MINUTES
DUKES COUNTY HEALTH COUNCIL
December 15, 2005 Meeting
West Tisbury Public Safety Building
CALL TO ORDER
Chairman Cindy Mitchell called the meeting to order at 7:40am. Chair determined that a quorum was present. Attendees included: Olga Church, Cathy Brennan, Terry Appenzellar, Patsy McCornack, Jane Cleare, Jacque Cage, Michele Lazerow, Linda Swanson, Judie Flanders, Tim Walsh, Ken Churchill, Jo Ann Murphy, Bob Tonti, Dr. Charles Silberstein, Dr. Ilene Klein, Tad Crawford, Matt Poole, Cindy Doyle, S. Patrick Donegan, and Nancy Gilfoy. Nelson Smith arrived at 8:10 am and Chris Knowles arrived at 8:30 a.m. Also present were, Sarah Kuh, VHCAP and member ex officio, Christine Stein, VHCAP/Vineyard Smiles, and Deborah H. Potter, executive assistant to the county manager to record minutes.
NEXT MEETING:
Cindy Mitchell advised the next meeting is January 26, 2006.
MINUTES:
The motion to accept the minutes of September 22, 2005 was made by Terry Appenzellar and seconded by Tad Crawford and the motion was SO VOTED unanimously.
The motion to accept the minutes of November 17, 2005 with the following four changes was made by Terry Appenzellar and seconded by Cindy Mitchell and the motion was SO VOTED unanimously.
- Add the following list to Dr. Klein’s recommendations for key informants: a hairdresser, a schoolteacher or principal, a representative from a religious organization, a person who uses traditional and non-traditional healing modalities, someone from a 12-step program, a family with a child with special needs, someone from law enforcement, a teen in a youth group, a representative from an Ethnic association or group, someone from the arts community or an elder association, or a veteran on page 2
- Add Susan Curnan of Brandeis on page 3
- Add Dr. Becker on page 5.
- Change colored to people of color on page 7.
TREASURER’S REPORT:
Terry Appenzellar provided a copy of the current account status. Although the report is marked draft it is complete with no pending issues. Cindy Mitchell asked for a motion to accept the Treasurer’s report. Michele Lazerow made the motion, Dr. Ilene Klein seconded to accept the Treasurer’s report and the motion was SO VOTED unanimously.
Terry Appenzellar continued with an actual vs. budget report and recommended a transfer of additional supplemental funds for the final Health Forum expenses. $700 will come from the CC and $50 dollars from the Chronic Illness Budget. Tad Crawford explained that the principal reason for the extra expense was that the group had been using the Hebrew Center which worked out very well; however, during the summer the center was not available so alternate locations had to be used which added costs not previously planned for. Also copies of the Health Forum results were given to each library. A motion to make the transfer of funds as recommended by Terry Appenzellar was made by Bob Tonti and seconded by Jane Cleare and the motion was SO VOTED
unanimously.
HEALTH COUNCIL COMMITTEE/PROGRAM/ISSUES REPORTS AND UPDATES:
Health Forum Committee: Tad Crawford advised the group that the health forum committee is still intact and working well. They are keeping some of the pending results of various surveys from being lost and determined they have a residual commitment to try to incorporate some of the recommendations and ideas from the various forums into current programs or create new ones to address the needs. Later the committee will provide a consolidated report to the DCHC to advise specific recommended actions. Dr. Silberstein noted that this was his last meeting and he also advised the council that Plum TV wanted to continue and expand the Health Forum televised public service program. He believes that the project could take on some additional strength if
the DCHC participated in the project. Dr. Silberstein asked if the council would consider creating a small group who could discuss content issues such as recommending topics or individuals to be on the show. Plum TV is expanding and the issues that are locally relevant may be helpful to other communities as well. The project could also expand into a more of a Healthy People format looking at larger, general public health issues as well; consequently he is asking for two things: one a sense of the interest of the DCHC in this role and two a sense of who would be willing to help. Cindy Mitchell wanted to know if Dr. Silberstein was continuing his role and he replied yes. After some discussion about the general nature of the show, Cindy Mitchell asked for a show of hands for people interested in working on this project. Michele Lazerow, Cindy Doyle, Olga Church, Susan Wasserman, Sarah Kuh, and Cathy Brennan all offered to
participate.
Nominating Committee: Cathy Brennan advised the group that several qualified applicants have submitted their interest for appointment; however, this time there are more applicants than available spots. She also noted that the committee really wants to improve attendance and are considering recommending a change to the by-laws to require a 75% attendance rate at meetings. That means a representative should not miss more than 3 meetings a year. There are a few people who already are missing more than 3 meetings so they might want to reconsider their status.
She added there were two openings in consumer area with Ms. Ropp stepping down; however, a minister has already been approached to fill one of the spots. Bob Tonti was in a consumer slot and now is the VNA representative. The committee has three good candidates for that remaining spot. The student slot is still pending and Cathy Brennan will be talking to Cindy Doyle about filling this position. Carlin Hart is the school representative; however, he has been unable to attend the meetings. The new Superintendent of Schools, Mr. Weiss, will be attending January meeting and appoint a representative who can attend the meetings. Commissioner Leslie Leland has stepped down and Commissioner Nelson Smith will now be filling the Dukes County Commissioners
slot. Charlie Silberstein is stepping down and there are a couple of qualified people being approached for his position. In the community health area, the Martha's Vineyard Aids Alliance ended but Chris Knowles is now filling that spot for the Martha's Vineyard Hospital. There are a few other positions open and as a result of the number of applicants, Cathy Brennan advised the council that the committee may need some extra time to properly review the applications.
Tad Crawford added that it would be a shame to have to turn away interested candidates and that it is incumbent upon current members that if they are not able to be fully committed to consider stepping down. He also re-mentioned considering not including the three Associate Commissioners as members for a quorum stating that it would be easier to achieve a quorum if they were not considered.
Rural Health Network Oversight Committee: Dr. Klein gave a brief overview of the progress of the group. There have been two meetings so far of the RHN planning committee. She added that the consultants are working very diligently and moving the project forward expeditiously. The group will meet again next month to get all of the participants to sign the guiding principles and the committee will also be collecting financial information that will help for the coordination services provided and consolidation of efforts. She will also be talking to everyone in the group to make sure they feel the process is on track. We also had another meeting on Monday with a variety of people to help try to access the quality of services and availability of
services on Martha's Vineyard. The committee tried to survey across a broad spectrum of participants. Another area still requiring a lot of effort is the need for translation services. One example was a parent who misread the instructions on the medicine label and ended up giving the child too much medicine. Dr. Klein noted that everyone had been particularly delighted to participate in the surveys. She also added that partners on the project include Ronny Rom from the State Department and Neva Flaherty of Congressman Delahunt’s office. They are both active and very involved in this project and they are discovering that the information coming out of this project is also being helpful to them as well.
MVCS Emergency Services Contract update: Susan Wasserman advised the council that she and Tom Bennett had a productive meeting at the state level to discuss the contract provided by MVCS. MVCS is on the top of the agenda due to Senator O’Leary’s help and they are hoping to get additional revenue for this year. She is confident that there will be some additional funding for next year to help ease the financial burden. Cindy Mitchell asked when they would know for sure. Susan Wasserman said that if the state conference committee meets on Dec 20 as scheduled, the process would continue moving along but a specific resolution date was unavailable. MVCS is focusing most on fixing the problem for next year.
Other Reports: Cindy Mitchell noted that VHCAP has funding from Blue Cross/Blue Shield to establish an interpreter service. VHCAP attracted a top notch coordinator and last week they hired Miryam Gerson , who is tri-lingual, to fill this spot. She will be start January 9, 2006 and believes that the group will be able to move forward substantially within 60 days.
Special Report and Discussion: Christine Stein, Oral Health Group: Ms. Stein passed out five documents that provided the preliminary findings of their work so far. She acknowledged the work of all of the members of the group who worked diligently to make this a success. She stated that Dr. Dougherty, the participating dentist, offered a dental screening to all 1st ,3rd , and 6th grade students, as well as all children in Head Start, a variety of seniors at the COA’s, elder housing, and Windemere; some adult screenings, and through the Island Health Center. The group tried to offer the screening to as many people as possible within a tight time frame. In addition to the physical screenings a
questionnaire was also included. She noted they had more questionnaires than actual screenings. They also interviewed key informants to add another dimension to the assessment.
The preliminary findings of the report included a National and State Benchmarks for Oral health. There are certain aspects that they were able to compare and but they also used the information to help identify what the basic dental standards are and how the group would like to proceed in those areas. They screened a total of 105 adults and the key finding was that 37% of the adults had untreated dental disease. They also screened 155 children and the key findings included 26% had untreated dental disease. Terry Appenzellar asked why it seemed that Oak Bluffs 6th grade did not participate and neither Sarah nor Christine knew why that group had such a low participation rate. Across the board the findings for children showed 33% percent had
fillings, 26 had caries, 40% had sealants, and 21% had some form of treatment urgency. She added that for adults the group made an attempt to really reach low-income adults. When the groups data is compared to the National and State benchmarks, the objectives for 6-8 year olds doesn’t show a huge difference but does show room to improve.
Dr. Silberstein asked what criteria was the baseline developed on and Ms. Stein stated the baseline data is from the last national survey performed and the objective is the intended level the nation will meet for HP 2010 objectives. Nancy Gilfoy asked if the national data covered all people or just low-income participants. Ms. Stein stated that it did not emphasize low-income status but that their group did because that is where they felt the need was and wanted to accurately assess the needs of the community. Dr. Klein also asked why the adult information for 35-44 is not included in the Benchmarks. Ms. Stein responded the categories don’t correspond perfectly but they did the best they could in comparing data. Dr. Klein added that there are several
primary physicians that also may have information regarding dental care for their patients who could provide valuable information to enhance the data results.
She discussed some of the Statewide data for children again noting it is not a perfect comparison but it serves to help establish an idea of how the Martha's Vineyard community is comparing to the other groups. Terry Appenzellar asked if there was any opportunity to follow up with Oak Bluffs School to determine why the 6th grade group had such a low participation rate. Sarah Kuh advised that they are working to keep the lines of communication open and that limited availability of screening times could have been an issue. Ms. Stein also reminded that these are just the preliminary findings and that over the next few weeks she will be working on revising the information and presenting it in a more user friendly format. Dr. Silberstein asked when she
expected to have the report completed and she said at the end of January.
She then reported on the findings of the Vineyard Smiles Questionnaires. They collected 169 questionnaires from adults asking a variety of questions regarding their dental health. She noted that 170 questionnaires may not accurately reflect the true picture of dental health on Martha's Vineyard; however, this information is appropriate for identifying the community needs for the Dental Health grant. Dr. Silberstein asked if because of the focus placed on lower income adults the results of the survey could be skewed. Ms. Stein replied that the assumption is that middle and high income individuals have dental care but the grant would probably be addressing the needs of low income individuals, so targeting this group helps to better identify what specific
needs this group has. The preliminary data from the questionnaires shows a better dental picture for children than for adults. She then asked the group to take a look at some of the comments made by participants of both surveys and noted the participants of the Oral Health Key Informant Interview and some of the questions asked of them.
Sarah Kuh added that this is for a planning grant and this was the assessment phase of the project. Now they are moving into the crafting of the program. The group had their first meeting and is starting to work towards designing and implementing the various suggestions. She noted they are working hard to reopen the dental center at the hospital because of the great need for it. The oral health foundation does not see themselves funding the entire project but wants to work towards helping the overall dental health of the community and to partner with various providers. The Oral Health Working Group will meet in January to refine their ideas and will continue to gather input as needed to incorporate into their program which they hope to have by March.
She hopes to have a focus on community programs and involvement. Jane Cleare asked are there any dental service vans is Massachusetts that are mobile and is it possible to have them contracted to come over here on a regular basis. Sarah said yes there are but it is actually the equipment itself that is mobile. They bring the equipment over and then set up in a location where the services can be provided. Olga Church asked if they are including any provisions for dental school students. Ms. Stein said that it had been tried in the past but that the time and cost of commuting here has made it not work well in the past; however, it has not been ruled out either. Nelson Smith asked about outreach in terms of say an Oral Health day or to provide services on the weekend if parents can’t get the day off. Cindy Doyle asked if the grant with Delta Dental will cover the entire expense any recommendation. Sarah Kuh
said they are working on but in all probability not all aspects of their recommendation will be covered. She believes the grant will be for about $70,000-80,000 dollars a year but it won’t cover everything. Dr. Klein re-emphasized her belief that a strong formal relationship with primary care providers should be created. Cindy Mitchell added that the re-opening of the Dental Clinic at the Hospital is still on track and they are hoping to re-open by February and the hospital is doing a great job in their efforts.
Continued Discussion- MVH Determination of Need: Chris Knowles advised the group that original plan has grown from three pages to six and now details some specific information regarding the distribution of some of the funds. The primary focus of the plan originally presented has not changed but a fourth area has been added: Emerging Needs/New Priorities. This new area will receive $20,000 a year to provide seed money for any new initiatives or emerging needs that may not be addressed in other areas. DPH accepted the content but wanted more specifics on how this will be done.
In the area of Behavioral Health, DPH wanted to know how the hospital was going to make the distribution of the grant money. The hospital is suggesting that with the help of the DCHC and a designee from the DPH an objective scoring and ranking method would be established and the monies then distributed according to the numerical rank assigned.
For emerging needs and new initiatives, Mr. Knowles noted that the island BOH’s probably see health issues before many others and they could make recommendations on compelling need of current issues. He added that input from other sources could be included as well. Cindy Doyle asked if the numbers in his report could be broken down and Chris replied that the information is from DPH. He did not have the data but they would. Terry Appenzellar noted that $20,000 may serve an emerging need or it may not and asked if the money could be carried forwarded if needed. Chris Knowles stated that DPH requested it to be segregated and it is seed money; however, any funds, by agreement, could move from one area to another if needed.
Sarah and Tad both noted that the “sentinels” for emerging need should not be limited to just the BOH’s as they are not the only front line key informants available. Cindy Mitchell noted that the plan does well to incorporate the DCHC and the town BOH’s involvement in ways not normally covered. Cindy Mitchell continued by asking if the hospital was trying to pay for work they planed to do anyway in the primary care element. Dr. Klein noted that the hospital doesn’t make money on primary care but it is an attempt to attract and retain primary care doctors which has always been a problem for the island. The island is four doctors short and you need to have doctors here in order to provide services of any kind and to any groups.
Cathy Brennan asked if the VHCAP was covered in this proposal and Chris responded that it is not off the table but it is not presented in this plan. VHCAP is more of a sustainability issue vice a 5 year plan issue. The hospital was meeting with Sarah in the future to determine what may or may not be done.
Adjournment: Cindy Mitchell adjourned the meeting at 9:35 a.m.
Respectfully submitted,
Deborah Holtzer Potter
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