people who inject drugs and use methamphetamines. MCHD worked with partners at the Oregon Health Authority and in Washington and Clackamas counties to coordinate their response. The activation of incident command was initially triggered by the identification of a group of persons diagnosed with genetically similar HIV strains. Concurrently, MCHD realized the outbreak was entwined with other complex diseases and community circumstances.
Kim Toevs, the Communicable Disease, STD and HIV director for Multnomah County, has taken the lead in responding to the HIV increase, which she describes as part of a broader “syndemic.”
Syndemic is an emerging term used to describe the interaction of coexistent diseases and additional health burden on the affected individual. During a syndemic, populations are at risk of multiple co-infections that may thrive concurrently due to interaction of diseases and social conditions that increase transmission among vulnerable populations.
Benton County Environmental Health and Communicable Disease Teams Find Their “Bug”
Benton County Health Department (BCHD) estimates that their Environmental Health and Communicable Disease teams identify the primary source of a foodborne illness in community outbreaks in approximately 90% of their investigations. According to Bill Emminger, Environmental Health Division Manager for BCHD, that is an uncommonly high rate of success for local investigations.
Charlie Fautin, Deputy Director of Public Health at BCHD, promotes successful investigations by keeping the right teams working closely and supporting each other. Emminger elaborated that the health department’s exceptional investigation protocols stem from well-planned collaboration between the department’s experts in environmental health (EH), communicable disease investigation (CD), and epidemiology. “I think it really helps us having that experience locally and being able to have a plan thought out in advance has been really helpful for us to investigate and find a bug.”
Collaboration from Day 1 of an outbreak is the key to success and finding the source of a foodborne illness outbreak, or finding “the bug.” Emminger prioritizes communication between three partners: the state epidemiologists, the state public health lab, and local environmental health specialists. At BCHD, another key local partner is communicable disease nurses and epidemiologists. Mary Shaughnessy, Communicable Disease Nurse for BCHD, regularly supports investigations by adding communicable disease and nursing skills. Shaughnessy shared, “Having the other team in the same space is a constant reminder that we have support close by.”
Outbreak investigations require a fast and meticulous response from both EH and CD teams if local health officials hope to find “the bug.”
New Klamath County CHIP Emphasizes Cross-Sector Partnership
Klamath County Public Health, as part of the Healthy Klamath Coalition, will soon officially release their 2019 Community Health Improvement Plan (CHIP). The CHIP will include six priority areas that collectively demonstrate a new level of focus on the social determinants of health and health equity for the coalition.
The Healthy Klamath Coalition “Core Four” partners, (Klamath County Public Health, Cascade Health Alliance Coordinated Care Organization (CCO), Klamath Health Partnership (FQHC) and Sky Lakes Medical Center) began work on the new CHIP in February 2019. The finalized CHIP will be unveiled in October at the next Healthy Klamath Coalition meeting.
The overarching categories of the CHIP are: behavioral/mental health, physical healthy, and social determinants of health. Under these broad categories, the CHIP priority areas are: suicide prevention, physical well-being, oral health, infant mortality, food insecurity, and housing.
Healthy Klamath will utilize its cross-sector partnerships to work towards these shared goals. Jennifer Little, Director of Klamath County Public Health, is excited about the early plans that are in place for cross-sector work to address housing as a public health issue.
Union County’s “One Stop Shop” for WIC and Other Public Health Services
The Center for Human Development (CHD) in Union County provides local public health services to the community, and uses cross-sector partnerships and creative outreach to bring community members into the agency. These approaches support CHD’s mission of working for healthy communities.
Union County is one of the 4 local public health authorities out of 33 total that uses a public-private partnership to manage local public health services.
CHD Women, Infants & Children (WIC) Coordinator, Kim Adams, says the agency is working “to bridge a gap between our local agency and the community by creating a “one stop shop” for multiple services while removing the barrier of multiple appointments/transportation concerns. This allows us to promote services that our community might not otherwise know about, which in turn can help us improve health outcomes for our community, be that nutritional, dental, public, behavioral, physical, or mental health.”
CHD has brought together several partners that are a natural fit for co-promoting improved health outcomes. Partners include Advantage Dental, Liv Fit and Dance (Toddler Time), NEON (North East Oregon Network), WIC, and Public Health.
Umatilla County Public Health Implements Equity Assessment
Local public health authorities work to promote and protect the health of everyone in Oregon. In order to effectively do this, it is essential that they understand the diverse conditions in which their communities live, work, play, learn, and age. There are gaps in health across Oregon, and the country, that are caused by barriers to things like access to care, living wage jobs, and safe and affordable housing. Conducting a health equity assessment is an essential process to understand these health disparities that exist in communities and serve as tools to inform guiding documents like strategic plans. Umatilla County Public Health (UCo Health) used the Bay Area Regional Health Inequities Initiative (BARHII) Organizational Self Assessment Tool to conduct their health equity assessment which helped UCo Health understand both how health equity is viewed within the department and partner organization perspectives about how well UCo Health meets health equity needs.
Clatsop County’s Community Health Advocacy and Resource Team
According to a 2016 Community Health Needs Assessment, when compared with other counties, Clatsop county residents are seven times more likely to have one or more chronic health conditions. Because of the prevalence in chronic diseases in Clatsop county and the growing understanding of how the social determinants of health impact them, in 2018 Clatsop County Public Health launched the Community Health Advocacy and Resource Team (CHART). CHART comprises education, housing, healthcare, and transportation partners, as well as community members, to impact policy, systems, and environmental changes with the goal of positively impacting the health of all Clatsop County residents.