How DHEC can help make your Professional Lives Easier

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How DHEC can help make your Professional Lives
Easier

• AN OVERVIEW
• Harvey Kayman, MD, MPH
• Medical Consultant to the Maternal Child Health
  Bureau, SC DHEC

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South Carolina Department of Health
Environmental Control
Resource for Clinicians to Promote High Quality
Health Care
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Objectives for Presentation to Clinicians

• Present information and case studies about
• WHAT DHEC DOES operative support DHEC can offer
  to practitioners.
• WHERE TO GET INFORMATION about DHEC access
  information on how practitioners can get the help
  they need from DHEC.
• HOW TO INTERACT with DHEC personnel to attend to
  patients needs.

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A Case of Diarrhea in a Four Year Old in
Greenville County

• In June, 2004, a 4 y/o boy comes to your recently
  opened office severely ill with dehydration,
  fever and bloody diarrhea.
• You take a quick history, do a physical exam and
  decide to hospitalize via ambulance.
• In your evaluation at the hospital, you question
  the family for detailed information, conduct a
  more thorough physical, obtain lab data and begin
  managing the patient.
• Eventually blood and stool culture grow
  salmonella typhimurium.

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A Case of Diarrhea in a Four Year Old

• His family purchased a hamster in June from a
  local pet store that died 2 days after purchase.
• PFGE (pulse field gel electrophoresis) looks at
  the genetic pattern of the Salmonella isolates to
  determine if different samples match genetically.
• The PFGE pattern from this child's stool sample
  match isolates from cases and hamster samples
  from Minnesota and Kentucky.

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Salmonella Case, cont.

• The local pet store, in conjunction with DHECs
  Acute Disease Epidemiology staff, are tracking
  down the records for their hamster supplier
  also calculating the of returned hamsters for
  the months of June and July.
• CDC is currently involved in a trace-back of the
  animals.

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Disease Reporting

• What diseases are reportable?
• Reportable by telephone
• Reportable by mail-in card
• In 2005, you should be able to report on-line
  with Carolinas Health Electronic Surveillance
  System (CHESS)

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Disease Reporting-Contact information

• http//www.scdhec.net/hs/diseasecont/disease.htm

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Disease Reporting

• Who is required (i.e. LEGALLY MANDATED) to make
  reports?
• Physicians
• Laboratories
• Hospitals (Infection Control)

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Disease Reporting

• EPI Team provides
• Trained staff to conduct surveillance and case
  investigation.
• Appropriate and timely public health response to
  urgent immediately reportable conditions.

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Disease Reporting

• Reporting by telephone
• Monday Friday 830-500
• County Health Dept
• 24/7 pager for Epi in each County in SC
• What happens next?
• HIPAA does not prevent or inhibit reporting
• WHEN IN DOUBT, REPORT

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A moderately ill 3 year old girl in late August
in Oconee County.

• A 3 year old comes to your office with fever of
  102.4F, vomiting, some dehydration, somnolence,
  rash on hands, feet, mouth.
• While waiting to see you, she has a brief seizure
  in your busy waiting room.
• Your staff brings her to the examining room.
• As they wheel her out of the waiting room, a
  child-care classmate arrives with a similar
  history.

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Viral Meningitis Cases

• Twelve (12) confirmed cases of viral meningitis
  since from 8/25 to 09/14/04 diagnosed.
• Three (3) cases in one childcare center that
  include an adult childcare worker.
• Three (3) other cases that are not in this
  childcare center are siblings, the others are not
  epi-linked.
• Only one (1) CSF viral culture has been done and
  it was enteroviral.
• Isolate was not sent to DHEC BoL.

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Viral Meningitis Cases, cont.

• Physician advisory was sent to all Oconee MD's,
  and letters with fact sheets sent to all Oconee
  County childcare centers.
• Letters were also sent to all school nurses and
  principals.
• Infection control nurse with Oconee Medical
  Center is to inform the lab to send at least 4-5
  isolates for typing to DHEC Bureau of Laboratory.

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Important Public Health Websites

• SC 2004 List of Reportable Conditions
• Epi Notes (Jan. 2004).
• Free download at www.scdhec.gov/hs/diseasecont/A
  CUTEEPI/docs/epinote.pdf

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Lead level somewhat increased

• When the patient was admitted, a blood lead level
  was drawn due to the seizure. It came back 22
  micrograms/dL.
• You repeat the test, after re-hydration and it
  comes back 16micrograms/dL.
• Do you need to report at this time?

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DHECs Role in Childhood Lead Poisoning
Prevention (CLPPP)

• Assist private providers with follow up testing
  and case management, once the provider has
  obtained a confirmatory (venous) sample
  (10mg/dL) sample.

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DHEC/CLPPP also provides

• CDC, DHEC, and EPA educational materials
• Public awareness
• Provider education
• Training and presentations
• Technical assistance
• Statewide surveillance

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Follow up services may include

• Health education
• Nutrition counseling
• Family support services
• Venous blood samples at intervals specified by
  CDC guidelines and DHEC policy

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DHEC/CLPPP also provides

• Environmental investigations of the childs
  primary and secondary residences triggered by
  blood lead levels established by CDC and DHEC
  policy
• Any venous result 20 mg/dL, or two venous levels
  between 14 19 mg/dL drawn at least three months
  apart

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DHEC/CLPP also provides

• Childhood Lead Poisoning Prevention Program
  (CLPPP)
• For additional information please call
• Toll-free 1-866-466-5323
• 1-(866)- 4NO-LEAD

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Women Infants Children (WIC)

• Who is eligible?
• WIC (women, infants, and children) who are at
  nutritional risk
• Women prenatal and post-partum
• Infants 0-1 years
• Children 1-5 years
• Income 185 of poverty level

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Women Infants Children (WIC)

• What DHEC provides
• Food vouchers
• Nutrition screening and education
• Basic health screening

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Women Infants Children (WIC)

• How to refer a patient
• Call or have patient call for an appointment to
  become certified at the County Health Department

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Case Study Three

• You are completing a well-check visit with Sally
  Oliver, a 13-year old white adolescent, who is a
  new patient in the practice you just opened.
• The family has no medical care coverage. Her
  mother is out in the waiting room during the
  visit.
• While completing the examination, Sally requests
  family planning services.
• What do you do?

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You recall the SC Minors Law which states the
following

• Health services of any kind may be rendered to
  minors of any age without consent of a
  parent/guardian when, in the judgment of a person
  authorized by law to render a particular health
  service, such services are necessary, except for
  operations.

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Case Study Three

• 1. Determine if Sally is sexually active
• 2. Determine if sexual coercion/abuse took place
  ? Call Department of Social Services (DSS).
  First, look _at_ the DSS webpage http//www.state.sc
  .us/dss/contact/index.htm Then use the Contact
  Information link to find the appropriate toll
  free number to call.

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Case Study Three

• 3. You may then choose to contact the DHEC Family
  Planning Clinic in your county and refer Sally
• DHEC Family Planning Clinic personnel will
  conduct counseling for Sally regarding
  contraception methods and refusal skills
• DHEC Family Planning Clinic personnel will refer
  to DHEC FSS (Family Support Services) for full
  evaluation of family stress, if patient and
  family are interested

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Family Planning Services

• Any woman of childbearing age is eligible to
  receive Family Planning Services. These services
  are offered without regard to religion, race,
  color, national origin, creed, handicap, sex,
  number of pregnancies, marital status, age, or
  contraceptive preference.
• Funded through Title X federal block grants

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Family Planning

• Counseling and education about planning and
  spacing pregnancies
• Counseling relative to risk-taking behaviors
  including risks for HIV/AIDS
• A comprehensive physical exam

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Family Planning

• Pap smear (cervical cancer screening test)
• Screening and, if needed, treatment for sexually
  transmitted diseases
• Pregnancy testing
• Providing information about all methods of birth
  control, including abstinence

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Family Support Services

• Purpose is to enhance and support primary medical
  care for mothers and children
• Includes an interdisciplinary team of Public
  Health Professionals (ie. Social worker, nurse,
  dietitian, nutritionist, etc.)
• Settings for services include
• Clinic, home, school, or day care

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Family Support Services

• Services include
• Follow-up for missed appointments
• Coordination and reinforcement for the
  primary/acute care
• Social work assessment and treatment
• Nutritional counseling
• Parent/Child education regarding developmental,
  safety and envtl issues
• AND LOTS, LOTS MORE!

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Important Public Health Websites

• South Carolina Directory of Services for Women,
  Children and Families
• Resource guide (167 pages) with county-specific
  information regarding services for women and
  children ranging from family planning to clothing
  assistance.
• www.scdhec.gov/hs/mch/directory/20directory.pdf

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Care Line

• 1-800-868-0404
• Improve access to and utilization of healthcare
  for women, children and families.
• Identify and address barriers for clients in need.

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Case Study Four

• You are seeing an 8-year-old African American
  male, Steven C., and his mother today.
• The boy is suffering from asthma. The mother
  thinks that Stevens asthma could be exacerbated
  by mold in their apartment.
• Neither the mother nor the child know how to use
  the nebulizer they got from the hospital on
  discharge and do not have the adequate funds to
  purchase the medicine that go in the nebulizer.

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Case Study Four

• The mother also tells you that she does not have
  enough money to pay the rent at the end of the
  month.
• You have many patients to see in your newly
  opened office.
• What can you do?

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Case Study Four

• 1. Tell the mother that you will be making some
  calls to the local county health department on
  behalf of she and her son. Someone will be in
  contact with her as soon as possible concerning
  asthma management and the other financial
  concerns.

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Case Study Four

• 2. Verify that all of her contact information is
  correct.
• 3. Call the local county health department and
  ask to speak with someone from Home Health
  Services, which is a provider of in-home services
  for medical devices, disease management programs
  and support programs.

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Case Study Four

• 4. Explain the needs of the patient and family.
  Someone from DHECs Home Health Services will
  speak to her while she is still in your office.
• 5. The DHEC intake person will schedule a home
  visit where the mother and son will have
  instruction on how to use the nebulizer, home
  evaluation, asthma education, as will as a
  disease management program for asthma, and a
  discussion with DHEC EQC (Environmental Quality
  Control) personnel re mold.

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Case Study Four

• 6. Home Health Services will then contact other
  service providers to assist with other needs of
  the mother and son. This includes, but is not
  limited to Family Support Services (Medical
  Social Worker evaluation about money for
  apartment and medicine.)

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Home Health Services

• Skilled Nursing
• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Medical Social Work

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Home Health Services

• Nutrition Education and Counseling
• Home Health / Personal Care Aid
• Pediatric Services
• Family Support Services

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Home Health Services

• Diabetes Education
• Asthma Education
• Women's Health
• http//www.scdhec.net/hs/health/contacts.htm

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Home Health Services

• Disease Management Programs for
• Asthma
• Diabetes
• Congestive Heart Failure
• Wound-Ostomy Care
• Stroke (Brain Attack)

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Home Health Services-Payment

• Patients with no pay source will be billed based
  on their ability to pay or use the sources listed
  below
• MedicareMedicaidPrivate insurance
  plansVeterans AdministrationHealth Maintenance
  Organization (HMO)Managed Care Organization
  (MCO)Preferred Provider Organization (PPO)

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Environmental Quality Control and Evaluation for
Mold

• The Bureau of Air Quality (BAQ) of DHECs
  Environmental Quality Control does not keep a
  list of indoor air contractors.
• They usually refer callers to the "Environmental
  Consultants" section of the yellow pages in the
  phone book.
• For those with Internet access, BAQ likes to
  suggest that families visit the American
  Industrial Hygiene Association web site for
  certified contractors and consultants
  (www.aiha.org).
• Many asbestos contractors also address indoor air
  
• quality (IAQ) such as mold and mildew.

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Case Study Four

• 7. Clinician should schedule a follow-up
  appointment during the initial visit.
• 8. At the follow-up appointment, ask the mother
  if anything else can be done to improve the
  quality of health care provided. You discuss the
  issue of mold management which the mother learned
  about from DHECs EQC (Environmental Quality
  Control).

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Important Public Health Websites

• SC Department of Health and Environmental Control
  (SC DHEC) Main Page www.scdhec.gov

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Department of Health and Environmental Control

• Health Services
• Environmental Quality Control
• Health Regulations
• Ocean and Coastal Resources

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Important Public Health Websites

• Public Health Statistics and Information Services
  (PHSIS) SC DHEC
• Under the Information link, one has access to
  updated data bases with state, county and zip
  code specific information regarding critical
  health indicators.
• www.scdhec.net/co/phsis/
• biostatistics/

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Other DHEC Health Services

• STD/HIV Contact tracing Disease Investigation
• Syndromic Surveillance
• Bioterrorism preparedness
• Provider of immunizations
• Immunization Birth Defects Registry
• Vital Records, Data analysis

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Important Public Health Websites

• SC Department of Health and Environmental Control
  (SC DHEC) Health Services Links for all of the
  health services provided by the state including
• Maternal and child health, chronic disease, home
  and environmental health departments with related
  services to children and families
• http//www.scdhec.net/hs/

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Case Study Five

• You are discharging a pre-term baby from the
  NICU, whose mom is young and struggling to do her
  best for this baby.
• The baby has had a a difficult course while in
  the NICU.
• The baby has had the expanded newborn metabolic
  screen and a hearing test.
• You ask nursery personnel to arrange for a
  newborn home visit.

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DHEC Health Services-Screening

• Mandated to provide screening for the entire
  population
• Newborn Screening for metabolic diseases
• Newborn hearing screening via First Sound
• Developmental screening and follow up
• Support for clinicians who have done the EPSDT
  (early periodic screening, diagnosis, and
  treatment) mandated test for Lead, and confirmed
  an abnormal value

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NEWBORN SCREENING

• What DHEC provides Support for First Sound
• Metabolic Testing of all newborns for
• PKU (phenylketonuria)
• Congenital hypothyroidism
• Galactosemia
• CAH (congenital adrenal hyperplasia)
• Hemoglobinopathies
• MCADD (medium chain acyl-coA dehydrogenase
  deficiency)

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NEWBORN SCREENING, cont.

• Expansion to 30 tests includes
• Cystic fibrosis
• Biotinidase deficiency
• Fatty acid disorders
• Amino acid disorders
• Organic acid disorders
• Screening is MORE than a blood test!

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NEWBORN SCREENING

• What DHEC provides (continued)
• Locate and provide health education to families
  of infants with abnormal screening results if
  their primary care provider was not identified.
• Assure appropriate retesting and follow-up is
  completed.
• Assist with subspecialty care if indicated.

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NEWBORN SCREENING

• How and when to refer
• Make a referral if the patient does not come to
  the office for the two week check-up and the
  screening results are abnormal.
• Call County Health Department.
• If patient is there for the two week check-up and
  results have not been received call 803-898-0593,
  Linda Baker, to check results.

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NEWBORN HOME VISITS

• Who is eligible?
• Moms/Infants on Medicaid or eligible at delivery.
• How to refer
• DHEC nurses provide an assessment on all
  eligibles from newborn nursery.
• From NICU request referral through NICU social
  worker.

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NEWBORN HOME VISITS

• What DHEC provides
• Assessment of health, safety and psycho-social
  environment of the infant
• Health education
• Appropriate referrals, such as WIC (women,
  infants and children)
• Care coordination as needed
• Assure family has a medical home or assist with
  locating one.

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Medical Home Concept
Continuous
Comprehensive
Coordinated
Family-Centered
Primary Health Care
Compassionate
Accessible
Culturally-Competent
Health Department
Pediatric Health Care Professionals
Parents
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How will the Medical Home Benefit the Physician?

• Maximize productivity
• Enhance the quality of care provided for the
  children and their families
• Share the challenges of providing comprehensive
  care

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NEWBORN HOME VISITS

• What DHEC provides (continued)
• Assure the mother has an appointment for the
  -six-weeks check-up.
• Assess birth control and STD prevention.
• Blood pressure evaluation.
• Nutrition assessment and counseling
• Screen for post-partum depression

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BABYNET

• Who is eligible?
• Suspected or diagnosed developmental delay - or
• Physical condition with high probability of
  resulting in developmental delay
• Infants and Children from birth though 3 years of
  age and their families.

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BABYNET

• Entry point for services
• What DHEC provides
• Early intervention services including
• multi-disciplinary evaluation
• identification of needed services
• assistance obtaining services
• Payor of last resort
• Transition to school-based services at age 3

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BABYNET

• How to refer
• Referral is mandatory
• First call
• BabyNet division in District or County Office,
• Or call
• Statewide CARE line at 1-800-868-0404

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Children's Rehabilitative Services

• Who is eligible?
• Legal resident of US and South Carolina.
• Less than 21 years old.
• Have a condition covered by the program
• Meet family income guidelines (250 of the
  poverty level) or TEFRA based on childs income

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Conditions covered by the Childs Rehabilitative
Services program

• Bone and joint diseases
• Hearing disorders and ear disease
• Cleft lip and palate and other craniofacial
  anomalies
• Spina Bifida and other congenital anomalies
• Epilepsy (seizures), cerebral palsy and other
  central nervous system disorders
• Rheumatic fever

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Conditions covered by the Childs Rehabilitative
Services program

• Problems from accidents, burns, and poisoning
• Endocrine disorders
• Hemophilia (children and adults)
• Sickle cell disorders (children and adults)
• Developmental delays such as speech/language,
  motor and growth abnormalities and
• Kidney diseases.

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Children's Rehabilitative Services

• What DHEC provides
• Payor of last resort for specialty medical
  services including hospital care, medicines,
  medical supplies, therapy, and other services.
• Care coordination
• Social work and nutrition counseling and special
  formulas.
• Summer camp for children aged 7-19 years.

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Children's Rehabilitative Services

• How to refer
• For the referral process to be initiated, call
  the County Health Department to request the
  CRS(Childrens Rehabilitative Services) phone
  number for that county.

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Outside resources-Family Connections

• Value of parent to parent counseling to help
  families who have children with developmental
  delays, disabilities, or chronic illness with
  support, information, community awareness, and
  enhanced parent/professional relationships.

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The State Oral Health Plan

• The State Oral Health Plan is a comprehensive
  blueprint for oral health promotion and oral
  disease prevention.
• Major priorities are Policy and advocacy to
  increase the recognition of oral health issues
  among policy makers and the public.

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The State Oral Health Plan

• Education of the public, policy makers, and
  health care providers on the importance of oral
  health improvement.
• Dental public health infrastructure development
  to strengthen partnerships with private
  practitioners, other public programs, and
  voluntary groups.

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The State Oral Health Plan

• Dental workforce development to increase and
  diversify the pool of talent in oral health.
• Increase access to oral health services.

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Immunization Program

• Who is eligible?
• All childhood immunizations are free to all
  people under 19y/o eligible for VAFAC (vaccine
  assurance for all children).
• How to refer
• The patient may call for an appointment at county
  health department clinic site preferred.
• Walk-ins are welcome.

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Immunization Program

• What DHEC provides
• Recommended childhood immunizations
• Foreign travel consultations and immunizations
• Other immunizations
• Meningococcal
• Immune globulins for Hepatitis A, Hep B, Measles
• Rabies post-exposure prophylaxis
• Support to VAFAC (vaccine assurance for all
  children) providers

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Federal Vaccine For ChildrenVFC

• CDC Advisory Committee on Immunization
  PracticesACIP
• Vaccine Information StatementVIS
• Vaccine Adverse Event Reporting SystemVAERS
• National Immunization ProgramNIP
• South Carolina Vaccine Assurance For All
  ChildrenVAFAC

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South Carolina Vaccine Assurance For All Children
(VAFAC) Eligible

Medicaid Enrolled

Uninsured

Underinsured

American/Alaskan Native Children

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VAFAC (Vaccine Assurance for All Children)

• Family pays the vaccine administration fee,
  unless Medicaid pays through DHHS (Dept. of
  Health Human Services).
• Practitioners can not deny immunization if the
  family is unable to pay the vaccine
  administration fee.

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Immunization Registry

• Legislation is pending and a pilot is ongoing to
  assess barriers and any problems.
• Data needed Patients name, address, date of
  birth, VAFAC (vaccine assurance for all
  children) eligibility category
• Providers name, practice name, VAFAC (vaccine
  assurance for all children) pin,
• CPT code of vaccine administered, date, etc.

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TB Program

• Who is eligible?
• Any person suspected of having tuberculosis.

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TB Program

• What DHEC provides
• Diagnostic services
• Medications for treatment of active cases and
  prophylaxis
• Directly observed therapy
• Case management
• Contact tracing
• Screening services

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TB Program

• How to refer
• Call the TB Clinic at County Health Department
  for an appointment.
• Send written documentation of date, exact
  measurement and antigen used for the skin test.
  Be sure to evaluate risk.
• Do a chest x-ray prior to their appointment with
  the Health Department if possible.

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DHECs STD and HIV Services 1-800-322-AIDS

• S.C. STD/HIV/AIDS Hotline is a statewide
  toll-free service to answer questions pertaining
  to STDs and HIV/AIDS, and South Carolina
  resources for prevention and care services.
• SHARING (Statewide HIV/AIDS Resources) is an
  information source of available HIV prevention,
  care, and supportive services by county. SHARING
  information is available through the hotline (1
  800 322-AIDS)

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STD Dx and Rx

• STD Diagnosis and Treatment County health
  departments provide testing, diagnosis,
  treatment, and educational services for
  individuals requesting such services and those
  who have had contact with an STD-infected
  individual.

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HIV Counseling and Testing

• Health department staff and some HIV prevention
  collaborations provide HIV testing and referral
  to care and other services counseling to assist
  clients in assessing personal risk of acquiring
  or transmitting HIV and negotiate a realistic and
  incremental plan for reducing risk.

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Partner Counseling Referral Services

• DHEC personnel assist clients in locating and
  notifying partners of possible HIV and syphilis
  exposure and assist partners in accessing
  counseling, testing, and other support services.

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Environmental Health

• Food Protection-Restaurant Inspection
• Onsite Wastewater-Septic Tank Approval
  Inspection
• Rabies
• Mosquitoes
• Vector Control

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DHEC Laboratory

• Newborn ScreeningBlood Environmental
  LeadDrugs of Abuse ScreeningIndustrial
  HygieneBacteria, ParasitesHepatitis, HIV,
  Chlamydia, STD TuberculosisInfluenza, Rabies
  Food and DairyPAP Smears

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Where do we in MCH go from Here?

• A multi-disciplinary group is working on
  creating the Child Health Connection (CHC)
• Mission To assure and promote a systems based
  approach to ensure the health of children and
  their families

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Where do we in MCH go from Here?

• Main Components of Action Plan
• DHEC will be available and responsive to the
  needs of the community
• Select specific content and methods used to
  deliver information to clinicians
• Expand and improve interface between DHEC and the
  community

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Core Functions of Public Health

• Assessment
• Assess
• Investigate
• Analyze
• Policy Development
• Advocacy, stakeholder collaboration
• Prioritize
• Plan

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Core Functions of Public Health

• Assurance
• Manage
• Implement-Direct Service
• Inform/Educate
• Evaluate, including monitoring quality of
  services provided by others.

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Essential Public Health Services

• Assessment
• Monitor health status to identify health
  problems.
• Diagnose and investigate health problems and
  health hazards
• Inform, educate, and empower people about health
  issues

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Essential Public Health Services

• Policy Development
• Monitor community partnerships to identify and
  solve health problems.
• Develop policies and plans that support
  individual and community health efforts.
• Enforce laws and regulations that protect health
  and ensure safety.

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Essential Public Health Services

• Assurance
• Link people to needed personal health services
  and assure the provision of health care when
  otherwise unavailable.
• Assure a competent public and personal healthcare
  workforce

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Essential Public Health Services

• Assurance
• Evaluate effectiveness, accessibility and quality
  of personal and population based health services
• Research new insights and innovative solutions to
  health problems

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Objectives for Presentation to Clinicians

• Present information and case studies about
• WHAT DHEC DOES operative support DHEC can offer
  to practitioners,
• WHERE TO GET INFORMATION about DHEC access
  information on how practitioners can get the help
  they need from DHEC.
• HOW TO INTERACT with DHEC personnel to attend to
  patients needs.