Local health department staffing and services summary for fiscal year

              North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics
January 2012
Local Health Department Staffing and Services Summary
Fiscal Year 2011Cover photo — pharmacist, www.morguefile.com
Cover photo — man having his blood pressure taken, James Gathany photographer, http://phil.cdc.gov/phil/home.asp
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Cover photo — brickwall, www.morguefile.comLocal Health Department
Staffing and Services Summary
Fiscal Year 2010–2011
N.C. Department of Health and Human Services
Division of Public Health
State Center for Health Statistics
1908 Mail Service Center
Raleigh, North Carolina 27699-1908
(919) 733-4728
www.schs.state.nc.us/SCHSState of North Carolina
Beverly Eaves Perdue, Governor
Department of Health and Human Services
Lanier Cansler, Secretary
www.ncdhhs.gov
Division of Public Health
Jeffrey P. Engel, M.D., Health Director
www.publichealth.nc.gov
Chronic Disease and Injury Section
Ruth Petersen, M.D., M.P.H., Chief
www.publichealth.nc.gov/chronicdiseaseandinjury
State Center for Health Statistics
Karen L. Knight, M.S., Director
www.schs.state.nc.us/SCHS
The Department of Health and Human Services does not discriminate
on the basis of race, color, national origin, sex, religion, age or disability
in employment or the provision of services. 1/12
January 2012Local Health Department Survey — FY2009 iii Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Changes to the Survey Instrument. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Staffing (Section A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Local Health Department Occupations and FTEs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Total FTEs. . . 2
Occupational Composition of LHDs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Change in 2009 and 2011 FTEs, by County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Public Health Services (Section B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Health Support Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Environmental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Personal Health. . 7
Bilingual Health Initiatives (Section C). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Non-English Information and Education Material in LHDs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Bilingual Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Bilingual Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Information Technology (Section D). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Local Health Department Survey — FY2011 1 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Introduction
This survey is the latest in a series of surveys of North Carolina health departments which, since 1984, have provided a count of health department employees by occupational groups, a summary of essential public health services, and assessments of other topics, such as bilingual health initiatives and the use of information technology in health departments. All surveys have been oriented to the state’s fiscal year: beginning July 1 and ending June 30 of the subsequent year. The current survey was administered in the summer of 2011 and covers the 2010–2011 fiscal year (FY2011).
All of North Carolina’s 100 counties are represented in this survey. A total of 85 surveys were returned, consisting of 79 single-county health department respondents and six multi-county district health department respondents. The district health departments included are: (1) Alleghany, Ashe and Watauga counties (Appalachian District); (2) Granville and Vance counties; (3) Martin, Tyrrell and Washington counties; (4) Rutherford, Polk and McDowell counties; (5) Avery, Mitchell and Yancey counties (Toe River Health District); and (6) Albemarle Regional Health District (consisting of Bertie, Camden, Chowan, Currituck, Gates, Pasquotank and Perquimans counties).
In this report, we summarize the data from the FY2011 survey, and we present comparisons with the FY2009 survey data where possible. For the section of the survey on staffing, we use the same definitions that have been used in the past to calculate the number of full time equivalent (FTE) employees in order to ensure consistency across reports. Throughout this report, health department respondents are referred to as health departments, health departments/health districts or LHDs (Local Health Departments).
Changes to the Survey Instrument
There were a number of changes to the survey instrument implemented in FY2011. Several additional service categories were added to the Personal Health Services section of the survey. Additionally, the Communicable Disease section was expanded to collect more surveillance and control information. Lastly, the Information Technology (IT) section of the survey was updated to better reflect current technology and IT standards.Local Health Department Survey — FY2011 2 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 1. Health Department Staffing for FY2011:
Full-Time Positions, Part-Time Hours, Annual Contract Hours and FTEs by Occupation
Occupational Groups
Total
Funded
Full-time
Positions
Total
Vacant
Positions
During Year
Total Hours Worked by
Part-time Staff
Annual
Contract
Staff Hours Worked
Total
FTE (Not Including Contract)
Total FTE (Including Contract)
Health Director
85
15
85
4,160
87
89
Administrative/Management
Support Staff
2,066
182
1,346
257,351
2,100
2,228
LAN/PC Support
49
4
20
16,064
50
58
Physician
36
3
601
30,522
51
67
Physician Assistant
38
7
251
23,872
44
56
Dentist
46
8
187
39,074
51
70
Dental Assistant
104
25
286
20,263
112
122
Dental Hygienist
51
6
251
12,847
57
64
RN (Clinical)
1,270
169
2,295
82,033
1,328
1,369
RN (Enhanced Role)
319
10
522
21,143
332
343
RN (Home Health)
417
83
422
230,042
428
543
LPN (Clinical)
102
12
232
9,984
108
113
LPN (Home Health)
10
4
42
1,224
11
12
Occupational Health Nurse
9
2
20
3,120
10
11
Nurse Practitioner
122
23
1,097
41,682
149
170
Certified Nurse Midwife
11
2
111
10,489
14
19
Pharmacist
22
3
3,232
18,192
103
112
Nutritionist
400
64
679
41,466
417
438
Therapist
36
28
20
95,263
37
84
Social Worker
410
53
399
67,411
420
454
Environmental Health Specialist
730
34
358
95,281
739
787
Environmental Health Technician
14
5
0
0
14
14
Public Health Investigator
10
1
0
4,163
10
12
Lab Technician
210
28
234
32,295
216
232
X-Ray Technician
3
1
20
255
4
4
Health Educator
298
45
213
46,458
303
326
Interpreter, Spoken Language
198
11
397
72,478
207
244
Aides (all types)
405
49
972
48,553
429
453
Landfill Operators/Workers
92
1
20
9964
93
97
Animal Control Officers
130
21
32
25,716
131
144
Epidemiologist/Statistician
10
1
0
4,070
10
12
Other
609
87
3,925
75,309
707
745
TOTAL
8,313
986
18,269
1,440,741
8,769
9,490
Note: Part-time hours per week were converted to FTEs by dividing by 40; annual contract staff hours were converted to FTEs by dividing by 2000.Local Health Department Survey — FY2011 3 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Staffing (Section A)
Local Health Department Occupations and FTEs
Table 1 presents data regarding health department staffing for FY2011. Data are presented for each occupational group, and include the total number of full-time positions, the total hours worked by part-time staff per average week, the annual number of contract staff hours worked, as well as the total FTEs — both including and excluding contract staff. FTEs were calculated as the number of full-time funded positions, plus the number of part-time hours divided by 40 (one work week).
Total FTEs
As of July 1, 2011, there were 8,769 full-time equivalent employees in county health departments (not including contract personnel), which is below the 2009 FTE total by 798 employees (Figure 1). Based on the FTE total for FY1989, the number of additional FTE health department employees in FY2011 constituted an increase of 50 percent over the past 22 years.
Figure 1Full-Time Equivalent Employees, FY1989–FY2011(Not Including Contract Personnel) 9,5678,7699,6768,7055,8396,3367,0268,1798,2368,59502,0004,0006,0008,00010,00012,00019891990199319951997199920032005200720092011ote: 2003, 2007, 2009 and 2011 were the only years with a 100 percent response rate.9,480Local Health Department Survey — FY2011 4 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
F
igure 2Staffing Change by Occupational Category, FY1989–FY2011(Not Including Contract Personnel) 02505007501,0001,2501,5001,7502,0002,2502,5002,75019891990199319951997199920032005200720092011Fiscal YearFTE EmployeesTotal NursingAdministration/Management Support StaffEnvironmental Health Specialist
In Figure 2, trends from FY1989-FY2011 are shown for three of the largest professional groups working in North Carolina health departments: nurses (LPNs and RNs), management support staff and environmental health specialists. Within the nursing profession, the total number of FTE nurses increased by 23 percent from FY1989 to FY2011. Environmental health specialist positions also increased by 21 percent (126 FTEs) since 1989. In addition, the number of administration/management support staff positions has increased since 1989, with an increase of 426 positions (25 percent) during this time period.Local Health Department Survey — FY2011 5 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
F
igure 3FTE Employees by Occupation, FY2011(Not Including Contract Employees) Other22.6%Health Educators3.5%Nutritionists4.8%Social Workers4.8%E.H. Specialists8.6%Aides4.9%Mgmt. Support23.9%Nurses27.0%
Occupational Composition of LHDs
Figure 3 shows the distribution of all public health occupations in North Carolina health departments for FY2011. The nursing profession made up the largest percentage of personnel with 27 percent, followed closely by management support staff with 24 percent. The remaining specified occupations — aides, environmental health specialists, social workers, nutritionists and health educators — accounted for approximately 27 percent of all health department personnel. Those who were assigned to the “other” category in the survey comprised an additional 23 percent of the occupations. This occupational distribution, shown in Figure 3, is similar to the results found in the FY2009 health department survey, with nurses representing 28 percent and support staff representing 24 percent of the health department personnel.
Change in 2009 and 2011 FTEs, by County
Table 2 shows the change in the number of FTEs from 2009 to 2011, along with the percent change. Overall, 54 out of 85 health departments/health districts lost FTE positions during this period, and 18 out of 85 health departments gained FTE positions. Between FY2009 and FY2011, there was virtually no change in the number of FTEs for 13 health departments (they lost or gained one or fewer positions during this time period).Local Health Department Survey — FY2011 6 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 2. Health Department Staffing: Change in Number of Fte s,
Fy2009–Fy2011, Number and Percent Change by Health Department
2009
Fte s
2011
Fte s
%
Chg.
2009
Fte s
2011
Fte s
%
Chg.
Alamance
111
112
1.1%
Jackson
57
50
-12.0%
Alexander
445
343
-22.8%
Johnston
113
114
1.0%
Appalachian District
45
34
-24.2%
Jones
17
17
1.5%
Anson
24
20
-18.0%
Lee
51
41
-19.4%
Albermarle District
92
82
-10.9%
Lenoir
56
58
5.2%
Beaufort
41
40
-3.9%
Lincoln
76
80
5.4%
Bladen
65
63
-2.9%
Macon
66
66
1.2%
Brunswick
87
88
1.1%
Madison
29
32
8.6%
Buncombe
233
143
-38.5%
Mecklenburg
518
535
3.3%
Burke
81
53
-34.8%
Montgomery
39
34
-12.1%
Cabarrus
213
157
-26.4%
Moore
62
52
-16.9%
Caldwell
114
95
-16.3%
Martin/Tyrrell/Washington
110
101
-8.4%
Carteret
65
60
-7.4%
Nash
128
116
-9.3%
Caswell
41
44
7.8%
New Hanover
172
206
19.9%
Catawba
146
151
3.2%
Northampton
75
58
-22.4%
Chatham
80
73
-8.8%
Onslow
126
97
-22.8%
Cherokee
37
32
-14.6%
Orange
95
93
-1.9%
Clay
28
26
-7.6%
Pamlico
21
17
-18.7%
Cleveland
217
229
6.0%
Pender
63
46
-26.8%
Columbus
66
64
-3.8%
Person
67
51
-23.6%
Craven
149
143
-3.7%
Pitt
137
130
-5.1%
Cumberland
262
193
-26.3%
Randolph
84
85
1.7%
Dare
106
91
-14.6%
Richmond
65
69
5.9%
Davidson
122
92
-24.0%
Robeson
174
151
-13.2%
Davie
54
50
-7.4%
Rockingham
86
77
-10.8%
Duplin
52
59
13.5%
Rowan
93
90
-2.8%
Durham
236
206
-12.7%
Rutherford/Polk/McDowell
136
121
-10.8%
Edgecombe
119
103
-13.4%
Sampson
43
41
-4.7%
Forsyth
248
249
0.5%
Scotland
52
39
-25.0%
Franklin
67
60
-11.0%
Stanly
64
64
-0.3%
Gaston
188
212
12.7%
Stokes
32
44
38.3%
Graham
23
29
26.4%
Surry
222
169
-23.9%
Granville/Vance
79
70
-10.9%
Swain
46
48
2.8%
Greene
26
29
13.9%
Toe River District
124
153
23.2%
Guilford
457
409
-10.5%
Transylvania
28
29
5.6%
Halifax
101
99
-2.5%
Union
108
57
-47.4%
Harnett
84
94
11.9%
Wake
680
648
-4.8%
Haywood
76
68
-10.7%
Warren
42
41
-2.5%
Henderson
90
89
-0.5%
Wayne
130
127
-2.2%
Hertford
71
67
-5.2%
Wilkes
60
58
-2.4%
Hoke
68
34
-50.5%
Wilson
148
147
-0.7%
Hyde
15
20
32.0%
Yadkin
38
34
-10.5%
Iredell
115
107
-6.8%
Note: FTE figures do not include contract staff.Local Health Department Survey — FY2011 7 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
— text continued on page 12
Public Health Services (Section B)
According to North Carolina laws: “The Public Health Laws of North Carolina establish categories of essential public health services that are to be made available and accessible to all citizens of the State [G.S. 130A-1.1(b)].” The services that appear in Table 3 include all essential services established by this law as well as other services that were deemed to be essential to the public health of North Carolina citizens. For each service, counties were asked to indicate if the service was provided in their health department or health district.
Health Support Services
A total of 76 out of 85 health departments/health districts in North Carolina (89%) provide registration of vital events (see Table 3). Vital records and statistical services are maintained in 93 percent of all health departments (n=79). Nearly all health departments indicated that are engaged in bioterrorism/other emergency preparedness response planning/assessment (99%) and health education services (99%). In addition, most health departments report that they perform comprehensive community health assessment (98%), offer interpretation of spoken language (97%), lab services (97%), community health education (93%) and communicable disease surveillance (94%). However, significantly fewer reported that their health department/district is engaged in chronic disease surveillance (58%) or collects morbidity data (61%). Most health departments reported offering child health services (90%) and prenatal care services (88%). While 70 percent (n=59) health departments reported offering public health nurse pharmacy dispensing, less than half (47%) reported offering other pharmacy services. The health support service provided least frequently was pesticide poisoning investigation, with only 19 percent of health departments reporting that they offered this service.
Environmental Health
Almost all county health departments reported offering restaurant and lodging inspections (98%) and on-site sewage and wastewater disposal services (98%). With regard to water sanitation and safety, 82 out of 85 county health departments (97%) offer private water supply services and 84 percent (n=71) offer water sanitation and safety services. Public swimming pool sanitation was available in all but one health department (99%). Lead abatement is offered by 74 percent (n=63) of the health districts surveyed. Regarding pest management, 29 health departments (34%) provide mosquito control and 14 health departments (17%) provide rodent control. Tick control is provided by 17 percent of all health departments (n=14) and bedding control is offered in 12 health departments (14%).
Personal Health
Personal health services comprised the largest category of services. Slightly more than half of all health departments (54%) reported offering pediatric primary care services, while adult primary care was offered in fewer health departments (44%).
Under the sub-category of Maternal Health services, all 85 health departments reported offering pregnancy care management. Over 90 percent of health departments provided maternal WIC services (97%), SIDS counseling (94%) and most health departments (90%) reported that they Local Health Department Survey — FY2011 8 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 3. Public Health Services
(As of 7/1/2011 with 100 percent of Health Departments/Health Districts reporting)
Services Offered
Number of Health
Departments
Offering Service
Percent of Health
Departments
Offering Service
HEALTH SUPPORT
Registration of Vital Events
76
89.4%
Assessment of Health Status, Health Needs and Environmental
Risks to Health Epidemic Investigations
♦ Risk Assessment
60
70.6%
♦ Pesticide Poisoning
16
18.8%
Health Assessment
♦ Comprehensive Community Health Assessment
83
97.6%
♦ Behavioral Risk Assessment
43
50.6%
♦ Morbidity Data
52
61.2%
♦ Reportable Disease
77
90.6%
♦ Vital Records and Statistics
79
92.9%
♦ Chronic Disease Surveillance
49
57.6%
♦ Communicable Disease Surveillance
80
94.1%
♦ Bioterrorism/Other Emergency Preparedness Response
Planning and Assessment
84
98.8%
Policy Development Functions/Services
♦ Health Code Development and Enforcement
60
70.6%
♦ Health Planning
66
77.6%
Health Assurance
♦ Health Education
84
98.8%
♦ Child Health
76
89.4%
♦ Prenatal Care
75
88.2%
Community Health Education
79
92.9%
Interpretation, Spoken Language
82
96.5%
Laboratory Services
82
96.5%
Public Health Nurse Pharmacy Dispensing
59
69.4%
Other Pharmacy Services
40
47.1%
School Nursing Services
35
41.2%
ENVIRONMENTAL HEALTH
Restaurant/Lodging/Institutions Sanitation and Inspections
83
97.6%
On-Site Sewage and Wastewater Disposal
83
97.6%
Water Sanitation and Safety
71
83.5%
♦ Private Water Supply
82
96.5%
♦ Milk Sanitation
6
7.1%
♦ Shellfish Sanitation
9
10.6%
♦ Public Swimming Pool
84
98.8%
Bedding Control
12
14.1%
Pest Management
25
29.4%
Mosquito
29
34.1%
Rodent
14
16.5%
Ticks
14
16.5%
Lead Abatement
63
74.1%Local Health Department Survey — FY2011 9 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 3. Public Health Services
(As of 7/1/2011 with 100 percent of Health Departments/Health Districts reporting)
Services Offered
Number of Health
Departments
Offering Service
Percent of Health
Departments
Offering Service
PERSONAL HEALTH
Primary Care
♦ Adult
37
43.5%
♦ Pediatric
46
54.1%
Maternal Health
♦ Prenatal and Postpartum Care
76
89.4%
♦ Pregnancy Medical Home
22
25.9%
♦ Pregnancy Care Management
85
100.0%
♦ Postnatal Home Visits
23
27.1%
♦ SIDS Counseling
80
94.1%
♦ WIC Services — Mother
82
96.5%
Family Planning
♦ Preconceptional Counseling
82
96.5%
♦ Contraceptive Care
85
100.0%
♦ Fertility Services
39
45.9%
♦ Pregnancy Prevention — Adolescent
83
97.6%
Child Health
♦ Well-Child Services
71
83.5%
♦ Genetic Services
20
23.5%
♦ Services to Children with Developmental Disabilities
32
37.6%
♦ Care Coordination for Children (CC4C)
82
96.5%
♦ Adolescent Health Services
59
69.4%
♦ School Health Services
38
44.7%
♦ Lead Poisoning Services
78
91.8%
♦ WIC Services — Children
81
95.3%
♦ Immunizations
84
98.8%
♦ Newborn Home Visiting Services
68
80.0%
♦ Children with Special Health Care Needs Services
27
31.8%
Chronic Disease Control
Early Detection and Referral
♦ Kidney Disease
19
22.4%
♦ Hypertension
58
68.2%
♦ Cancer
59
69.4%
♦ Diabetes
63
74.1%
♦ Cholesterol
48
56.5%
♦ Arthritis
20
23.5%
♦ Glaucoma
8
9.4%
♦ Epilepsy
11
12.9%
Patient Education
♦ Kidney Disease
26
30.6%
♦ Hypertension
68
80.0%
♦ Cancer
59
69.4%
♦ Diabetes
69
81.2%
♦ Cholesterol
62
72.9%
♦ Arthritis
28
32.9%
♦ Glaucoma
24
28.2%
♦ Epilepsy
22
25.9%
Chronic Disease Monitoring and Treatment
36
42.4%Local Health Department Survey — FY2011 10 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 3. Public Health Services
(As of 7/1/2011 with 100 percent of Health Departments/Health Districts reporting)
Services Offered
Number of Health
Departments
Offering Service
Percent of Health
Departments
Offering Service
PERSONAL HEALTH (continued)
Home Health Services
31
36.5%
Behavioral Health Services
♦ Child Behavioral Services
11
12.9%
♦ Adult Behavioral Services
12
14.1%
Health Promotion and Risk Reduction
♦ Nutrition Counseling
71
83.5%
♦ Injury Control
40
47.1%
♦ Tobacco Cessation
68
80.0%
Communicable Disease Control
♦ 24/7 day Communicable Disease Response
81
95.3%
♦ CD Reporting Information for Health Care Providers
82
96.5%
Acute Communicable Disease Control
♦ Surveillance
84
98.8%
♦ Case investigation
84
98.8%
♦ Post-exposure prophylaxis
80
94.1%
♦ Implementation of control measures
84
98.8%
♦ Outbreak investigations
84
98.8%
Tuberculosis Control
♦ Surveillance
85
100.0%
♦ Case and contact investigation
85
100.0%
♦ Direct and observed therapy
83
97.6%
♦ Treatment of contacts
84
98.8%
♦ Isolation and other control measures
84
98.8%
STD Community Level Surveillance, Investigation, Prevention
and Control
♦ Examination and testing of at risk individuals for STDs
within one workday of request
79
92.9%
♦ Examination, Testing, Treatment, Counseling and Referral
85
100.0%
Partner notification
76
89.4%
♦ Investigation of Disease Control Measure Violations
81
95.3%
♦ Counseling/education — community outreach
78
91.8%
♦ Counseling/education — individual
83
97.6%
AIDS/HIV Community Level Surveillance, Investigation, Prevention
and Control
♦ HIV/Syphilis Partner Notification Services
56
65.9%
♦ Case Management
17
20.0%
♦ Investigation of Disease Control Measure Violations
67
78.8%
♦ Opt-out testing in clinics
63
74.1%
♦ Community-based testing in partnership with CBOs
27
31.8%
♦ HIV seropositive counseling, follow-up and referral
68
80.0%
Hepatitis A and B Immunizations
83
97.6%
Rabies Control: Provide a full range of services when people are
bitten by dogs or cats
♦ Identify and confine the biting animal for observation or
submitting animal for rabies testing
51
60.0%
♦ Receive reports from physicians of persons bitten by animals
capable of transmitting rabies
76
89.4%Local Health Department Survey — FY2011 11 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 3. Public Health Services
(As of 7/1/2011 with 100 percent of Health Departments/Health Districts reporting)
Services Offered
Number of Health
Departments
Offering Service
Percent of Health
Departments
Offering Service
PERSONAL HEALTH (continued)
♦ Provide rabies exposure risk assessments
69
81.2%
♦ Coordinate administration of rabies post exposure prophylaxis
if necessary
75
88.2%
Rabies Control: Provide services when people are exposed to rabies
vector species (bats, terrestrial carnivores)
♦ Identify (if possible) the biting animal and submit for rabies
testing
53
62.4%
♦ Receive reports from physicians of persons bitten by animals
capable of transmitting rabies
76
89.4%
♦ Provide rabies exposure risk assessments
66
77.6%
♦ Coordinate administration of rabies post exposure prophylaxis
if necessary
72
84.7%
Rabies Control: Provide services for domestic animals that are
reasonably suspected of being exposed to rabies
♦ Identify (if possible) the biting animal and submit for rabies
testing
47
55.3%
♦ Order rabies booster, quarantine or euthanasia of the exposed
animal
55
64.7%
Coordinate at least one annual rabies vaccination clinic in the
county for dogs, cats and ferrets
53
62.4%
Canvas the county to search for unvaccinated dogs/cats/ferrets
and appropriately administer all animal sheltering functions
26
30.6%
Administer the voluntary Certified Rabies Vaccinator Program in
the county if one exists
25
29.4%
Dental Health
♦ Dental Health Education
60
70.6%
♦ Topical Flouride Application
63
74.1%
♦ Sealant Application
50
58.8%
♦ Dental Screening and Referral
60
70.6%
♦ Dental Treatment
46
54.1%
♦ Community Fluoridation
13
15.3%
♦ “Into the Mouths of Babes” Dental Preventative Services
30
35.3%
Other Personal Health
♦ Migrant Health
15
17.6%
♦ Refugee Health
21
24.7%Local Health Department Survey — FY2011 12 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
provide prenatal and postpartum care. Only 23 health departments (27%) reported that they offer postnatal home visits.
Within Family Planning services, all health departments reported offering contraceptive care (100%). In addition, most health departments also provide adolescent pregnancy prevention (98%) and preconception counseling (97%). Fertility services were less likely to be offered, with fewer than half of health departments (46%) reporting that they offered this service. Within Child Health, immunizations (99%), care coordination for children (97%), child WIC services (95%), lead poisoning prevention (92%) and well child services (84%) were provided by most health departments. Services which were offered less frequently included school health services (45%), services to developmentally disabled children (38%), services for children with special health care needs (32%) and genetic services (24%).
For services related to Chronic Disease Control, early detection and referral services were most often provided for diabetes (74%), cancer (70%), hypertension (68%) and cholesterol (57%). Less than 25 percent of health departments offered early detection and referral for kidney disease, arthritis, glaucoma and epilepsy. In every category, the provision of Patient Education services for these same chronic diseases tended to be somewhat higher than that of early detection and referral. Fewer than half (42%) of health departments reported that they offer chronic disease monitoring and treatment services.
Regarding Health Promotion efforts, the majority of health departments reported that they offer nutrition (84%) and tobacco cessation counseling (80%). However, slightly less than half (47%) reported health promotion efforts aimed at injury control.
Under services for Communicable Disease, the majority of health departments (greater than 95%) reported that they offer 24/7 communicable disease response and reporting information for health care providers. Nearly all health departments reported that they offer acute communicable disease control surveillance (99%), case investigation (99%), implementation of control measures (99%), outbreak investigations (99%) and post-exposure prophylaxis (94%).
With regard to Tuberculosis Control, all health departments reported offering surveillance, case and contact investigation. Nearly all (98%) reported offering direct and observed therapy, treatment of contacts, and isolation and other control measures.
Under the STD section, all health departments (100%) reported offering examination, testing, treatment, counseling and referral. Nearly all health departments reported that they investigate disease control measure violations (95%) and provide individual counseling/education (98%). Most health departments also report providing examination and testing of at-risk individuals for STDs within one workday of request (93%), community outreach counseling/education (92%) and partner notification (89%).
With regard to AIDS/HIV, the majority of health departments offered HIV seropositive counseling, follow-up and referral (80%) and investigation of disease control measure violations (79%). Many provide opt-out testing in clinics (74%) and HIV/syphilis partner notification services (66%). Only about a third (32%) report offering community-based testing in partnership with Community Based Organizations (CBOs), and only 20 percent provide AIDS/HIV case management.Local Health Department Survey — FY2011 13 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Under Rabies Control services, most health departments receive reports from physicians of persons bitten by or exposed to animals capable of transmitting rabies (89%) and most coordinate administration of rabies post-exposure prophylaxis if necessary for those bitten (88%) or exposed (85%). Over half of health departments report that they identify the biting animal and submit it for rabies testing (55%) and coordinate at least one annual rabies clinic in the county for dogs, cats and ferrets (62%). However, only one in three health departments report that they canvas the county to search for unvaccinated dogs, cats, or ferrets, appropriately administer all animal sheltering functions (31%) and administer the voluntary “Certified Rabies Vaccinator” Program (29%).
Under Dental Health services, more than 70 percent of health departments report offering topical fluoride application (74%), dental health education (71%) and dental screening and referral (71%). Slightly more than half (54%) of all health departments report that they offer dental treatment and 50 health departments (59%) offer dental sealant application. Slightly more than one-in-three (35%) health departments participate in the “Into the Mouths of Babes” dental preventative services program. Only 15 percent of health departments (n=13) indicate that they have community fluoridation.
With regard to Other Personal Health services, 15 health departments (18%) report that they offer migrant health services and 21 health departments (25%) provide refugee health services.Local Health Department Survey — FY2011 14 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 4. Bilingual Health Initiatives:
Change in the Number of FY2011 Bilingual Staff from FY2009,
by Health Department
FY2009
Bilingual
FY2011
Bilingual
Chg.
FY2009
Bilingual
FY2011
Bilingual
Chg.
Alamance
7
7
0
Jackson
2
2
0
Albemarle District
2
2
0
Johnston
0
20
20
Alexander
1
1
0
Jones
4
3
-1
Anson
3
3
0
Lee
7
5
-2
Appalachian District
0
0
0
Lenoir
4
5
1
Beaufort
2
2
0
Lincoln
2
1
-1
Bladen
2
3
1
Macon
2
2
0
Brunswick
8
8
0
Madison
2
3
1
Buncombe
38
7
-31
Martin/Tyrrell/Washington
1
2
1
Burke
2
3
1
Mecklenburg
17
30
13
Cabarrus
16
25
9
Montgomery
6
5
-1
Caldwell
4
4
0
Moore
2
2
0
Carteret
2
1
-1
Nash
6
8
2
Caswell
0
*
N/A
New Hanover
8
7
-1
Catawba
8
10
2
Northampton
0
*
N/A
Chatham
10
10
0
Onslow
2
3
1
Cherokee
2
0
-2
Orange
8
11
3
Clay
0
0
0
Pamlico
3
1
-2
Cleveland
1
1
0
Pender
6
6
0
Columbus
3
2.5
-0.5
Person
1
1
0
Craven
3
4
1
Pitt
2
5
3
Cumberland
5
*
N/A
Randolph
14
14
0
Dare
3
3
0
Richmond
1
1
0
Davidson
3
*
N/A
Robeson
14
11
-3
Davie
3
1
-2
Rockingham
3
4
1
Duplin
10
13
3
Rowan
9
9
0
Durham
17
17
0
Rutherford/Polk/McDowell
5
6
1
Edgecombe
2
2
0
Sampson
7
5
-2
Forsyth
*
35
N/A
Scotland
1
0
-1
Franklin
0
3
3
Stanly
2
2
0
Gaston
15
8
-7
Stokes
1
1
0
Graham
0
0
0
Surry
9
10
1
Granville/Vance
1
3
2
Swain
0
0
0
Greene
4
4
0
Toe River District
7.5
8
0.5
Guilford
15
15
0
Transylvania
1
1
0
Halifax
2
1
-1
Union
*
7
N/A
Harnett
3
3
0
Wake
*
*
N/A
Haywood
7
6
-1
Warren
1
*
N/A
Henderson
15
13
-2
Wayne
8
6
-2
Hertford
0
0
0
Wilkes
11
6
-5
Hoke
3
5
2
Wilson
5
2
-3
Hyde
0
0
0
Yadkin
3
3
0
Iredell
11
13
2
N.C. Total
420.5
456.5
36
* Changes in Bilingual staff data are not available for this health department due to missing data for FY2009 and/or FY2011.Local Health Department Survey — FY2011 15 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Bilingual Health Initiatives (Section C)
Non-English Information and Education Material in LHDs
The majority of health departments reported providing educational and informational materials in other languages, with 98 percent of them reporting that they offer materials in Spanish (n=83). In addition to Spanish, a few health departments also provided educational material in other languages such as Hmong (7%), Mandarin (2%) and Arabic (2%).
Regarding the use of non-English material in health department service areas, all health departments (100%) reported that their Family Planning clinics use non-English material. In addition, most health departments stated that they use non-English material for Maternal Health (94%), Patient Education (93%), Child Health Services (89%), Communicable Disease Control (92%) and Health Promotion (86%). Non-English materials were least likely to be available for Chronic Disease Control (65%) and Dental Health (69%).
Examining the need for non-English education/information material, Chronic Disease Control, Health Promotion, Communicable Disease Control, Patient Education and Dental Health were the areas where some health departments reported needing non-English materials.
Bilingual Staff
Seventy-two health departments (85%) reported having staff positions designated as interpreters and 13 health departments (15%) did not report having designated interpreters.
Table 4 shows the number of FY2009 and FY2011 bilingual staff by county. In FY2011, health departments reported that there were approximately 456 local health department staff members (including contract staff) who were bilingual. This figure is slightly higher than the number of bilingual staff reported in 2009 (n=420). The number of bilingual health department staff ranged from zero (8 health departments) to 35 (one health department). The number of bilingual staff increased for 22 health departments and decreased in 20 health departments. For 35 health departments, the number of bilingual staff remained virtually unchanged. Six counties reported that they had no bilingual staff members in both the FY2009 and FY2011 surveys. Eight counties left this field blank in either FY2009 and/or FY2011, so for those counties no changes in bilingual staffing could be calculated.
Bilingual Training
More than half of health departments (60%) reported that special training is provided for health care providers who work with non-English speaking clients. In addition, 66 percent of health departments report that their service population is becoming more non-English speaking. In light of this, all health departments report that their staff has undergone cultural diversity training (100%) and only four health departments (5%) indicated that cultural diversity training is needed. Slightly less than half of health departments (48%) report that their department has specific outreach efforts targeting non-English speaking populations.Local Health Department Survey — FY2011 16 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 5. Information Technology:
Summary of Technological Capabilities Among Health Departments, FY2011
Number
Percent
Number of Personal Computers by
Model and Operating System
Local Area Network (LAN) Administrator
Desktops:
Health Department Staff
18
21.2%
Less than 5 years old–Windows 7
1,067
County Staff
64
75.3%
Less than 5 years old–Windows Vista
306
Contracted
13
15.3%
Less than 5 years old–Windows XP
4,369
Internet Provider Type
Less than 5 years old–Windows 2000
107
State WAN (ITS)
20
23.5%
Less than 5 years old–Other OS (Mac, Linux)
0
County Government
32
37.6%
Total Less than 5 years old
5,849
Cable
7
8.2%
DSL
7
8.2%
5 or more years old–Windows 7
91
Fiber Optic
33
38.8%
5 or more years old–Windows Vista
14
Connection Level
5 or more years old–Windows XP
2,381
56kb or less
1
1.2%
5 or more years old–Windows 2000
40
Fractional T1
3
3.5%
5 or more years old–Other OS (Mac, Linux)
3
T1
20
23.5%
Total 5+ Years Old
2,529
T3
5
5.9%
Better
51
60.0%
Total Desktops
8,378
All Staff Have Access to Internet at Work
71
83.5%
Wireless Protocol:
Laptops:
None
15
17.6%
Less than 5 years old–Windows 7
680
A
21
24.7%
Less than 5 years old–Windows Vista
141
B
34
40.0%
Less than 5 years old–Windows XP
1,710
G
49
57.6%
Less than 5 years old–Windows 2000
0
N
28
32.9%
Less than 5 years old–Other OS (Mac, Linux)
10
LAN accessible via Virtual Private Network
Total Less than 5 years old
2,541
(VPN)
61
71.8%
High Bandwith
57
67.1%
5 or more years old–Windows 7
52
Content filtering can be/has been applied
74
87.1%
5 or more years old–Windows Vista
12
Business Continuity/Disaster Recovery Plan
5 or more years old–Windows XP
571
in Place
79
92.9%
5 or more years old–Windows 2000
3
Plan has been tested
41
48.2%
5 or more years old–Other OS (Mac, Linux)
0
Geographic Systems:
Total 5+ Years Old
638
County-wide GIS
70
82.4%
Health Department GIS
11
12.9%
Total Laptops
3,179
Global Positioning Systems (GPS)
24
28.2%
Desktop Video Conferencing
44
51.8%
Department has a website
79
92.9%
Network Enabled Devices:
Smartphones
49
57.6%
Tablet PCs
37
43.5%
Plan to upgrade PC’s this Fiscal Year
59
69.4%
Plan to make major IT upgrades in the next
Fiscal Year
27
31.8%
Build wireless access
8
9.4%
Build County GIS
0
0.0%
Add server(s)
14
16.5%
Other
18
21.2%
Server Administration Environment
Novell Netware
3
3.5%
Windows Server 2003
55
64.7%
Windows Server 2008
59
69.4%
Unix/Linux
9
10.6%
None
2
2.4%
Other
5
5.9%
Internet Browser
Internet Explorer
84
98.8%
Firefox
25
29.4%
Chrome
6
7.1%
Other
0
0.0%
Use Clinical Software (in addition to HIS)
36
42.4%
Use Billing Software (in addition to HIS)
54
63.5%Local Health Department Survey — FY2011 17 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Table 6. Information Technology:
Percent Change in Selected Technologies from FY2009 to FY2011
Health Departments with:
Number
in FY2009
% of Health
Depts Having
Number
in FY2011
% of Health
Depts Having
Percent Change in Number
Total PCs in Health Departments
7,630
n/a
8,378
n/a
9.8%
Total Laptops in Health Departments
2,545
n/a
3,179
n/a
24.9%
Internet Connection Level of T1 or
better
69
81.2%
76
89.4%
10.1%
Virtual Private Network
61
71.8%
61
71.8%
0.0%
Business Continuity/Disaster Recovery
Plan in Place
47
55.3%
79
92.9%
68.1%
Business Continuity/Disaster Recovery
Plan has been tested
10
11.8%
41
48.2%
310.0%
Desktop Video Conferencing
41
48.2%
44
51.8%
7.3%
n/a = Not Applicable
Information Technology (Section D)
Table 5 and Table 6 provide a summary of the technological capacity of North Carolina health departments. As shown in Table 5, there were a total of 8,378 desktop/personal computers (PCs) in use in 2011. This figure is up approximately 10 percent from the number of PCs reported in the FY2009 survey (Table 6). The majority of health department PCs are less than five years old (70%), with only one-third (30%) being five or more years old. Most health department PCs, regardless of age, employed the Microsoft Windows XP operating system (81%). In addition to desktop computers, health departments reported having more than 3,000 laptop computers (n=3,179); up 25 percent from the number of laptops reported in FY2009 (n=2,545). As with PCs, most laptop computers (80%) were less than five years old and most used the Microsoft Windows XP operating system (72%).
For the first time in this survey, all health departments reported having a Local Area Network (LAN). Three-quarters of all health departments (75%) had a LAN administrator on staff with their county, while only one in five (21%) had a LAN administrator on staff in their health department (Table 5). In past surveys, most health departments reported that their Internet provider was the State Wide Area Network (ITS WAN). However, in FY2011 39 percent of health departments reported a fiber optic provider, 38 percent reported a county government provider, and only 24 percent reported utilizing the state ITS WAN. The majority of health departments reported having an internet connection of T1 or better (89%). More than half had LANs that were accessible via virtual private networks (72%), which was the same number as reported in FY2009.
Business continuity and recovery planning is a process developed to assess and minimize the impact of IT systems failure. In FY2011, more health departments reported having a business continuity or disaster recovery plan in place (93%) when compared with FY2009 (55%). However, only about half (48%) had a recovery plan that had been tested; up from just 12 percent in FY2009.
While 70 percent of health departments report that they plan to upgrade PC’s this fiscal year (n=59), only 27 health departments (32%) report that they are planning to make major IT upgrades in the next fiscal year. Among those making IT upgrades, eight health department are planning to build wireless access, 14 health departments are adding servers and 18 health departments plan to make other IT upgrades.Local Health Department Survey — FY2011 18 Division of Public Health
N.C. Department of Health and Human Services State Center for Health Statistics
Seventy-nine health departments (93%) reported that they had a website in 2011, which is roughly consistent with the 2009 report (n=78). The availability of Geographic Information Systems (GIS) decreased in 2011, with only 11 counties (13%) reporting GIS capabilities in their health department compared with 14 counties in FY2009. However, 70 counties (82%) reported that their county maintains county-wide GIS services (Table 5).
With regard to clinical and billing software, 36 health departments (42%) reported that they use clinical software applications and 54 health departments (64%) reported that they use billing software. CherokeeClayMaconJacksonGrahamSwainHaywoodBuncombeTransylvaniaHendersonRutherfordPolkMcDowellDistrictMadisonToe River DistrictAppalachian DistrictBurkeCaldwellWilkesYadkinSurryStokesRockinghamCaswellPersonGranvilleVanceDistrictWarrenHalifaxNorthamptonHertfordAlbemale DistrictMartin-Tyrrell-Washington DistrictDareHydeBeaufortPamlicoCarteretForsythGuilfordAlamanceOrangeDurhamWakeFranklinCravenJonesOnslowClevelandGastonLincolnCaawbaAlexanderIredellDavieRowanMecklenburgCabarrusUnionAnsonStanlyDavidsonRandolphChathamJohnstonNashEdgecombeWilsonPittGreeneWaneLenoirDuplinPenderNew HanoverBrunswickColumbusSampsonBladenCumberlandHarnettLeeMooreMontgomeryRichmondScotlandHokeRobesonNorth CarolinaLocal Health DepartmentsDepartment of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699-1908
(919) 733-4728