QUINNIPIACK VALLEY HEALTH DISTRICT

BOARD OF HEALTH MINUTES

North Haven, CT

March 26, 2009

4:30 p.m.

Attendance: A.McClure; D.Cofrancesco; L.DeNegre;  J.Donaldson; C.Goldberg; A.Levison; P.Marone; B.Scott; A.Sofair; V.Masi; M.Rochow; L.Haddad; D.Culligan, staff; L.Fox, staff.

Not in Attendance: S.Faris; T.Gersdorf; L.Balch, ex officio.   

President A.McClure called the meeting to order at 4:40 p.m. and declared a quorum present. D. Culligan introduced L. Fox, who was assisting with minutes in the absence of J. Silvestri. D. Culligan reported that the notice of the public hearing for the QVHD budget did appear in the New Haven Register on March 24, 2009. The public hearing will be held on April 7, 2009 at 5:00 p.m. at the QVHD office. P. Marone, A. McClure and L. Balch will be in attendance. Other Board members may attend if desired.

Minutes: A motion to approve the February, 2009 minutes was made by R. Masi, seconded by D. Cofrancesco and unanimously approved.

Financial Report:

The Financial Report for the period ending February 28, 2009 was reviewed.  D. Culligan noted that: Target is 66.67%; Revenue is 71.77%; Expense is at 64.84%. The revenue is above the projected target because the food service license fees have come due. As stated last month, it is not expected that revenue will continue to be above target. A motion to accept the financial report and place it on file was made by J.Donaldson, seconded by D. Cofrancesco, voted unanimously to place on file.

Committee Reports:

Finance Committee: P. Marone stated that the finance committee had met twice during the past month and drafted a budget for FY 2009-2010. He distributed a copy of this draft budget to the group. (See attached.) He noted that there are many financial issues that the District is facing, including a decrease in revenue. The budget presented is a worst case scenario, should revenue issues remain the same. P. Marone noted that: Contributions from the town are up slightly by $750; Grant revenue (BT and Lead) are unknown at this time; interest income and fees are projected to be decreased; and the state subsidy has been reduced by about $80,000. Totaled together this adds up to about a $170,000 decrease in revenue. He noted that several actions may be taken including no salary increases, furlough days for union employees, changes to fringes (health insurance and prescription medication rider) as well as layoffs. The current draft budget includes eliminating two staff positions. To balance the budget, it includes about $111,000 from the reserve, which is about 50% of the reserve. A. Sofair asked if it was possible to decrease work hours and have part-time positions; what are current employee contributions for health insurance; and if it is possible to go to towns for more funds. P. Marone stated that several options were being discussed with regards to staff hours. D. Culligan stated that employees pay about 6% of health insurance currently. L. Balch will be looking at other insurance options for the district. D. Culligan noted that there may be other times during the year to go to the towns for more funds, however the towns are also facing financial issues.  

Personnel Committee:

J. Donaldson stated that the Personnel Committee met at the District office on March 17, 2009. She read the following report:

The Personnel Committee was updated by the Executive Director regarding the negative financial realities being faced by the district for the 2009-10 fiscal year. A number of possible changes in staffing and benefits were reviewed and discussed. It was moved by M. Rochow and seconded by R. Masi that: the Personnel Committee recommend to the full Board that the Executive Director be authorized to adjust the staffing at the District Office to accommodate budget constraints recommended by the Finance Committee for FY 2009-2010 offering a variety of options including: union and management concessions, union and management furloughs and if necessary layoffs and/or early retirements. The motion passed unanimously.

J. Donaldson moved that the QVHD Board accept the above recommendation of the Personnel Committee; seconded by L. Haddad and voted unanimously.

School Based Health Center (SBHC) Committee:

J. Donaldson, QVHD Board liaison to the SBHC reported that the SBHC Advisory Committee met on March 10^th, 2009. Minutes from that meeting as well as a Utilization and Financial report were distributed. (See documents)

J. Donaldson noted:

·         The number of uninsured uses increased significantly from about 8% to 20% from the last school year half-year report to this years report. This indicates that the SBHC is truly serving children in need.

·         The Advisory Committee recommended for acceptance three policies regarding immunizations and notifications to primary care providers.

·         Several new immunizations are proposed for both kindergarten entry and 7^th grade. This could impact the SBHC in catching older students up on new immunization requirements. 

Administrative Reports:

Health Education Report:

D. Culligan presented the following:

·         The SBHC storyboard that was created for legislative event held in Hartford last month was displayed.  

·         QVHDs participation with the Hamden Partnership for Young Children continues. This group is creating a health task force to look at health issues in the community.  

·         The QVHD Annual Report for FY 2007-08 was distributed. Questions about the contents will be addressed next month.

·         QHVD has submitted a letter of intent to apply for the HEI Demonstration Project, which focuses on health equities in a community. The grant is due by April 24, 2009.

·         An article on preventing falls (with follow up materials upon request) has been sent to the QVHD senior network through the senior center contacts. She noted that this continues to be an excellent route to reach seniors with health promotion materials.

·         Website information on needle disposal and safe medication disposal has been updated. QVHD receives many inquiries about the disposal of needles. A fact sheet about med disposal which is now accessible on the website (produced by the State of CT) was distributed to Board members.  

·         The Board was reminded that an Emergency Prepared Drill is slated for May 19, as reported last month by L. Balch. In addition, a second drill will be occurring over the summer dealing with community mitigation. QVHD will be working with CADH (CT Association of the Directors of Health) on this drill.  

There was no specific Directors Report this month.  

Motion to adjourn was made by R. Masi, seconded by B.Scott and voted unanimously. Meeting was adjourned at 5:25 p.m.

The next meeting is scheduled for April 23, 2009 at 4:30 p.m.

Minutes prepared by:

D. Culligan, QVHD staff

Moms Advisory Committee Meeting

March 10^th, 2009

Minutes

Present: T. Arbo (LCSW supervisor); D. Diaz (parent, Hamden resident); A. Williams (Hamden resident, PA, Research scientist); M. Kanner (parent); D. Bekeny (community pediatrician); C. Giles (Yale New Haven Hospital); J. Donaldson (QVHD Board Liaison); D. Culligan (Coordinator, Moms Clinic); L. Balch (Administrator, Moms Clinic.)

The meeting was convened at 4:10 pm.

Utilization Review

D. Culligan shared some information about the changes in Medicaid and how it has affected some students. School based health centers are clearly a safety net provider for many children. D. Culligan distributed a data report for the time period July 1, 2008-December 31, 2008. (See written report.) She noted that the total enrollment is lower than at this time last year. However, with an APRN finally on board, it is expected that enrollment numbers will go up. Utilization for the APRN is also lower than desired, but it is expected that this will also increase as it is recognized that Moms Clinic has an APRN. The most significant change noted was in the number of uninsured users compared to last year for the same time period. The uninsured users went from 8% to 19%; privately insured dropped by a couple of percentage points and Medicaid increased by a couple of percentage points.

Financial Status

D. Culligan reported that Moms Clinic is currently in year 2 of a 3 year contract. The Governors budget did not cut the current funding level, however it is unclear as to the final outcome of the State budget. It appears at this time that funds will be level.

208-09 budget is $148,334; State grant is $122,094; funds needed for 2008-09 budget: $26,641; carry-over revenue (from 2007-08 is $30,255. Therefore, barring any unforeseen events, funding for this year is adequate to complete the year. Current income from third party reimbursement is $15,800, which is about equal to that collected through the same time period last year.

Policy Reviews:  

Three policies were put forth to the group for review and approval.

Policy # 1: Notification to PCP of vaccination or PPD tests administered at Moms Clinic. (See attached.) A motion to recommend acceptance of this policy was made by T. Arbo, seconded by D. Bekeny and approved unanimously.

Policy # 2: Notification of certain services to Students Primary Care Provider (PCP). (See attached.)

A motion to recommend acceptance of this policy was made by D. Diaz, seconded by S. Rubino and approved unanimously. A. Williams suggested that when able to faze in, it would be a good practice to send a report of all encounters to the PCP, as this would open communication in both directions (from SBHC to PCP and from PCP to SBHC.)

Policy # 3: Administration of State-supplied HPV vaccine (Gardasil) and/or Hepatitis A vaccines to Moms Clinic members who are VFC-eligible.  A motion to recommend acceptance of this policy was made by J. Donaldson, seconded by T. Arbo and approved unanimously. Dr. Bekeny suggested that a statement be included in the parental permission letter that states that the vaccine does not prevent other sexually transmitted diseases/infections or pregnancy and that annual age-appropriate PAP test screenings are still necessary. D. Culligan will add that information to the parental permission form.

OTHER:

The Rotary Club of Hamden has (again) generously donated $1,500 to Moms Clinic. These funds are to be used for students without insurance (or who are underinsured) for medication or lab services. Appropriate thank-you notes have been sent out to the Rotary Club.

CASBHC (the Connecticut Association of School Based Health Centers) held a legislative information session in February. Two staff members from Moms Clinic attended. D. Culligan developed a storyboard for the event. The storyboard is now placed in the teachers lounge to educate new teachers about Moms Clinic, especially highlighting the name origin.

The meeting ended at 5:00 p.m. The next meeting is scheduled for May 12, 2009.   

Minutes prepared by:

V. Deborah Culligan

Coordinator for Moms Clinic

MOMS CLINIC MIDYEAR REPORT

JULY 01, 2008-DECEMBER 31, 2008

CURRENT ENROLLMENT: 495                                                                                                       

NUMBER ENROLLED THIS SCHOOL YEAR: 107

VISIT INFORMATION

AGGREGATE VISITS    

·         551 clinical visits were made by 105 students; 193 to the NP; 314 to the LCSW; 4 to the MD.        

·        39% (39) clinic users were male, 63% (66) female.  (n=105)

·        18% (19) clinic users were 9^th graders, 24% (25) were 10^th, 31% (33) were 11^th graders and 27% (28) were 12^th graders.  (n=105)

·        Clinic users were: 39% (41) white, 47% (49) black, 8% (8) Hispanic, 6% (6) Asian, 0% (0) Unknown.  (N=105) 

·        Collateral contacts made by staff: Total =150 (Clinic secretary-31, NP-4, SW-110, MD-5) (Collateral contacts reflect non-billable time spent by staff on contacts to insurance companies, telephone calls, MD consults and case coordination.) 

TOP FIVE DIAGNOSES  (in descending order of number of visits for dx)

Medical services: Physical Exam; Immunizations; Health and Sexuality Counseling; Headache; and Acute Upper Respiratory Infections.  

Psychosocial services: Prolonged Posttraumatic Stress Disorder; Adjustment reaction with depressed mood; ADD with hyperactivity; Adolescent Adjustment Disorder; and Adjustment Disorder with mixed emotions and conduct.     

CONSULTS

NP   3        SW  49

REFERRALS

NP   1        SW 31 

INSURANCE: Status of users of services (N=105)

No insurance-20 (19%), Private insurance-39 (37%), Medicaid-48 (46%)

FINANCIAL STATUS

2^ND YR OF A 3 YR CONTRACT

CURRENT BUDGET IS $148,334

STATE GRANT           $122,094

NEEDED FUNDS        $  26,641 (LESS THAN EXPECTED DUE TO LATE START OF NP)

CARRY OVER FUNDS $  30,255

FROM REIMBURSEMENT

REIMBURSEMENT (3^RD PARTY) THRU 02/10/2009: $15,800  (Last year to this date abt $16,501)

Received a donation from Rotary Club for $1,500 to be used for those without insurance or pending insurance for medications and lab tests.