HomeMy WebLinkAbout2023/03/28 - BOH Packet MASON COUNTY
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Building,Planning,Environmental Health,Community Health
MASON COUNTY BOARD OF HEALTH
March 28,2023
' PUBLIC 3:00 PM
Commission Chambers
HEALTH411 North 51h Street
Shelton,WA 98584
Meeting ID: 834 8034 3274
Passcode: 721009
DRAFT AGENDA
1. Welcome and Introductions Cmmr. Shutty
2. Approval of Agenda—ACTION Board Members
3. Resolution—National Public Health Week—ACTION Board Members
4. Approval of Minutes—January 2023—ACTION Board Members
5. Health Officer Report Dr. Keri Gardner
6. Administration Report Dave Windom
a. Workforce Report
b. County Health Rankings
c. Fiscal
7. Environmental Health Report Ian Tracy
a. 2022 West Nile Virus Surveillance Report
b. Onsite Sewage Advisory Committee By-Laws
8. Community Health Report Melissa Casey
a. Behavioral Health Systems Update by Christina Muller-Shinn
9. Other Business and Board Discussion Board Members
10. Public Comments
11. Adjourn
If special accommodations are needed,please contact McKenzie Smith at(360)427-9670 ext.589 or
msmitha,masoncountywa.gov
Mason County Public Health
415 N 6t'Street,Bldg. 8, Shelton WA 98584,
Phone(360)427-9670 ext.400 ❖ Fax(360)427-7787
Proclamation
National Public Health Week
April 3-9, 2023
WHEREAS, the week of April 3-9, 2023 is National Public Health Week and the theme is "Centering and
Celebrating Cultures in Health"; and,
WHEREAS, since 1995, the American Public Health Association, through its sponsorship of National Public
Health Week, has educated the public, policymakers, and public health professionals about issues important to
improving the public's health; and,
WHEREAS, a person's health status can differ drastically due to differences in the built environment,
environmental quality, community context, access to healthy food,access to education, and access to health care; and,
WHEREAS, there is a significant decrease in health status among persons who are more likely to face social
determinants that negatively impact health, such as racism, poverty, adverse childhood experiences, transportation
barriers,and lack of economic opportunity; and,
WHEREAS,public health professionals help communities prevent,prepare for,withstand, and recover from the
impact of a full range of health threats, including disease outbreaks such as the COVID-19 pandemic, tuberculosis,
natural disasters, and disasters caused by human activity; and,
WHEREAS,public health action,together with scientific and technological advances,has played a major role in
reducing and eliminating the spread of infectious disease and in establishing todays' disease surveillance and control
systems; and,
WHEREAS, studies show that relatively small strategic investments in disease prevention can result in
significant savings in health care costs; and,
WHEREAS,efforts to adequately support public health and the prevention of disease and injury can continue to
transform a health system focused on treating illness into a health system focused on preventing disease and injury and
promoting wellness; and,
NOW,THEREFORE,BE IT RESOLVED,that the Board of Mason County Commissioners hereby proclaims
April 3-9,2023 as National Public Health Week and encourages all county officials, employees, schools, and residents
to observe this week by celebrating the value of public health in improving the quality of life for all its communities.
Signed this day of March 28,2023.
MASON COUNTY,WASHINGTON
BOARD OF HEALTH
MASON COUNTY,WASHINGTON
Darrin Moody,Hospital District#1
Kathy McDowell,City Council
Kevin Shutty,Commissioner
Randy Neatherlin,Commissioner
Sharon Trask,Commissioner
Peggy Van Buskirk,Hospital District#2
Gary Plews,Fire Commissioner
Keri Davidson, Shelton School Board
MASON COUNTY BOARD OF HEALTH PROCEEDINGS
411 North 511 Street,Shelton,WA
January 24,2023
Attendance: Randy Neatherlin,County Commissioner;Kevin Shutty,County Commissioner; Sharon Trask,
County Commissioner;Dr.Keri Gardner,Health Officer;Darrin Moody,Hospital District No. 1;Peggy
VanBuskirk,Hospital District No. 2;Kathy McDowell, City of Shelton;Keri Davidson, Shelton School Board;
Ian Tracy,Environmental Health Manager;Melissa Casey,Community Health Manager;McKenzie Smith,
Clerk of the Board;and Dedrick Allen,MasonWebTV
1. Chair Peggy VanBuskirk called the meeting to order at 3:03 p.m.
2. Approval of Agenda
Cmmr. Shutty/Cmmr. Trask moved and seconded to approve the agenda as presented. Motion carried.
3. Resolution to Set 2023 Meeting Dates
Cmmr. Trask/Cmmr. Shutty moved and seconded to approve the Resolution setting the 2023 meeting
dates. Motion carried.
4. Elect Officer Positions
Peggy/Cmmr. Trask moved and seconded to appoint Cmmr. Shutty as Chair. Motion carried.
5. Approval of the September 27 and November 29,2022 Minutes
Peggy/Keri moved and seconded to approve the September 27 and November 29,2022 Minutes.
Motion carried.
6. Health Officer Report
Dr. Gardner shared that it is a rough season for Influenza A,Respiratory Syncytial Virus(RSV),and
COVID. Influenza A is a strain of H1N1 which the flu vaccine covers. The number of cases has
tapered,but flu season is not over. There have been several serious Tuberculosis cases and two deaths
over the last few months and the Department of Health and Mason Health have been doing contact
tracing. More resource allocation is needed for communicable disease. Screening is needed to help
identify Tuberculosis cases in the community to avoid it spreading. For Hepatitis C,an individual
needs to be hired to do case management and treatment. Mason Matters shared that 50%of cases in
Mason County are 55 years old and older. The rate of treatment in Mason County is less than
10%even though it is a largely insured population. Assistance is needed to get patients treated.
Most treatments are a pill taken every day for 8 weeks and allows the patient to avoid liver
damage,liver cancer,and death. The Human Papillomavirus(HPV)vaccine recommendation has
been lowered from ages 12+to ages 9+.
Xylazine,a veterinary tranquilizer also known as"Tranq",is linked to an increasing number of
overdose deaths and is being used both intentionally and unintentionally. This drug can cause severe
wounds and even amputation. Xylazine is a sedative that lasts a long time,is addictive, and does not
respond to Narcan.
Broad themes to consider for strategic planning include homelessness,fresh water, and substance use
and treatment. Homelessness—while Public Health cannot provide housing, it can help with the
coordination of service for sanitation assessments for homeless camps. The City of Shelton has taken
lead on the Homelessness Task Force. Fresh water—assessment of water quality in fresh water needs
to be done. Substance use and treatment—the County has limited services to address this problem.
Mason County is in the top 30%of Washington counties for smoking rates. Tuberculosis and
Hepatitis C screening and vaccinations need to be focused on. There is also an emergence of
infectious diseases such as polio,measles,mumps, and rubella due to an uptake against childhood
vaccinations. Unity is needed and there is room for improvement of the coordination of care services
in both health care and social services. COVID put a huge strain on healthcare services. There is also
a lack of value of Public Health. The Public Health department protects the safety of the community,
drinking water, shellfish, air,waterways, sewer,and more. The value needs to be highlighted.
On a positive note,life expectancy has gone from below the State average to being at the State
average and is projected to exceed the State average in the next ten years. The current life expectancy
is 79.6 years.
Peggy VanBuskirk added that children need to be vaccinated and COVID gave a negative view on
vaccinating. The HPV vaccine can prevent cancer. Fresh water is also important.
Keri Davidson shared that the schools have high rates of vaping in the Junior High and High School.
Highlighting the value of public health to the community is important.
Cathy McDowell added that both freshwater and saltwater are important.
Cmmr. Shutty shared the importance of partnership opportunities. The City and County are both
facing homelessness issues,need substance use prevention and response, and need to know how to
best deploy the opioid settlement funds. Staff need to have resources available to them.
7. Administration Report
Dave Windom shared that it is still flu season. There are positions open on the Board of Health for
representatives from the Squaxin Island and Skokomish tribes and for underserved communities. The
American Indian Health Coalition is helping to find members. The Public Health Strategic Plan was
last completed in 2018 and was through 2020. Staff has worked to identify strengths,weaknesses,
opportunities,and threats. The work plan will be done every year and reviewed in December. The
focus is to move away from COVID and more towards preventative care. $104k is set aside for Hep
C. Mason County ranks 5'worst county in the state. Over 25%of constituents work outside of the
County. The healthcare community is not as focused on latent Hep C care. The medical system, staff,
and financial system are stressed. The hope is to coordinate people and physicians interested in
tackling Hep C.
State legislature is in long session and the budget looks good compared to previous years. A lot of
public health work is hinged on Foundational Public Health Services(FPHS)funding. Unfortunately
contracts were not signed until late in the season which limits the use of funds. New funded positions
include a Health Educator and an Epidemiologist. Public Health is partnering with Mason Health and
the YMCA for WIC services and is funded for training and facility prep. The goal is to open around
June or July.
The opioid settlement funds have come in and the County is partnering with the City of Shelton to
decide how best to use those funds. There has been discussion with the CEO of Cascade Pacific
Alliance regarding the State's funds.
Cmmr. Shutty added that this is also an opportunity to look at other opportunities and services such as
childcare.
8. Environmental Health Report
Ian Tracy shared that FPHS funding added an additional food enforcement position and on-site code
enforcement position.
Ian worked with the On-Site Sewage Advisory Committee(OSSAC)regarding the Environmental
Health Building Permit Policy and Environmental Health On-Site Sewage Requirements Based on
Location of Proposal Policy. The original policy was set in the 1990s and revised in 2001. Changes
include requiring treatment level B for existing septic systems. Drain fields such as dry wells or
seepage pits are very harmful to the environment and difficult to detect. Effluent needs to be treated
to a higher standard. There was a change in the law that when you sell your home you must get a
septic inspection instead of just getting your septic pumped.
Peggy/Kathy moved and seconded to approve the updates to the septic regulations. Motion carried.
The County has a county-wide Clean Water District that covers all areas which drain into Hood Canal
or South Sound and is supported by a$5.06 fee applied to all parcels. Funds cover surveillance and
investigations for pollution sources. This is primarily focused on marine shorelines; lakes are fairly
limited due to state regulations. Anna's Bay and Oakland Bay are the focus. Staff walk shorelines to
collect samples and monitor major rivers and creeks. A live web map was created to allow the view
of monitoring results from monthly samples. The Clean Water District meets quarterly.
9. Community Health Report
Melissa Casey highlighted the strategic planning process. Grant cycles are ending and a request for
proposals is moving forward for different programs. Health Educator,Emily Laymen,creates the
reports and infographics and will be working on video. Large strides have been made to get the
Mason County Health Coalition running. The Community Health Assessment has been updated;
however,there are gaps due to COVID. Quantitative data tells half of the story while qualitative data
tells the whole store. Positive social norms are a focus. Funding dollars for this project are focused
on tobacco,vaping,alcohol,and marijuana. Education needs to be increased around fentanyl as well.
Youth voices allow them to target intervention and engage youth as well as increase positive
childhood experiences.
Ben Johnson, Substance Abuse Prevention Coalition Coordinator, added that part of the discussion is
prevention and works Choice,Cedar, and North Mason schools. Students have done a community
neighborhood survey regarding a community norm mapping project. Listening sessions allow time
for a question and answer group on where substances are from,how students are sneaking substances,
what places don't ID,all without identifying specific individuals. Schools are struggling to prevent
vaping. The County provides funding for youth groups for these types of projects and prevention
services.
Nieves Villa,Choice student representative, shared it is crucial to target youth to educate on the
consequences of substances which are often romanticized by social media and advertisements. A
group of students walked around the community where such substances are sold and looked at the
establishments and advertisements. The industry attracts youth and young adults. Substance abuse is
very common and it is important to have conversations and questions around it. Students were able to
point out areas that have issues such as the Huff n Puff trail. It is important to understand how youth
gets ahold of these substances. Social media,music,etc.pressures youth to use substances. The goal
is to promote better decisions. Posters were put up around school and presentations were given in
advisory and homeroom classes. Students know where they can go for help. Nieves is trying to make
this program more bilingual.
Jack Lommel sees a lot of promotion around drugs and cigarettes being adorable or cool. Friends and
parents are providing these substances. Kids need to be taught from a young age about substance
abuse.
Scott Bowen added that social media plays a key role. Posts show individuals with cigarettes and the
viewer thinks that it is cool and wants to try it out. Stores attract youth with cool decorations and
flashing lights and don't always as for an ID. Social norms are classifying this as a normal and cool
thing to do. There are a lot of syringes laying around.
10. Other Business and Board Discussion
Dave shared that him and two staff are going to the Agents of Change Conference to learn how to
better communicate looking at demographics and micrographics.
Ben shared that the Mason County Prevention Summit will be April 14 at the Skokomish Tribe
Community Center.
Cmmr. Shutty encourages setting aside time for substance abuse topics,funding,grants,etc. A bigger
discussion is needed around Narcan and the ability to push it out to the community. Treatment Sales
Tax funds can help purchase additional Narcan kits. There may be broad protections around the Good
Samaritan laws regarding Narcan.
Cmmr. Trask would like to store these kits with AED kits.
Emily Laymen,Health Educator, introduced herself.
11. Public Comment
Constance Ibsen,Co-Chair of Lower Hood Canal Watershed Coalition and member of the On-Site
Sewage Advisory Committee,receives a lot of questions regarding individual septic. Currently,many
questions are centered around the king and continuous high tides and what individuals should do about
their septic systems. Wells along the shoreline have debris in them and individuals do not know what
to do. Constance encourages Environmental Health to make a local video or website and target people
to come to a local meeting. Other questions are regarding funding match amounts,the difference
between state and indirect federal monies,discretionary money amounts from the County,why certain
grants were applied for,what is a priority,what is required by the state or federal government,etc. It
is integral to community health that these topics are discussed.
12. Adjourned at 4:37 p.m.
ATTEST MASON COUNTY,WASHINGTON
BOARD OF HEALTH
MASON COUNTY,WASHINGTON
McKenzie Smith,Clerk of the Board
Darrin Moody,Hospital District#1
Kathy McDowell,City Commissioner
Kevin Shutty,Commissioner
Randy Neatherlin,Commissioner
Sharon Trask,Commissioner
Peggy Van Buskirk,Hospital District#2
Gary Plews,Fire Commissioner
Keri Davidson, Shelton School Board
From the Director I Desk 7AI
March 2023
Where is Spring?
Things have been calming down across the COVID-19 front. A year ago, we had our worst
month during the pandemic. Since the beginning of the year, we've seen a flat rate which may
well become the background rate for COVID going forward. We hear anecdotally that cases are
increasing but the data is showing little change since the end of last year. With the number of
people using take-home tests or not testing at all, the data is not as specific or as accurate as
earlier in the pandemic.
7-Day 14-Day}
53.3
tan 202Z ju 2OZZ Jan 2u23
We are moving to a new focus with the implementation of the 2023-25 Strategic Plan.
Environmental health will always be a focus but solid waste will be getting more attention in
the coming months. We hope to allocate more funds and staffing to working with property
owners to alleviate the hazards to the public and the environment. We'll be focusing on
housing, mental health/substance abuse, and chronic disease. We are in the process of hiring
an epidemiologist to ensure we have accurate data to support the focus areas.
We have renewed a long dormant account with InsightVision to continue to build a system that
accurately measures what we are doing in public health to support decision-making. We want a
solid baseline to reveal areas where we are making progress and highlight those areas that
either need more attention or a different approach.
A
From the Director Is Desk
I will be in Spokane helping to host the NW Rural Health Conference as the chair of the
Washington Rural Health Association which means I will miss our BOH meeting. Jacob Ritter will
also be going along to start building those connections with hospitals, clinics, FQHCs, and EMS
across the state and region. There was funding available from WRHA to support this conference
attendance and we're excited to be able to participate. We also sent three people to the Agents
of Change Conference to learn about the science and technology of behavior change. This
conference has been one of the very best at learning how to communicate with people in all
demographics across a broad variety of mediums. In the future, we will be rotating staff
through this excellent conference.
With the legislature still in session, it's a bit early to be projecting the financial support from
Olympia until the legislature is further along in the process. There haven't been too many
pieces of legislation of great concern to public health this year. We do continue to follow
growth management legislation because it does affect public health in community
development.
Lastly, I sent the current workforce report which highlights the critical state of the public health
workforce. This will be a topic that WSALPHO will be dedicating time and resources to address.
David Windom, MSHS
Director
WflSHinGTon STATE FISSOCIFITIOfl OF LOOK PUBLIC HEHLTH OFFICIHLS
Table of
Contents
Introduction 3
Overview of Local Health Jurisdictions 5
Foundational Public Health Services 7
and System Transformation
Current Challenges and Contexts 9
National Perspective 12
State/Local Perspective 14
Challenges to Building a Local Workforce 16
LHJ Workforce Survey 19
Recruitment Trends 21
Recommendations 23
Current Workforce Efforts 27
References 29
Appendices 30
Survey Raw Data (including salary information) 30
Survey Questions 30
This report provides an overview of what is needed to maintain
our local public health workforce and workforce development needs,
including those that are most critical to local health jurisdictions.
Introduction
The Washington State Association of Local Health Officials
(WSALPHO) is pleased to share its first-ever local health
workforce report. We thank local health jurisdiction leadership
and staff, who contributed and supported this effort during
a time of intense workload, demanding public pressure, and
tumultuous uncertainty. Thank you for prioritizing this effort
and sharing the realities each of your agencies are facing.
We are grateful for your openness and vulnerability. Our
appreciation extends to other public health partners who
have shared data, provided feedback, and have worked with
WSALPHO in addressing this complex and multi-faceted
issue. We are grateful for your partnership and continued
commitment to building and maintaining a robust local public
Ohealth workforce in Washington State.
Capable and
qualified Workforce challenges are not new phenomena in public
professionals health. Long before the COVID-19 pandemic, local health
are needed to jurisdictions (LHJs) faced budget cuts which led to the loss
fully actualize of job positions and staff. Rural counties have struggled to fill
modernization
positions like nurses or sanitarians for years. In many respects,
and innovation
efforts. the infrastructure that is most in need of modernization
and strengthening in public health is not data or technology
but the people behind these tools. Capable and qualified
professionals are needed to fully actualize modernization and
innovation efforts.
This report will provide an overview of the larger bucket
3
Introduction
areas needed to maintain our local public health workforce and workforce
development needs, including those that are most critical to local health
jurisdictions. Recognizing that local health jurisdictions are part of a larger
state and federal public health system, the report will also identify federal,
state, and local strategies and policy recommendations that can support
and enhance local workforce infrastructure.
Our report includes a variety of sources of information. Local health
jurisdictions completed a workforce survey in the Spring of 2022. We're also
using national survey data where Washington LHJs provided input. While
not representative of just Washington State, these surveys reflect many local
experiences among LHJ leadership and staff. Many of the recommendations
in the report have been informed from feedback and discussions with LHJ
leadership, WSALPHO subject matter committees, and WSALPHO partners.
_ •x. * 'G
4
There are 35 local health jurisdictions in
Washington State, serving all 39 counties.
Overview of Local
Health Jurisdictions
Local health jurisdictions are a critical part of Washington's
public health system. LHJs have several statutory duties that
direct them to investigate disease outbreaks, prevent illness
and injury, respond to emerging threats, and control health
hazards. LHJs provide a range of essential public health
services such as: Administering immunizations, implementing
opioid response taskforces, conducting restaurant inspections,
ensuring clean water systems, and connecting people to
healthcare. Each of these programs has a wide-reaching impact
on communities, helping create vibrant and thriving places to
call home.
Washington State's governmental public health system is
LHJs provide decentralized and comprises the Washington Department of
essential Health, Washington State Board of Health, tribes, and local
public health health jurisdictions. In addition to these four parts, many
services, with community-based organizations also work to reach and
wide-reaching support communities and populations in Washington.
impacts on
Washington There are 35 local health jurisdictions in Washington State
communities. that cover the
39 counties. 22 of these LHJs are under
county governance as either a health department or a health
and community services agency. 11 LHJs are districts, 3 of
which are multi-county health districts. Districts are semi-
autonomous to county government and operate outside
5
Local Health Jurisdiction Overview
of county organization and budget. The two largest LHJs in Washington
are combination city-county health departments, representing both the
largest cities (Seattle and Tacoma) as well as the counties (King and Pierce,
respectively).
San °an`t Skagit Okanogan LHJs are primarily funded
Island with local revenue (local tax
Snohomish revenue and fees collected for
Kitsa Seattle-
Spokane services), state appropriations,
King
Grant and state and federal grants.
Adams Tacoma
PierceWhitmanLHJs are governed by a local
Garfield board of health which includes
Yakima
Wahkiakum Asotin membership of local elected
officials, medical professionals,
community members, and tribal
■ County Health & Human Services representatives.
■ County Health Department ■ Multi-County District
Single County District City-County District
SUMMARY - 2020 EXPENDITURES BY FUNDINGSOURCE; ALL LHJS
SOURCE: 2020 LHJ
EXPENDITURE REPORT 0
38.6% 26.3%
■ Local Government
Licenses, Permits, Fees
■ Revenue from State
Federal Revenue
■ Misc/Fund Balance/Other
14.9% — — 19.0%
Source:WA Department of Health, 2020, Local Health Jurisdiction Public Health Expenditure Report
6
FPHS funding has been a historic investment
for local public health.
Foundational Public
Health Services
and System
Transformation
Workforce development is intimately linked to Washington's
effort to rebuild and transform its governmental public
health system through the Foundational Public Health
Services (FPHS). FPHS and modernization began a decade
A 2018 ago in 2010 with an initial call to action titled Agenda for
baseline Change.'The first action plan was published in 2012 and
assessment further refined in 2015 and 2o18, respectively. This action
identified plan outlined recommendations and a plan to ensure that all
$450 M Washingtonians, regardless of where they live, will have access
per biennium to a core set of public health programs and services - the FPHS.
needed to
fill current The system has reached several milestones in the last five
FPHS gaps in years toward fully funding and implementing FPHS. A 2o18
programs and baseline assessment identified $4S0 M per biennium needed
services. to fill current FPHS gaps in programs and services. Since 2017,
FPHS funding has slowly increased over time, with the 2022-
2023 biennium appropriation totaling $175 M. In 2019, the State
Legislature codified FPHS into statute, as well as a funding
decision-making process that requires agreement between state
and local public health agencies as well as tribal consultation.
Foundational Public Health Services and System Transformation
FPHS funding has been a historic investment for local public health. It
has empowered LHJs to bring back positions cut from budget recessions
and add new capacity and programming. There is a system-wide need
to address the workforce needs of incoming staff that are new to public
health, new to Washington's public health system, or filling new roles
within LHJs. However, as much as FPHS has been transformative for LHJs in
strengthening the local workforce, it is one facet of a very complex issue.
4. -
Overall, public health funding has been on the
decline for years and has created an insufficient public
health system at all levels.
Current Challenges
and Contexts
• Ongoing patterns of decreased public health funding
• Funding that is inconsistent, intermittent,
and reactive instead of proactive
• Funding that is categorical
• Increased demands from emerging
threats and emergencies
• Politicization of public health issues
• Post-COVID workforce attrition
Overall, public health funding has been on the decline for
„ years and has created an insufficient public health system
The last three at all levels. Cuts to federal funding are challenging in two
years have ways: Local health jurisdictions experience the trickle-down
highlighted effect where federal and state programs absorb the bulk of the
the increased funding, and funding becomes more and more categorical.
demand for This means locals receive less federal funding over time, and
public health that funding is more rigid in scope. For example, post 9-11,
to be nimble Congress began bioterrorism and public health response
and adaptive funding. Initially, this provided a half-time to a full-time
to emerging
threats and position in local health and additional regional support
emergencies. officers to conduct several activities, including planning
around mass vaccination, extreme weather events, mass
casualty and fatality, and all-hazard response. However, over
time, this funding has eroded to the point where most local
9
Current Challenges and Contexts
departments have funding to cover only a small portion of staff but are
still required to maintain all the federal deliverables. In Washington State,
dedicated state public health funding was cut in 2009 and has remained
stagnant since (apart from FPHS funding). Local funding is also volatile
and subject to economic environments and competing local government
operations.
Fluctuating and categorical funding has had a negative impact on LHJs
over time, forcing a scarcity and jurisdictional-focused mindset. Categorical
funding that "boxes" funding into specific program areas, such as maternal
and child health, HIV case management, or tobacco prevention, often
inhibits an LHJ's ability to make cross-programmatic investments like new
technology or communications staff. It also creates situations where local
needs and priorities identified through community health assessments do
not align with funding requirements, creating challenges in meeting local
needs and having the appropriate resources.
The last three years have highlighted the increased demand for public
health to be nimble and adaptive to emerging threats and emergencies.
Concurrently with the COVID-19 panic, LHJs also responded to three
wildfire seasons, massive flooding and extreme winter events, the
monkeypox pandemic, and an increasing behavioral and mental health
crisis. All of these are above public health's "normal" book of business,
putting further strain on resources and capacity. Often, emergencies and
crises do come with some relief, as evidenced by the influx of COVID-
response funding, but this funding is short-lived and reactionary. LHJs
received support to ramp up staff efforts, but rather than maintain a
proactive readiness, they are experiencing a funding cliff when resources
are divested from the system. Further, public health is emerging as the
convening leader for several social issues, from climate change to evolving
chronic disease trends and eliminating health disparities and inequity.
Public health has a long history of taking on controversial and political
issues, from the early days of tobacco control and the AIDS/HIV epidemic
of the 198os and 9os, to the public outcry over masking and vaccination
10
Current Challenges and Contexts
policies of the pandemic. However, the politicization of public health issues
has become more polarizing in recent years. Opposition to long-standing
public health strategies such as isolation and quarantine or vaccination has
permeated and hindered LHJs ability to work with communities. While this
certainly existed before the COVID-19 pandemic, LHJs experienced this in a
new magnitude through public protests, personal threats, and social media
misinformation and disinformation campaigns. This has created challenges
in working with communities where government involvement might clash
with individual choice or political issues.
Last, we are entering a make-or-break point for the public health workforce.
The stress and high intensity of responding and working through the last
three years have taken their toll on the physical, emotional, and mental well-
being of public health professionals. Many LHJ staff have left their positions,
either by taking early retirements, seeking employment in the private sector,
or pursuing new professional opportunities. These departures exist in all
levels of LHJs, from front-line staff to executive leadership, and from staff
hired within the last five years to long-tenured public health staff. While not
always the single factor for leaving, burnout is certainly a recurring factor
in nearly all departures. Since January 2020, over 6o% of LHJ leadership
(administrators and health officers) have left their positions. While it is
normal to have a couple of local leaders leave each year, this high number is
alarming.
LHJ LEADERSHIP
San Juan
O o Ska t N rtheast VACANCIES &
9' Tri County
Island TURNOVER SINCE
Clallam JANUARY 2020
Seattle
Grays UPDATED: 12/8/22
Harbor
Kittitas Grant
Tacoma Adams
- Pierce Whitman Administrator/Director
Pacific
■ Health Officer
Covert:
Wahkiakum Skaman'a ■ Both Positions
Clark
11
Local public health departments across the United
States have scaled up rapidly in the past three years
as they responded to the COVID-19 pandemic.
National
Perspective
Local public health departments across the United States have
scaled up rapidly in the past three years as they responded
to the COVID-19 pandemic, resulting in new and expanded
responsibilities while maintaining the core programs and
services that keep their communities healthy. The pressures
placed on local public health departments during the
COVID-19 pandemic caused intense stress and strain on a
workforce system that was already experiencing underfunding,
staffing shortages, and an aging workforce. The number of
employees in local public health agencies has declined by more
than 15% in the last decade. Federal, State, and local elected
officials alike have not responded proactively to requests
The public for additional funding to bolster the shrinking workforce
health and stabilize public health infrastructure.z In addition to the
workforce in current shortage of staff and strained infrastructure, it is
the United estimated that the public health workforce in the United States
States will will need to grow by 8o% to provide a minimum set of health
need to grow services to the country, which includes
by 80% to 54,00o additional FTEs
to local health departments.3
provide a
minimum The 2021 Public Health Workforce Interests and Needs
set of health
services the Survey (PH WINS) was conducted between September 2021
country and January 2022 and surveyed over 137,000 state and local
governmental public health workers. Results from this survey
12
Current Challenges and Contexts: National Perspective
indicate that 72% of governmental public health employees participated in
the COVID-19 response in some way which has demonstrated a significant
impact on workforce trends. The COVID-19 pandemic contributed to
increased stress and burnout, as well as post-traumatic stress symptoms.
Nationally, 32% of state and local public health employees said they are
considering leaving their organization in the next year, S% to retire, and
27% for another reason. 44% of state and local public health employees
said they are considering leaving in the next five years. Among those who
said they're considering leaving, 39% said the pandemic has made them
more likely to leave. As well as the pandemic, other reasons for leaving their
organizations included pay, work overload/burnout, lack of opportunities
for advancement, stress, and organizational climate/culture.4
%- .
r �
- s —
!W
' ka
13
In Washington state, the landscape of how local
public health agencies fit into the structure of each
county varies significantly.
State/ Local
Perspective
In Washington state, the landscape of how local public
health agencies fit into the structure of each county varies
significantly. Washington's 35 local health jurisdictions (LHJs)
are structured as follows: A district separate from the county
(11, some districts include multiple counties), a department of
the county government (22), or a city/county department (2)
(see map on page 6).
Each composition of LHJ presents unique challenges and
benefits. For example, districts must cover expenses that are
Training was absorbed by county functions in those LHJs that are county
identified departments, including, but not limited to, HR, IT servers
as an area and support, and fiscal management. Districts can pull
of potential
city funding into their budgets, which is something county
improvement
for the local departments cannot do. County departments are subject
public health to county prioritization and more intense scrutiny but are
workforce typically more financially stable. Multi-district counties also
with 23.7% of navigate competing local government interests but are better
respondents poised to serve mobile populations who move across county
reporting borders regularly for services.
that they do
not feel their In addition to the national PH WINS survey, WSALPHO
training needs
are assessed accessed Washington LHJ data for agencies that participated
in partnership with the University of Washington's Northwest
14
Current Challenges and Contexts: State/Local Perspective
Center for Public Health Practice (NWCPHP). Staff from 16 Washington LHJs
participated in the 2021 PH WINS survey, including 12 that are classified
as small or medium LHJs.S Washington's local public health workforce
is somewhat new to public health practice, with 37.9% of respondents
reporting their tenure in the field as between 0-5 years. 67.1% of respondents
also reported that they have been in their specific public health role less
than 5 years. Training was identified as an area of potential improvement for
the local public health workforce with 23.7% of respondents reporting that
they do not feel their training needs are assessed and 24.3% of respondents
reporting that they do not feel that they have sufficient training to fully
utilize the technology needed for their work.
Compared to the national data, the percentage of respondents who were
considering leaving their position in the next year was slightly higher in
Washington at 33%. The top reasons for considering leaving included;
stress, work overload/burnout, organizational climate and culture, lack of
opportunities for advancement, and pay. For those respondents intending
to stay at their organization, the top reasons for staying included; benefits,
job stability, flexibility (e.g. flex hours, telework), job satisfaction, and pride it
organization and its mission.
. . 5 Reasons . . 5 Reasons
. Organization Staying at Organization
Work overload/burnout 15.9% Benefits 47.1%
Stress 13.2% Job Stability 36.2%
Org. Climate and Culture 12.2% Flexibility (e.g., flex hours/ 35.3%
Lack of Opportunities for 11.1% telework)
Advancement Job Satisfaction 33.4%
Pay 9.6% Pride in Org. and its Mission 33.0%
Additional information related to the Washington-specific PH WINS results
can be found in the Appendix.
15
LHJs cannot compete with state agency salaries and are
often limited in their ability to offer incentives or restructure
salaries to retain staff.
Challenges to
Building a Local
Workforce
Many LHJs are housed in aging facilities that do not have
enough space to accommodate the staff they already have,
resulting in LHJs having to be strategic about what positions
they do recruit for due to limited facility space. County
governments often prioritize programmatic operations
over capital improvements, so investments in improved,
more spacious facilities for LHJs take a long time to achieve.
Safe, modern, and spacious working spaces contribute to
ti recruitment and retention issues. LHJs are also experiencing
The cycle recruitment and retention issues due to the rising costs of
of continual
employee housing in their communities. There are also inconsistent
turnover and limited remote/hybrid workplace policies amongst
makes it LHJs, preventing some LHJs from being able to capitalize
challenging on a broader recruitment pool while others do not have this
for LHJs to opportunity.
advance
their work Another barrier that LHJs report experiencing (especially
and sustain within the past three years) is the trend of employees leaving
capacity and LHJs for state agency employment. During the COVID-19
expertise in
pandemic, many state agencies instituted remote work
their agenc
policies, which increased the ability to recruit employees
from around the state rather than just the Olympia area. LHJs
16
Challenges to Building a Local Workforce
cannot compete with state agency salaries and are often limited in their
ability to offer incentives or restructure salaries to retain staff. There have
been many examples of state agencies hiring staff from LHJs, particularly
in rural communities that already struggle with recruitment. A common
trend LHJs have encountered is that when new graduates without work
experience are hired, they then dedicate resources to train and orient them,
only to have a state agency recruit that individual after a few months of
work. The cycle of continual employee turnover makes it challenging for
LHJs to advance their work and sustain capacity and expertise in their
agencies. While this cycle has always existed, it has become particularly
exacerbated in recent years due to state agencies' remote work policies.
Similarly, there is a long-standing pattern where smaller, more resource-
strapped LHJs hire inexperienced individuals and invest heavily in their
training, only to have them be recruited by more resource-rich LHJs or
system partners after a few years. This is especially relevant on the eastern
side of the state, where LHJs echo the sentiment of feeling like a "training
ground" for LHJs and system partners in western Washington.
This pattern is especially relevant to be aware of now due to the limitations
it imposes on ongoing efforts to build and strengthen the local public
health systems. When resources are spent in a cycle of recruitment, training,
and vacancy, it severely hampers the ability of local health to improve
their capacity and services to keep up with the demands of increasing
populations and emerging public health threats. This includes holding
back the potential of the state's Foundational Public Health Services (FPHS)
efforts, which provide funds to the entire governmental public health
system intended to "both reinforce current governmental public health
system capacity and implement service delivery models allowing for system
16
stabilization and transformation.
Another challenge that LHJs face is limiting the pools of qualified
individuals available for hire through their own restrictive hiring criteria.
Many LHJs are attempting to be more intentional in their hiring practices so
17
Challenges to Building a Local Workforce
that the demographics of their staff represent and reflect the communities
and populations they serve. Urban LHJs are doing great work in analyzing
and evaluating how to recruit and retain staff who represent BIPOC and
LGTBQA+ communities. A number of rural LHJs are focusing on a "grow
our own" framework, building their own workforce and future leadership
by hiring people who want to commit to the agency mission and the
communities they live in, regardless of education. While urban and rural
LHJs are approaching diversifying their workforce in different ways due
to variations in recruitment pools and community demographics, there
are common efforts to improve the diversity of their workforce that are
hindered by standardized hiring practices and strict qualification criteria.
18
WSALPHO surveyed LHJs to collect information including
staffing numbers, salary ranges, pay scale structure,
recruitment practices, and benefits offered.
LHJ Workforce
Survey
• There is a good deal of concern over losing staff
and being unable to adequately replace them.
• Administrators recognize some key reasons they have
a hard time hiring, but frequently are stymied by their
local government's staffing policies or unwillingness
to fund practices that would attract quality staff.
• The positions that have been most difficult to hire
consistently included public health nurses and
Nearly two- staff with management or leadership experience.
thirds of . Most felt that their inability to pay enough compensation
respondents is and will continue to erode their retention.
identified
inadequate In spring and early summer of 2022, WSALPHO conducted a
salary or survey of LHJs to collect information related to employment
compensation numbers, salary ranges, pay scale structure, recruiting
among their practices, and benefits. LHJ administrators received the online
greatest survey and, as appropriate, worked with other department or
concerns county staff to complete it. With 32 of 35 LHJs responding, the
related to staff
retention over response rate was approximately 91.4%.
the next five
When asked about which types of staff positions have been
years.
most difficult to hire, nearly all respondents identified nurses
or public health nurses, and about half identified people with
management and leadership experience. In several follow-up
conversations, administrators emphasized the difficulties their
19
LHJ Workforce Survey
LHJs faced when experienced managers were lost due to the inability to
compete with benefits or salaries offered at other agencies or organizations.
The detriment of leadership turnover was compounded by being unable to
recruit equivalent replacements. Gaps in management create a bloated span
of responsibility, increasing the workload on those individuals who must
take up the slack.
The other most common staff categories that had been difficult to hire
included: Environmental health specialists, administrative support, fiscal/
accounting support, epidemiologists, and mental/behavioral health
professionals.
Nearly two-thirds of respondents identified inadequate salary or
compensation among their greatest concerns related to staff retention
over the next five years. The other top concerns included burnout, the cost
of housing, and anticipated retirement of tenured staff, and the loss of
institutional knowledge.
With data from the survey, WSALPHO produced a salary survey report to
share back to the LHJs. This report included salary ranges, medians, and
averages for nine common role categories for public health staff. Several
administrators found it helpful to compare their pay scales to other LHJs to
help make the case for budgeting competitive salaries.
20
LHJ WORKFORCE
SURVEY
Recruitment
Trends
The prospect of remote work has come to the forefront in
the past couple of years.' Workers and employers have gotten
used to operating in a remote or hybrid capacity. Employers
with policies that allow or encourage this are more desirable
to many job-seekers, particularly new and young professionals.
When asked about whether their agency would continue to
provide mobile or remote work options over the next few
years, nearly half had very limited or no options for remote
work. About a fifth of the respondents indicated they would
continue to have partial or full remote work options, and a
third indicated that "select members" of their staff would
have a partial or full option. Some LHJs and associated county
governments have embraced remote work as a successful cost-
saving practice through COVID-ig. Others are reverting to
traditional on-site, mostly from the direction of their county
leaders, who are uncomfortable with newer, less traditional
approaches.
• Nearly three-quarters of responding LHJs put
the full range of what a person in each role could
make, regardless of the actual amount or range
that a successful candidate would be offered.
• Only five LHJs show the salary ranges a candidate
could realistically expect for their offer.
LHJ Workforce Survey: Recruitment Trends
• Advertising of new position postings mostly happens
on a passive, convenience basis, shared on the agency
or local government websites, with about three-
quarters of responding LHJs also posting to a third-
party website such as Indeed, Linkedln, or Craigslist.
• About half also do some outreach to local affiliates or partners.
• Several rely on county HR to recruit and are not involved.
• Two LHJs reported that they used professional recruiters.
• Those respondents who commented on recruitment
practices cited not having the time, personnel,
or money to do more for recruitment.
4
L .,
r
PP-
1
.ter �� , ■
WSALPHO hopes that they may help establish a case for county
leaders and boards of health to better understand the needs of their
public health workforce and take action to support it.
Recommendations
Recognizing that not all LHJs have control over all the actions identified
here, WSALPHO hopes these recommendations will help establish a case for
county leaders and boards of health to better understand the needs of their
public health workforce, and take action to support it.
NetworkThe National -alth Institutes identifies
these - broad recommendations - the public health
Increase & diversify recruitment
Provide needed training
Improve retention
Create staff reserves to augment the workforce
during public health emergencies
Develop leaders who exemplify Public Health 3.0 principles
WSALPHO's General Recommendations:
Evaluate options for recruiting and carefully analyze the impact
that their current recruiting practices are having on LHJs
Continue FPHS investments and expand FPHS funding to continue
to support the public health workforce, development of pipelines for
staff and careers, and creation of commissions and task forces.
23
Best Practices & Recommendations
Create system-wide strategic workforce development plans that
include hiring practice and salary incentive needs and enhancements.
Share successes like policies, job descriptions, workforce
development plans, etc. through WSALPHO and other forums.
Recruitment & Retention
Develop pipelines for staff and career advancement.
Expand internship and fellowship opportunities
Establish a loan repayment program for public health
staff dedicated to working in the public sector.
Create opportunities for leadership development
(potentially using FPHS funds).
Evaluate staff salary scales to ensure the organization can be
competitive with neighboring counties and like-sized agencies.
Take steps to reduce or eliminate cumbersome,
bureaucratic hiring processes that might unintentionally
be reducing or turning away applicants/candidates.
Increase transparency about actual on-hire salary ranges
on job postings and during the recruitment process.
Establish policies that allow for remote/hybrid work.
• Consult other existing policies for inspiration/proof of concept.
• Educate decision-makers by showing examples,
and demonstrating where cost savings come
in by updating their hiring policies.
Engage more directly in the recruitment process
24
Best Practices & Recommendations
by moving away from passive recruitment.
• Post and advertise positions out-of-state.
• Utilize Washington State Public Health Association's
new tool for sharing public health job opportunities.
• Ensure space in the county or department budget
to accommodate active recruitment.
Develop guidance on career ladders for public health. 9
Provide scholarships and paid internships with
diversity, equity, and inclusion as priorities. 9
Identify the supports needed for the optimal
mental health of public health staff. 9
Training
Develop peer networks and communities of practice (FPHS).
Encourage and provide leadership development (FPHS).
Succession
Prepare plans and taking pro-active steps to be
prepared for staff members' departures.
Encourage work sharing, so there is no single point
of failure in institutional knowledge when one person
who is the only one that knows a job leaves it.
Best Practices & Recommendations
Equity in Workforce
Evaluate hiring practices that may be hindering efforts to recruit a
workforce that is more representative of the community served.10
Engage with local colleges to discuss their public health curricula,
and collaborate to identify opportunities. to demonstrate
what career paths in local public health could look like.10
Develop and leverage partnerships with local
community-based organizations.
Assess organizational culture and make changes as needed to ensure
the workplace is culturally competent and supportive of all staff.10
ra
?6
The local public health system anticipates that workforce
development will be one of the most critical issues for
LHJs in the next ten years.
Current
Workforce Efforts
The local public health system anticipates that workforce
development will be one of the most critical issues for LHJs
in the next ten years. Recognizing this was an emerging issue
Mi&M back in 2021, WSALPHO began identifying opportunities
Y
An additional and target areas of focus, pulling in several state and
effort to private partners into a larger collective effort. This includes
onboard and a coordinated system approach with our partners at the
orient new Washington State Department of Health (DOH), deepening
and incoming connections and relationships with higher and secondary
local board education institutions, and leveraging private partners with
of health
members was other associations such as the Washington State Public Health
implemented Association (WSPHA).
in late summer
of 2022 with Already, there is work underway. A job posting site was
plans to developed in 2021 with DOH and WSPHA to provide a
continue an "one-stop" place for job seekers pursuing government or
annual and community-based public health employment. WSALPHO
virtual training provided input into DOH's CDC Workforce Development
program. grant application, ensuring that local needs would be
prioritized with dedicated workforce funding. Student intern
opportunities are evolving through improved relationships
with higher education programs including the UW School of
Public Health and Washington State University's new public
health program.
27
Current Workforce Efforts
Through FPHS funding, several workforce efforts are also underway,
including; a large-scale system assessment of workforce skill needs and
training gaps, the development of a training curriculum and virtual
platform, and the development of communities of practice to strengthen
peer networks. These efforts aim to address multiple target areas
simultaneously, including employee retention, mentoring and training,
and succession planning and leadership development. An additional effort
to onboard and orient new and incoming local board of health members
was implemented in late summer of 2022 with plans to continue an annual
and virtual training program. These efforts come at a pivotal time for our
system. It indicates large support for building and strengthening the local
workforce from elected officials, state policymakers, our partners, and LHJs
themselves. It is a sign of hope that through partnership, coordination,
and additional resources, LHJs will be able to remain an effective force for
modernization and positive health outcomes for our communities.
28
References
1. Department of Health. (2010). An Agenda for Change. https://doh.wa.gov/sites/
default/files/legacy/Documents/1200/A4C-Agenda.pdf?uid=63cb0e7318dl5
2. Castrucci, B, Valdes Lupi, Monica. (2020). When We Need Them
Most, the Number of Public Health Workers Continues to Decline.
https://debeaumont.org/news/2020/when-we-need-them-most-
the-number-of-public-health-workers-continues-to-decline/
3. De Beaumont Foundation. (2021). Staffing Up: Workforce Levels Needed
to Provide Basic Public Health Service for All Americans. https://phnci.
org/uploads/resource-files/Staffing-Up-Research-Brief.pdf
4. De Beaumont Foundation. (2022). Public Health Workforce Interests and
Needs Survey (WINS) National Summary Report. https://debeaumont.org/wp-
content/uploads/2022/11/National 2021 PH-WINS Summary Report.pdf
5. Northwest Center for Public Health Practice. (2023).
PH WINS - Washington-specific Data Set.
6. Public health system—Foundational public health services—Intent, RCW
43.70.512 (2019). https://app.Ieg.wa.gov/rcw/defauIt.aspx?cite=43.70.512
7. Owl Labs. (2022). The State of Hybrid Work, Remote Work, and
Office Work. https://owllabs.com/state-of-remote-work/2022
8. National Network of Public Health Institutes, Texas Health Institute. (2021).
The Future of Public Health:A Synthesis Report for the Field. htt s:
drive.google.com/file/d/lhkHkzxSHCDZR--XSMraedDMWkZ HtSJ1
9. Lights, Camera, Action: The Future of Public Health National Summit
Series, Summit 1. (2021).Achieving a Diverse and Effective Public Health
Workforce. https://futureofpublichealth.org/wp-content/uploads/2022/02/
LCA-Summit-1 Workforce -Summary-Report 02.07.2022.pdf
10. Armooh, T, et al. (2021) Public Health Forward: Modernizing the U.S.
Public Health System. https://bipartisanpolicy.org/download/?file=/wp-
content/uploads/2021/12/BPC Public-Health-Forward R01 WEB.pdf
29
Appendices
WA PH WINS Additional Information
■ General Demographics
° 836 respondents from 16 LHJs
° 77.4% of respondents identify as female
° 13.5% of respondents identify as Hispanic/Latino
• 21.2% of respondents stated that they
were very dissatisfied (5.6%) or somewhat
dissatisfied (15.6%) with their level of pay.
RespondentsRacial Category With Which - .
White 77.2%
Asian 8.1%
Two or more races 6.0%
Black or African American 5.4%
American Indian or Alaska Native 1.4%
Native Hawaiian or other Pacific Islander 0.5%
Age of Respondents Tenure in Position Tenure in Public
<21 0.2% 0-5 years 67.1% Health Practice
21-30 12.0% 6-10 years 11.8% 0-5 years 37.9%
31-40 25.7% 11-15 years 6.6% 6-10 years 16.1%
41-50 23.1% 16-20 years 4.1% 11-15 years 11.6%
51-60 17.2% 21 or above 7.3% 16-20 years 8.9%
61+ 11.1% 21 or above 19.7%
WSALPHO 2022 Workforce Survey Raw Data
(including salary information):
https://www.dropbox.com/s/nlg64omOz5ew251/Survey%20Raw%20Data.xlsx?dl=0
WSALPHO 2022 Workforce Survey Questions
https://www.dropbox.com/s/31gg9ildexlgaaf/WSALPHO%20Workforce%202022%20
Survey%20Questions.pdf?dl=0
30
Environmental Health Report
For Board of Health March 28, 2023
From Ian Tracy, Environmental Health Manager
Staffing update
We recently filled 3 vacancies on our team. Andrea Tubens and Dave Anderson started on
February 1 st. Andrea's work focuses on Sewage code enforcement and septic maintenance.
Dave is a new Onsite Septic permit specialist with work focusing on Septic Permits, 2 Party Well
permits and EH review of building permits. Randi Ocean has accepted a position in our Food
Program and her start date is May 16th. Randi is coming to us from Larimer County CO where she is
currently a food inspector.
We have shifted funding to allow us to hire a second EHS to work in our Solid Waste code
enforcement program. The position will be posted soon and we hope to fill within the next few
months. This shift was driven by increased need in the County and we have FPHS funding
available to accommodate.
Solid Waste
We are exploring funding mechanisms for County abatement of major solid waste accumulations.
We have several properties where typical code enforcement tools are ineffective. These situations
often involve a property owner who is physically and financially unable to clean-up their property.
Many of these landowners have stated that they would be willing to allow the county to clean-up
the property and then lien the costs.
We also encounter vacant properties with significant solid waste accumulations where the owner
lives out of state and does not communicate or respond to notices. Hearings Examiner
judgements and fines do not result in the property being cleaned up until there is a real estate
transaction or the property is developed which can often take 10-20yrs if not longer.
Water Quality
We will be receiving two grants with billable work expected to begin July 1 st and run for 2yrs. We
have yet to receive the scope of work for either grant but we have a rough idea.
The first grant comes to us through Mason Conservation District which will allow our staff to send
out educational mailers and host public meetings. This outreach work will focus on South Sound
and Oakland Bay.
The second grant comes to us through Peirce County and the South South Partnership to which
Mason County is a member. This funding is focused on Pollution Identification and Correction work
and will likely drive the need to hire a third Water Quality FTE.
Mosquito Surveillance in Washington, 2022
February 2023
zd@doh.wa.gov
Mosquito Trapping and Testing
Each year, mosquito surveillance in Washington State relies heavily on a network of partners, comprised of mosquito
control district agencies, local health jurisdictions, academic partners, volunteers, and tribal, federal, and state
partners; to trap and speciate mosquitoes and perform testing on mosquitoes for agents of human disease, such as
West Nile Virus (WNV). Results of trapping, speciation, and testing, are reported to WA DOH through a variety of
mechanisms. This document summarizes reported data generated by these activities.
In 2022, 18 mosquito control, military, academic, and DOH partners collected adult mosquitoes from 304 trap site
locations in 18 counties, primarily using carbon dioxide traps. Trapping began on Apr 07, 2022, and concluded on
Nov 10, 2022; trapping start and end dates varied among partners conducting surveillance.
A total of 4,179 trapping events occurred, with 720,858 mosquitoes collected, and 235,920 identified as Culex tarsalis
or Cx. pipiens, the WNV vector mosquitoes in WA. Figures 1 and 2 show the species breakdown of mosquitoes
collected in Eastern and Western Washington.
Figure 1.Mosquito Species Reported from Collections in Eastern Washington,2022
Culex tarsalis
Aedes vexans
Culex pipiens
Aedes dorsalis
Anopheles freeborni
Culiseta inornata
Aedes increpitus
Aedes sp.
Other
Coquillettidia perturbans
0 25,000 50 000 15,000
Number of Mosquitoes Collected
* "Other"includes Unknown,Aedes flavescens,Aedes melanimon, Culiseta
incidens,Aedes nigromaculis, Culiseta particeps,Aedes fitchii,Anopheles sp.,
Anopheles punctipennis, Culiseta sp.,Aedes campestris,Aedes cinereus,Aedes
excrucians, Culex territans,Aedes sierrensis, Culiseta impatiens,Anopheles
earlei.
1
Figure 2.Mosquito Species Reported from Collections in Western Washington,2022
Aedes vexans
Aedes sticticus
Culex tarsalis
Culex pipiens
Coquillettidia perturbans
Aedes sp.
Other
Culiseta inornata
Culiseta incidens
Aedes increpitus
0 50 000 1p0,000
Number of Mosquitoes Collected
* "Other"includes Unknown,Aedes aboriginis,Aedes sierrensis,Aedes fitchii,
Culiseta impatiens,Aedes melanimon, Culiseta particeps, Culiseta minnesotae,
Aedes flavescens,Anopheles punctipennis, Culiseta sp., Culiseta morsitans,
Anopheles sp.,Aedes dorsalis, Culex erythrothorax, Culex territans, Wyeomyia
sp.,Anopheles freeborni,Aedes cinereus,Anopheles earlei.
Variation in the abundance of vector mosquitoes collected over the course of the season differed by geography.
Abundance is calculated as the number of mosquitoes collected per trap night for a given period of time. Each night
a trap is set is counted as one trap night. Figures 3 and 4 describe the seasonal abundance patterns for Eastern and
Western Washington, respectively.
2
Figure 3.Vector Abundance in Eastern Washington State by MMWR Week,2022
75- — Culex pipiens
Culex tarsalis
a>
50-
d
25-
20 30 40
MMWR Week
Figure 4.Vector Abundance in Western Washington State by MMWR Week,2022
200-
Culex pipiens
150- — Culex tarsalis
a>
U
100-
Q
50-
0-
20 30 40
MMWR Week
Vector mosquitoes were speciated and separated into pools of 12-50 mosquitoes for WNV testing. Testing was
performed using either the Rapid Analyte Measurement Platform (RAMP) or with polymerase chain reaction (PCR)
3
techniques. RAMP values of 100 are negative, 100-299.9 are indeterminate, and > 300 are positive. Some specimens
tested by PCR were also tested for St. Louis Encephalitis (SLE) or Western Equine Encephalitis (WEE), depending
on the type of PCR used.
Of the 235,920 Cx. tarsalis and Cx. pipiens that were collected, 82,990 were separated into 2,483 pools and tested
for WNV (Table 1). RAMP testing was performed on 1,348 vector pools. PCR testing was performed on 1,135
vector pools. In addition, 349 vector pools were also tested for SLE and 367 were also tested for WEE.
Table 1: Proportion of Culex pipiens and Culex tarsalis Tested for WNV in Washington State, 2022
County Species Total Collected Total Tested Proportion Tested
Benton Culex pipiens 5760 2787 0.48
Culex tarsalis 6626 3553 0.54
Clallam Culex pipiens 0 0 0.00
Culex tarsalis 2 0 0.00
Clark Culex pipiens 22468 11192 0.50
Culex tarsalis 48283 9527 0.20
Cowlitz Culex pipiens 426 0 0.00
Culex tarsalis 96 0 0.00
Franklin Culex pipiens 16159 1398 0.09
Culex tarsalis 18675 2189 0.12
Grant Culex pipiens 18775 8257 0.44
Culex tarsalis 29659 13013 0.44
Kittitas Culex pipiens 29 22 0.76
Culex tarsalis 184 33 0.18
Klickitat Culex pipiens 15 0 0.00
Culex tarsalis 90 34 0.38
Mason Culex pipiens 6 0 0.00
Culex tarsalis 1 0 0.00
Pierce Culex pipiens 1003 959 0.96
Culex tarsalis 174 94 0.54
Skagit Culex pipiens 741 726 0.98
Culex tarsalis 172 146 0.85
Snohomish Culex pipiens 537 483 0.90
Culex tarsalis 215 116 0.54
Spokane Culex pipiens 283 262 0.93
Culex tarsalis 1073 1048 0.98
Thurston Culex pipiens 1 0 0.00
Culex tarsalis 465 87 0.19
Walla Walla Culex pipiens 0 0 0.00
Culex tarsalis 61 0 0.00
Whatcom Culex pipiens 379 306 0.81
Culex tarsalis 51 19 0.37
Yakima Culex pipiens 23446 10191 0.43
Culex tarsalis 40065 16548 0.41
Total Culex pipiens 90028 36583 0.41
Culex tarsalis 145892 46407 0.32
4
Figure 5.Reported Numbers of Mosquitoes Collected
and Proportion Tested for West Nile Virus in Washington State,2022
Numbers of Mosquitoes Collected
Culex pipiens Culex tarsalis
Total Collected
�� Q6
40000
30000
20000
10000
0
Proportions of Collected Mosquitoes Tested for West Nile Virus
Culex pipiens Culex tarsalis
Proportion Tested
0.75
0.50
0.25
0.00
Six mosquito pools tested positive for WNV, with no positive detections for either SLE or WEE. The first positive
WNV detection was collected from Kittitas County on Jun 28, 2022. This finding was actually in a pool of Aedes
vexans that one partner tested for research purposes. Aedes vexans is not considered to be directly involved in the
maintenance of WNV in the bird-mosquito cycle. The remaining positive WNV mosquito pools were samples of Cx.
tarsalis and Cx. pipiens collected on Jul 28, 2022 through Aug 23, 2022. (Figure 6)
5
Figure 6.West Nile Virus Surveillance Sites and Positive Detections in Washington
in 2022,by County
Whatcom
ON
Skagit
Clallam n
Snohomish
Spokane
Mas
Grant
Kitt'
hursto pierce
Frankli
Yakima
Cowlitz nt alla Wal
Klickitat
Clar
Trap sites without WNV detections
WNV positive mosquitoes detected
Trap data not available
6
Mosquito Surveillance by Agency
Mason County Public Health & Human Services performed mosquito surveillance in 2022, with trapping beginning
on Jun 09, 2022, and concluding on Sep 15, 2022.
During this time, the agency set up 15 overnight traps, collecting 197 mosquitoes. Of these, 7 were identified as
Cx. tarsalis or Cx. pipiens. Figure 7 shows the breakdown of mosquito species collected by Mason County Public
Health & Human Services.
Figure 7.Mosquito Species Reported from
Mason County Public Health&Human Services,2022
Unknown
Aedes sp.
Coquillettidia perturbans
Culex pipiens
Culiseta inornata
Aedes flavescens
Anopheles punctipennis
Culiseta incidens
Culex tarsalis
0 30 60 90
Number of Mosquitoes Collected
No testing was conducted due to lack of sufficient numbers of vector species.
7
Acknowledgement
We gratefully acknowledge the following partners for submitting data for inclusion:
Benton County Mosquito Control District
Clallam County Health & Human Services
Clark County Mosquito Control District
Columbia Mosquito Control District
Cowlitz County Mosquito Control District
Franklin County Mosquito Control District
Grant County Mosquito Control District #1
Grant County Mosquito Control District #2
Island County Public Health
Klickitat County Health Department
Dr. Kristzian Magori, Eastern Washington University
Mason County Public Health & Human Services
Skagit County Public Health and Community Services
Snohomish Health District
Spokane Regional Health District
Tacoma-Pierce County Health Department
US Army Preventive Medicine Department, Joint-Base Lewis McChord and Yakima Training Center
Whatcom County Health Department
8
Resources
Links to West Nile virus resources
WNV surveillance maps and statistics for the current season
WNV surveillance sites and activity (VectorSurv)
WNV surveillance maps and statistics, historical
WNV surveillance reports
Additional tools, including a video on how to set up an EVS trap (bottom of page)
and tools for mosquito surveillance partners (links below):
Local Health Resources - WNV
Tools for DOH mosquito surveillance partners:
1. Mosquito Trapping Reporting Form (WORD) to track a trapping event's field, identification, and test data
2. Trap Equipment Checklist (PDF) helps ensure that necessary EVS trap equipment is on hand before leaving to
the field
3. Protocol on Transporting, Packaging, and Shipping Mosquitoes (PDF) provides instructions on how to safely
transport, prepare, pack, and ship mosquitoes to DOH
4. WNV-Positive Mosquito Pool Reporting Form (WORD) for surveillance partners testing mosquitoes to timely
report positive findings to DOH.
9
• MASON COUNTY
Public Health & Human Services
West Nile Virus Monitoring 2022
Lake Linden
Cushman
Salvage
•
Sand Hill
Olympic Ball Field
tional Forest
006
3
106
Eels Hill l
Transfer
Station •
Legend Shelton
Ball Field
She
0
0 County—Boundary 0 Squaxin Island
WNV Active Sample Walker Park eservation
Sites
• WNV Inactive Sample
Sites WA State Parks GI , Esri, HERE,Garmin,SafeGraph, FAO,METI/
101 NASA, GS, Bureau of Land Management, EPA, NPS
0 2.5 5 10 Miles
I l l l l l i i l
N
MASON COUNTY ON-SITE SEWAGE ADVISORY COMMITTEE
BY-LAWS
I. PURPOSE
The On-Site Sewage Advisory Committee (hereafter referred to as the Committee) is
established by the Mason County Health Department and shall work towards the following
objectives:
Provide technical expertise to the Mason County Health Department in the
development of ordinances, policies, procedures and priorities that will protect the
public health and be consistent with state and local regulatory mandates.
Provide perspective for the Mason County Health Department to assure that wherever
possible, on-site sewage programs ordinances, policies, procedures, and priorities are
practical, understandable, functional, and sensitive to the county's economic base.
Provide support to the Mason County Health Department by educating represented
constituencies concerning Committee findings and recommendations.
II. REGULAR MEETINGS
The committee shall meet regularly on a monthly basis, and no less than quarterly, at the
date and time set by the Committee at their first meeting of the year, unless otherwise
notified by the President.The location for each meeting will be arranged by the Mason
County Health Department.
III. RULES OF ORDER
The proceedings of the Committee meetings shall be governed by and conducted according
to the latest edition of Robert's Manual of Parliamentary Rules, except when State Law
takes precedent.
IV. AMENDEMENTS
These By-Laws may be amended by simple majority vote of the Committee members
present at any regular meeting of the Committee, if notice of the proposed amendment is
contained in the agenda of the meeting.
V. QUORUM
Six members of the Committee shall constitute a quorum and shall have authority to
transact Committee business.A quorum shall be established at roll call and shall not be
affected by member departures during the course of a meeting.
VI. MEMBERSHIP
A. Committee Makeup: Committee members will consist of up to 13 persons selected as
follows:
One representative of the Mason County Homebuilders Association
One representative of the Mason County Realtors' Association
One representative of the shellfish industry
Three citizens of Mason County
Three Licensed On-Site Wastewater Designers
One certified Installer
One certified Pumper
One certified Operations and Maintenance Specialist
One representative of the Mason County Health Department
B. Selection of Members:All members shall be appointed by the Mason County Board of
County Commissioners per the Mason County Boards and Commissions Handbook.
C. Terms of Membership: Committee membership shall serve three year terms, although
nothing contained herein shall prohibit the Board from re-appointing Committee
members for more than one (1) consecutive term. Initially, one third of the membership
will have one year terms, and one third of the membership will have two year terms, so
that vacancies will be staggered. Initial designations of terms shall be determined
randomly.
D. Ad Hoc Member: In addition to the membership delineated in Section VI.A. of these by-
laws, a representative from Washington Department of Health On-Site Program will be
considered a non-voting ad-hoc member of the advisory committee.
VII. OFFICERS
A. The officers of the Committee shall include a President and Vice-President.The
President and Vice-President may be removed by a simple majority of the Committee.
B. Elections shall be held at the first regularly scheduled meeting after January 1 each year.
C. The President shall preside over all meetings of the Committee.The Vice-President shall
preside over all meetings at which the President is not in attendance. Should both the
President and Vice-President be absent, an Acting President may be selected by the
member in attendance.
D. The term of office for President and Vice President shall be one(1)year.The President
and Vice-President may not serve more than two(2) consecutive terms.
VIII. AGENDA, MINUTES, CORRESPONDENCE,AND NOTIFICATIONS
A. The President and/or the Mason County Health Department Staff shall determine the
agenda for each meeting and notify each member of the Committee.
B. Minutes, notifications and correspondence shall be the responsibility of the Mason
County Health Department.
C. Minutes shall be written summary of the proceedings and shall be kept by the Mason
County Health Department. Copies shall be transmitted to each member prior to the
next regularly scheduled meeting.A copy shall be filed in the Health Department office
and shall be available to the public as a matter of record.
IX. ORDER OF BUSINESS
A. Call to Order
B. Roll Call and Determination of Quorum
C. Introduction of Guests
D. Approval of Minutes
E. Public Comment Period
F. Committee Business
X. ATTENDANCE
Committee members are required to attend all regularly scheduled meetings. It is the
responsibility of the members to contact the President or the Mason County Health
Department prior to any known absence from a regularly scheduled meeting.Three
unexcused absences may result in the On-Site Sewage Advisory Committee formally
submitting a petition to the appropriate party requesting that the member be removed
from the Committee and a new appointment be made.
XI. PUBLIC MEETINGS AND NOTICES
All meetings of the Committee shall be open to the public.
ADOPTED this 9th of June, 1995.
REVISED on 17th of July, 2019. (Not signed by BOH)
REVISED on 13T" of October, 2020. (Not signed by BOH)
REVISED on 28th of March, 2023.
MASON COUNTY BOARD OF HEALTH
Kevin Shutty, Chair of Mason County Board of Health Date
P UG ET S OU N D r Washington State Department of
� H E A LT H
National Estuary Program
Funding List for Shellfish Beds FFY21-22 Investment Priorities A-C: To Reduce Fecal Pollution to Increase Harvestable Shellfish Acreage in Puget Sound
More information about this Investment Priority is available in the FFY2021-2022 Strategic Initiative Lead Investment Plan. Proposals are funded through the Shellfish Strategic Initiative with EPA
Puget Sound Geographic Funds. The applicant, short description, geography, and recommended funding level for successful proposals are described in Table 1 below.
Applicant Title and Description Geography Implementation Funding
Strategy
King County King County Pollution Identification &Correction Priority Actions for OSS Management and Puget Sound WRIA 9 and 15 Shellfish Beds $455,000
Water Quality Improvements (King County) Partially fund
King County proposes to expand pollution identification and correction(PIC)and onsite sewage system (OSS) with intent to
management in Poverty Bay Shellfish Protection District(SPD)and Vashon Maury Island (VMI),which have high risk of fund in full
fecal pollution impact on Puget Sound water quality and high potential to maintain and upgrade harvestable shellfish contingent on
beds.The primary objectives are to: future funds
• Expand source tracking and pollution identification to high impact areas not yet surveyed in Massey Creek sub- available, up to
basin and areas on VMI.
• Continue freshwater monitoring in Poverty Bay SPD to support long-term water quality management and $910,000
upgrades to harvesting areas.
• Reach new audiences-property owners on sewer and inland Vashon residents, providing financial and technical
assistance for inspections and repairs.
• Strengthen partnerships with community-based organizations(CBOs)that serve disadvantaged communities.
• Improve OSS inspection enforcement and prepare for sea level rise impacts by expanding marine recovery area
(MRA)to all of VMI.
Mason Mason County Partnership for Clean Water WRIA 14, 15, and Shellfish Beds $438,807
Conservation Local partners participating in the Mason County Clean Water District have organized to protect and promote water 16 Fund in full
District quality. Partners include Mason Conservation District, Mason County Environmental Health,and The Squaxin Island (Mason County)
Tribe. Key outcomes of this project are aimed at reducing fecal pollution impacts on shellfish growing areas.Seven of
the eighteen identified 2022 Threatened Shellfish Growing areas exist within Mason County.With 25,365.50 total
shellfish growing acres it is imperative to our local industries and tribal partners to mitigate water quality concerns that
threaten a tribally and culturally significant resource,the local economy including many jobs,and recreational
opportunities that draw people from around the region.The objective of this proposal is to continue to provide
Technical Assistance to cooperators in the affected watersheds,and to continue the education and outreach campaign
through mailers,workshops,and public meetings.
Pierce County South Sound Shellfish Recovery WRIA 13, 14, 15, Shellfish Beds $501,767
Surface Water The South Sound Shellfish Recovery Project is a multi-partner effort to reduce bacterial pollution sources to Shellfish and 16 Partially fund
Management Protection Districts in Mason,Thurston,and Pierce counties. Partners will perform planning,water quality monitoring, (Pierce,Thurston, with intent to
on-site Pollution Identification and Correction(PIC)work,agricultural PIC work,address point sources,and perform and Mason fund further
education and outreach with the intent of upgrading shellfish growing areas acreage in South Puget Sound. Counites) contingent on
future funds
available, up to
$1,185,000
Skagit County Samish& Padilla Bay Pollution Identification &Correction WRIA 1 and 3 Shellfish Beds $587,111
Public Works Skagit County has been reducing pollution in Samish Bay since 2010.All large sources of pollution have been (Skagit County) Fund in full
addressed.We are now working to find and fix smaller and dispersed sources.This proposal supports source ID work
using a combination of lab testing,cheaper and faster Coliscan testing,and water level loggers to use with our existing
equipment to identify illicit discharges.
Skagit County will also collect storm data in the Samish River watershed and in Samish Bay.WDOH needs marine
samples to assist them in reclassifying the bay.Storm data from the watershed tells us where we should focus our
efforts.
Many sources are hard to pinpoint with source ID work,so outreach is a critical part of our work.A root cause analysis
identified several barriers for residents.We will address these barriers by:
• Providing residents temporary solutions while we work on permanent ones.
• Providing cost share for permanent solutions.
• Reducing fear of engaging with regulators by providing opportunities to meet us and learn.
• Normalizing pollution-reducing behaviors so that it's just"what we do".
We will also continue our successful PoopSmart campaign with advertisements that remind residents about the
importance of managing pollution sources.
Skagit County and Skagit and Whatcom County Joint Pet Waste Outreach Project WRIA 1 and 3 Shellfish Beds $99,687
Whatcom County Seasonal closures of shellfish harvest due to fecal bacteria pollution affect Samish Bay, Portage Bay,and Drayton (Whatcom and Fund in full
Harbor.Skagit and Whatcom County have established Pollution Identification and Correction programs which include Skagit Counties)
effective outreach campaigns based on social marketing techniques. Dog waste is a preventable, non-point source of
fecal bacterial pollution that has been identified as a key source of fecal bacterial pollution affecting these areas.Skagit
and Whatcom County are proposing a collaborative regional outreach campaign to decrease the amount of bagged,
and un-bagged,dog waste left behind at parks and trails,as well as yards. This regional campaign will ensure
consistent messaging around proper dog waste management among the recreational and dog-owning community in
northwest Washington.The campaign will:
• Identify behavioral motivations and campaign messages using root cause analysis and social marketing
techniques.
• Host pop-up events at parks and trailheads promoting messages and incentives.
• Provide scooping kits to dog adoption and training centers to promote messages with new owners.
• Partner with trusted messengers to promote key behaviors.
• Reach broader audiences through social media and ads.
Snohomish County Savvy Septic Program WRIA 5 Shellfish Beds $425,000
The Savvy Septic Program in Snohomish County aims to empower residential On-site Sewage System (OSS)owners to (Snohomish Fund in full
engage in a collective Puget Sound water quality solution through outreach,education,and finical aid for OSS County)
maintenance, repair,and replacement.The Stillaguamish watershed is our focus area for this funding,which is a
predominantly low-income, rural community that contains threatened shellfish growing areas,including port Susan and
Skagit Bay South. Key outcomes are to:
1. Increase homeowner knowledge of proper OSS maintenance.
2. Provide financial incentives to help homeowners with OSS maintenance,repairs,and replacement.
3. Reduce the overall impact of failing OSS on water quality and public health,including reducing the potential
health risks for shellfish consumption and reducing the threat to shellfish growing areas in the Stillaguamish
watershed.
Swinomish Indian Swinomish Indian Tribal Community PIC Program WRIA 3 Shellfish Beds $599,815
Tribal Community The Swinomish Department of Environmental Protection (DEP)would develop and implement a Pollution Identification (Swinomish Fund in full
and Correction(PIC) program with the following areas of focus: Reservation,
1. The section of shoreline in the Swinomish Growing Area currently classified as prohibited.The PIC program would Skagit County)
track sources of fecal pollution,support outreach to homeowners, provide financial assistance for inspections or
pumping,and work with Swinomish Utility Authority to initiate ongoing BMPs for homeowners.These actions
would improve water quality so that ultimately the entire section of shoreline would achieve approved status.
2. The unclassified section of shoreline located north of Kukutali Preserve and south of Turner's Bay in the Similk Bay
Growing Area.This area is currently being classified by DOH with Swinomish DEP assistance.There are 2-3 years of
data collection left prior to classification.The PIC program would initiate additional pollution source-tracking and
correction to ensure that this area will achieve approved status.
3. Current locations of active shellfishing and special concern for Tribal Treaty Rights to ensure that fecal pollution
sources are identified and corrected and that they can continue subsistence,ceremonial and commercial harvest
in these areas.
Tulalip Tribes of Shoreline OSS: Education &Assistance for Tulalip Reservation Residents WRIA 7 Shellfish Beds $278,986
Washington Tulalip will focus on five(5)shoreline neighborhoods on the Tulalip Reservation,a part of Puget Sound:Sunny Shores, (Tulalip Fund in full
Spee-Bi-Dah,Tulare,Tulalip Shores and Priest Point.These neighborhoods are adjacent to tidelands and in some cases Reservation,
encroaching on tidelands along the Reservation.A second focus is building Tulalip's Pollution Identification and Snohomish
Correction(PIC) program on the Tulalip Reservation through foundational research and community meetings. County)
Washington State Reducing Manure Impacts to Water and Building Climate Resiliency on Livestock Farms WRIA 1, 3, and 5 Shellfish Beds $750,000
Department of Through trusted partnerships,the WSDA Dairy Nutrient Management program and partners will improve nutrient (Whatcom, Partially fund
Agriculture Dairy management planning,develop adaptive management strategies,and build flood preparedness on livestock farms to Skagit, and with intent to
Nutrient support clean water WSDA proposes a three-yea project focused in north Puget Sound shellfish watersheds.The Snohomish fund in full
Management frequency and intensity of precipitation events in Puget Sound in increasing.The changing climate impacts shellfish Counties) contingent on
Program harvests. Livestock farmers who manage manure must adapt to farming conditions involving shorter periods of intense future funds
precipitation,increased flood frequency,and must plan to be prepared to make real time management decisions
during the rainy season to prevent pollutions.
This project will equip manure managers with long term planning solutions,adaptive management practices, available, up to
preparedness resources and will build off and directly support multi-agency and ongoing efforts to monitor water $1,500,000
quality,educate landowners to produce results in shellfish priority watersheds.
WSDA and its partners will provide inspections,application monitoring, runoff source IS investigations,climate focused
technical assistance,and updates to the design and scope of plans to support manure management.
Washington State Collaborative Strategy to Reduce Pollution in Shellfish Growing Areas WRIA 1, 3, 13, Shellfish Beds $624,330
Department of Ecology proposes to fund three Ecology Water Quality Nonpoint and Shellfish Specialists to work collaboratively with 15, 16,and 18 Partially fund
Ecology Pollution Identification and Correction(PIC) partners in Whatcom,Skagit, Pierce,Thurston, Mason,Jefferson,and (Whatcom,
Clallam counties to address sources of fecal coliform and other pollutants on agricultural lands. Ecology staff will focus Skagit, Pierce,
on non-dairy livestock operations and other sources of pollution,with a goal to protect,restore and upgrade Thurston, Mason,
commercial (including Tribal)shellfish growing areas in these counties. Ecology will implement the following activities Jefferson, and
to identify and correct discharges of runoff polluted with manure-contaminated water: Clallam Counties)
1. Employ social science principles to develop effective education and outreach tools.
2. Conduct watershed assessments to identify high risk to water quality priority areas.
3. Contact and engage landowners and operators to address identified water quality concerns.
4. Provide technical assistance to landowners and operators.
5. Respond to referrals and report environmental concerns from local partners and the general public.
Whatcom County Whatcom County PIC Program WRIA 1 Shellfish Beds $739,497
Public Works Adapt the successful Whatcom County Pollution Identification and Correction(PIC) Program to address fecal bacteria (Whatcom Partially fund
sources during critical environmental conditions and in hot spots still impacting areas with tribal,commercial,or County) with intent to
recreational shellfish harvest closures or declining water quality. fund in full
• Participate in Whatcom Clean Water Program (WCWP)and coordinate field staff and seasonal plans. contingent on
• Coordinate, manage,and map data collected by WCWP partners and community groups. future funds
• Engage community members in long-term water quality protection through social marketing campaigns and
focused messaging based upon root cause analysis and community metrics. available, up to
• Provide community workshops and events with focused messages and tools for addressing bacteria sources. $1,478,994
• Provide technical assistance through farm planners to enhance management practices.
• Provide financial incentives to expand community knowledge,make behavior changes easier to implement,and
engage residents in stewardship pledges and actions.
• Implement a regulatory backstop for violations and discharges that are not controlled through incentive-based
programs.
• Share data and information with transboundary partners to help identify and address fecal bacteria sources.
Total11 111
This work has been funded wholly or in part by the United States Environmental Protection Agency under assistance agreement PC-01189801 to the Washington State Department of Health. The
contents of this document do not necessarily reflect the views and policies of the Environmental Protection Agency, nor does mention of trade names or commercial products constitute
endorsement or recommendation for use.
11
• MASON COUNTY
Public Health&Human Services
. j, ' jk
' •
COMMUNICABLE DISEASE & HOUSING & HOMELESSNESS
NOTIFIABLE CONDITIONS*
290 cases of COVID-19 PQ�
Point-In-Time Count
26 cases of Chlannydia
The Point-in-Time Count event took place in
54 Contact TB tests Mason County on January 27th in both Shelton
and Belfair. Below is the unofficial count results
from collected PIT surveys and HMIS:
*CD rates are suppressed for all nonzero counts which are<10
SUBSTANCE USE Where they #of #of
E1 slept on 1.26.23 households individuals
MOBILE OUTREACH # •
RV/Boat 13 Households 21 individuals
Abandoned 3 Households 8 individuals
30,970 Building
L _ Vehicle 62 Households 106 individuals
ExchangedSyringes
Mi
Outdoors 139 Households 158 individuals
OVERDOSE DATA TO ACTION PF Type of #of #of W
Homelessness Households Individuals
(OD2A) f
� Unsheltered 217 HH 293 individuals
nuusxu�,_
Sheltered 88 HH 184 individuals
-'�-� Successful Overdose
Reversals with Naloxone
477
Note that as of November,we are now collecting all Total 305 HH individuals
overdose reversals that occurred since the last time we
saw that participant. Previously we collected one
overdose reversal per refill engagement,so it is not
accurate to compare this report with previous reports. There was increased outreach to people sleeping in vehicles
• 411 Naloxone Kits distributed and encampments than in the past, accounting for the
• 42 new people trained on overdose increase in the 2023 PIT count.The 2022 PIT Count was a
prevention, recognition, and total of167 HH and 238 Individuals.
response For additional previous results:
• Re-engaged with 54 participants to https://deptofcommerce.app.box.com/s/ek9pu2wO7oz8d77g
give refills g6clrlpxuwcw0515
• MASON COUNTY
Public Health&Human Services
. •
MATERNAL CHILD HEALTH BEHAVIORAL HEALTH &
^ RECOVERY SUPPORT
TRANSPORTATION PROGRAM
MCPH participates in the School Medical Autism This program provides transportation to
Review Team to help diagnose children saving substance use and mental health related
families a 1 1/2-2 year wait for specialty hospitals. medical appointments, inpatient and outpatient
substance use and mental health treatment,
SMART Team of Mason County recovery support meetings, UAs,jail re-entry
c 120 100 services, and other necessary support services
a lm for Mason County residents in substance use and
$° mental health recovery.
u 60 41
4 40 31
20 `2 1 2 1 ': �� a 278 transports by the Patty Wagon (in
°
� 2020ratei 2jD2Lrote1 xoZxTaeal zo23eodale county)
0=amebyYear • 22 transports by Gethsemane Ministry
w Rsfarels ■41esnosed with Autism ■Ui$not matt<r.iaeria (out of county)
RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP)
Mason Health's Peer Navigator has seen a sharp increase of referrals from ED, ICU, and Birthing
Center staff during this reporting period. She also continues to go on outreach in partnership
with MCPH's Behavioral Health Navigator.
The jail SUD RCORP team has seen great successes in getting clients furloughs into treatment,
or providing seamless transitions to treatment upon release. The team works diligently with
clients after they are released into the community during the re-integration period, securing
housing (often recovery housing) and employment for many, and helping break down all
barriers for treatment and recovery support services.
The team worked with 25 unique individuals in January, and 28 in February (including
duplication), but had 85 encounters with those individuals in January and 93 in February.
MASON COUNTY /\
HEALTH COALITION
On March 21st, we hosted the Mason County Health Coalition Kickoff at the Alderbrook Resort &
Spa in Union.This was an incredibly successful event with over 85 participants from a variety of
sectors and disciplines. We are excited to maintain the momentum of enthusiasm from our
kickoff event as we move forward into the next steps.The 2023 Community Health Assessment
will be developed and released by mid-April, and additional Coalition workshops will be
scheduled through the spring to develop our 2023-2025 Community Health Improvement Plan.
HealthMelissa Casey, MPH I Community Manager
COMMUNITY HEALTH
JANUARY - FEBRUARY 2023
MASON COUNTY
PREVENTION SUMMIT
2023
ENTRY FEE: NONE WORKSHOP SCHEDULE
Registration is Required
9:00 AMWelcome Introductions & Blessing
WHEN: ♦ I Shelly Willis&Abe Gardner
♦ O
FRIDAY, APRIL 14 - - 9:30AMWorkshop Mr. Jason Kilmer
♦ Cannabis/Marijuana and Recent Science:
9:OOAM — 3:OOPM ' ,♦ Prevention Opportunities and Lessons Learned
WHERE: 10.40 AMWorkshop 2Megan Moore &Alyssa Pavitt
Using Your Voice for Prevention
Skokomish Tribe 11:30 AMPick-Up Lunch
Community Center
19731 North U.S. Highway 101 11.50 AMWorkshop 3Sarah Ellsworth -ESD 113
Skokomish Nation, WA 98584 Student Assistance within a Multi-Tiered
System of Support Framework
12.50 PMWorkshop 4Alyson Rotter 4 D
REGISTRATION CONTACT: Handle with Care:A Trauma-Informed W
Community Strategy
n (360) 427-9670 x406 1.50 PMWorkshop SChristina Muller-Shi p
0elayman@masoncountywa.gov Fentanyl101 and Local Trends
2:40 PMClosing Statements
. . —. ■. — —. . . . a— — .—. —. . — . . . -.
4 Gr w—OONAL NEgerr�y
o. Illi o �
n �
Sir Z
n s
v
a�JL6 4nFrc A�„o
Behavioral Christina Muller-Shinn
Health Specialist
Health Behavioral Health Response
Systems cmuller-Shinn@masoncountywa.gov
Desk: 360-427-9670 ext. 410
Update Work Cell : 360-463-7949
III loday—
• Brief history to ground us
• Use the 2016-2019 Opioid Response Plan to guide us through our Behavioral Health Systems
Update
• Note: change in language, previously "Opioid/Substance Use Response:' Broadened focus to
encompass all BH in recent years instead of just opioid.
• Review Strategies for each Goal, then share progress and relevant data to each Goal
• End with final thoughts and next steps
Where did we start ? A look back in time . . .
• No OD or SUD related data was collected by County before 2016
• scope of problem unknown
• One of the highest death rates in the state due to opioid overdose
• No harm reduction programming—lots of pushback from community
• Community began mobilizing
• MCPH receives first opioid related grant in 2017—overdose prevention
• Begins acting as backbone to the behavioral health (BH) community response
• Begins tracking SUD related data
• Opioid Summits (Shelton and Belfair)
• Opioid Stakeholder Group
• Opioid OD notifiable condition (2017)
• Developed Opioid Response Plan
• Grant based programming for specific strategies
• Millions of grant dollars into the community for SUD and broad BH across many sectors
• Opioid Response Plan with goals in Prevention, Access to Treatment, Reduce Death, and Data Use
MASON COUNTY OP1 1D RESPONSE PLAN 201 -201
COALS STRATEG I E
. REDUCE 3.1 Increase 3.2 Increase Naloxone 3.3 Consider 3.4 Track non- 3.5 Increase access 3.6 Establish
DEATHS aarenesand access public fatal overdose to harm reduction support groups for
education about distribution (OD) information & families$friends
benefits of program for strategies
Naloxone Naloxone
3.1.1 Outreach to people in 3-2-1 Community Efforts 3.3.1 Mason County Public ?,AA Mason County Health 3.5.1 Increase access to 3,6.1 Facilitate support groups
active use Obtain funding and Naloxone for Health PDO Officer made OD reportable in syrienge servicesfor IDU's for family&friends
-FdD Pro.- distribution
ram Outreach -PDO Program began March 2417 "hr1CPH started the Substance Encourage family&friends
-Path/STR Recovery Supply obtained from E3H0,DOH&UW ADAI Programs distribution in 3/2017-see -MCPH has been tracking Use Mobile Outreach to join together forsupport
VSubstnate Use Mobile Community Training&Distribution 3.2.1 Community Efforts overd oses si nce March 2017 Program in November of 2018 -Encourage Basic CPR
Outreach of Mason Efforts
County -PDO Program Workshops&.Transit table 3.5.2 Consider strategies to deal 3.6.2Provide Naloxone Kits
training and distribution began 32018 with discarded syringes in -Naloxone Rx to any family&
3.1.2 Information& "Distribute Naloxone to locations where drug public Places friends interested-Standing
Education to public about overdoses are taking place -Pub .c campaign about haw orders in Shelton &Deifair
Naloxone "Encourage family,friends how to to safely pickup and dispose Pharmacies
administer
-PDO Program Workshops "Standing Order Naloxone RX at local of syringes- Training in Naloxone use
&Transit Table pharmacies obtained for Neils'and QFC healthymasoncounty.com and SUf-PDD program
-Mason County pharmacies in 92017
Community Forums "Naloxone distribution at Substance Use
-Mason County Mobile Outreach of Mason County
Substance Abuse "OD Prevention workshop and naloxone take
Resource Guide home program at Mason County Jail in
U2018
-Cammunitysupport 3.2.2 Increase number of physicians
groups prescribing Naloxone for patients on
Vhealthmasoncounty.com Opioid R
~MCPH social media "MGH?
ca m pa igns/accou nts/ra d i
0 3.2.3 First Repsonders Partnerships
"Law enforcement,EMT's,DOC Field office,
Court security are all trained and carry
Naloxone
Goal 1 . • Expand SUD prevention efforts in school
• Implement Prevention Coalitions
Prevention • Coordinate, sponsor and host prevention
activities
Strategies
• Decrease opioid supply
• Prescription Drug Takeback Boxes
• Change opioid prescribing practices
• Decreased opioid prescriptions
• Increase PDMP participation
• Long-term Drug Free Communities grant recipient for sustainable
programming
• Participate in state-wide prevention legislation Goal 1
Prevention
• Work on creating protective measures in our communities
progress
• 1 Coalition in 2014 expanded to now include all over the county
• LGBTQ+ Coalition at at Cedar High Expand SUD
• Projects throughout year include: National Kick Butts Day, Mental
Health Month, Suicide Awareness, Rx Take Back Month, assisted in prevention in
listening sessions for Drug Free Communities Grant
schools
• Youth SUD Community Forum in 2022
• Drug education classes, future goals to include more harm reduction in
prevention programming
Goal 1 : Prevention ' Medication Drug Take Back boxes first located at
Sheriff's Office in Shelton, North Mason Regional
progress Fire Authority in Belfair
• Year-round take back program vs. National Take
Decrease op ioid Back Day
supply Y • Expanded through Med-Project pharmacy program
• 13 year-round locations currently (as of
3/2023)
• Working on adding a location with Squaxin
Island Tribe in newly renovated pharmacy
9 Average monthly total of 153.17 lbs.
Goal 1 : Preventionprogress
Change opioid prescri i ng practices
Top line:Mason
Prevalence of prescription opioid 100
prescriptions in population tto n •
(Number of patients per 1,000 with at least one opioid so
prescription submitted into PDMP):
• 2016 Quarter One :
• WA rate : 95.0 per 1,000 40
• Mason rate: 105.0 per 1,000 20
• 2022 Quarter One :
• WA rate : 49.5 per 1,000 2013 2015 2017 2019 2021 2023
Calendar Year-Quarter
• Mason rate: 55.9 per 1,000
Source: Washington Department of Health,
Prescription Monitoring Program.
https://doh.wa.gov/data-statistical-reports/washington-tracking-network-wtn/opioids/county-prescriptions-dashboard
Goal 2 : Access to Treatment
• Reduce recidivism, increase partnerships within criminal justice system
• Increase access to MAT/MOUD
• Increase community capacity for SUD treatment
• Increase community capacity for integrated MH and SUD treatment, increase
peer recovery workforce
Goal 2 : Access to
Treatment * Therapeutic Courts
Re-entry services
progress * Jail Mental Health, Trueblood
Crisis services
Jail MAT re-entry program
Increase 13H * Behavioral Health Navigator
services within ' Law Enforcement Assisted Diversion
Jail SUD team
criminal * Youth CJP programs
justice s stem
y
Behavioral Health Transportation Program March 2022-Feb
2023
• Patty Wagon: 1522 trips (one individual may have more
than one "trip")
• Gethsemane: 157 trips
Goal 2 : Access to 0 Navigator Program March 2021-March 2023
Treatment 0 Approximately 710 contacts *low estimate
progress 0 LEAD 2020-March 2023
Total referrals: 396
Increase 13H 0 Jail MAT Re-entry January 2022-January 2023
services within 0 Total individuals: 20
criminal justice st i ce ' RCORP Jail 7/2021-9/30/2022
J Total individuals: 84 a 854 engagements)
( gg )
syst e m
0 Mason Health SUD Peer
Data coming soon
• Behavioral Health Resource Guide, healthymasoncounty.com
Goal 2 : Access ' Significantly increased access to MAT/MOUD
• All Mason Co. treatment providers accommodate MAT patients
to Treatment
0 Several programs are low barrier, harm reduction based
progress 0 Peer led
• Targeted programs to reduce rural barriers, many are innovative
Increase
0 Program/agency collaboration and network strong
integrated
service
• Crisis network continues to grow, identify cracks and fill them
capacity
• New inpatient E&T facility
OD Awareness Event and Mobile Resource Fairs
Goal 3 : Reduce Death
• Begin OD prevention awareness and education, implement low barrier naloxone access
• "Consider public distribution of naloxone"
• Naloxone distro was one of the first ways MCPH built partnerships
• Track non-fatal overdose
• Increase access to harm reduction and information strategies
• Implement local syringe services for injection drug users
• Establish support groups for families and friends who have lost a loved one
Overdose Prevention Education and Naloxone
Distribution (OPEND) program (data from 2017-
G oa 3 : Reduce 2022)
• 1709 unique individuals trained or engaged
Death p about overdose prevention, response, and how
n I x n to use a o o e
• There were 893 re-fill engagements
• 4,106 naloxone kits distributed within Mason
OD prevention County
• 407 reported successful overdose reversal events
and naloxone • Prior to November2022, only one overdose
event would be captured per re-fill event.
distribution Now we capture all reversals since
participant last saw us.
Goal3 : Reduce eatD h
-N n Ioverdose
o ata data
Non-fatal Opioid Involved Overdoses Through Emergency Systems
244
200
150
26 40
55 63 60
M M 0 0 0
2018 2019 2020 2021 2022 5-year Total
Note: Took several years for reporting system to work well (don't compare early years to later years). Still a work in progress to get all systems reporting regularly.
Substance Use Mobile Outreach of Mason County, 11/8/2018-12/31/2022
"Unduplicated" participants: 592 (with some duplications, though)
1,689 encounters
GoallReduce Average number of people participants are exchanging for: 3.77 (range 1- 100)
Death progress 238 encounters had experienced or knew someone who had experienced an OD in
the past 30 days
114 (19.26%) unique participants received behavioral health referrals
Increase harm Grant goal of 20%
109 (18.41%) unique participants received recovery support referrals
reduction strategies Grant goal of 10%
# Syringes exchanged: 953,692
670 encounters received naloxone
55% request fentanyl test strips (started January 2020)
70% requested wound care supplies
Goal 3 : Reduce Death progress
• Establish support groups for families and friends who have lost a loved one
• Have not done this—anyone interested in spearheading this?
• Encourage use of the Prescription Drug
Monitoring Program
Goal 4 .
• Implement opioid overdose data surveillance
Data • Make opioid overdose notifiable condition
• Collect data around substance use (see: COSSAP
Use Report, ADAI)
• Provide annual status report to community
Goal 4 : Data Use progress
PDMP, data to stakeholders
• MCPH no longer focusing on increasing PDMP usage
• Medical providers: how common is PDMP usage at your agency?
• MCPH provides data regularly to stakeholders
• Note: would be helpful to see non-MCPH program data to assess how the
system is working as a whole
Goal 4 : Using Data progress
Opioid OD Surveillance
Fatal Opioid Involved Overdoses
90 01O�1
80
70
60
50
'° 31
3° 15 21
20 12
0
2018 2019 2020 2021 2022 5-year Total
*pending * pending
Goal 4 : Using Data progress
Opioid OD Surveillance
2022 All Drug Overdose Data
45 40
40
35 31 28
30
25
20
15
10
5
0
2022 All drug overdose 2022 Opioid involved 2022 Fentanyl involved
deaths overdose deaths overdose deaths
"No Wrong Door Approach to Tackluig the
Goal 4 : Using Data
Opioid Crisis in Mason County
CunTrehenmw Collect data around substance
Discharged and rclvmed a[ Mason County Public Health{MCPH}identified a twofold problem
least once{Jr1y 2M-June Facing the community:
2021� i Need to understand the scope of epidemic in Mason County—what
Msucce ^ is the numberof individuals impacted,what are the types of
0t substances contrasting to the thigh overdose robes? /1
2 How are the Mason County Behavioral Health Services System C
stakeholders coordinating their efforts to tackle the epidemic—what
does the network of service and treatment providers look like?
COWAP Findirg9
•2104 unduplicated individuals interacted with community
stakeholders who are tackling the opiate epidemic;from July 2618 to
R..o. nnw.M June 2021�
•On average participants were referred to 1.3 recovery support provide—coordination is essential,agencies must work together to
r: provide the needed support C O A P C O S S A P Final Research Report
•Only 252%of participants are effectively referred to recovery
support services
��";!'. `"�1t •Multiple substa nce use is prevalent—in add ition to opicids,
participants report using alcohol,marijuana,heroin,meth;often Mason County Public Health (M C P H) identified a two-fold problem
simultaneously
t) C' •Challenges such as COVI D-19,turn over,and limited agency resources facing the community:
- fords stakeholders to prioritlue established relationships,as result
the network tightens,and community responses bemme'smaller"
Die...d.n W—rk •4796 individuals in our dataset;987 our of 2104}seek help but might
be finding the network unresponsive In their needs 1. Need to understand the scope of epidemic in Mason County —
Nex
ps
•Better coordination between agencies is necessary:agencies know
who has
re
who has resources,discussion networks are smaller and more what is the number of individuals impacted, what are the types of
conrerrlsaaoralsac substances contributing to the high overdose rates?
Ci •gefentfororJy]2X of discharges
•There is a need for sustained and improved data collection
•Supportfor agencies doing the work will improve the data that
informs polirydedsions 2. How are the Mason County Behavioral Health Services System
stakeholders coordinating their efforts to tackle the epidemic —
LachexarG.Anguelov,PhD—LGAConsultingLLC what does the network of service and treatment providers look like?
***A big THANKS to all partners who took
on the significant burden of detailed data
collection!***
COAP/COSSAP Final Research Report
• 2104 unduplicated individuals interacted with community stakeholders
who are tackling the opioid epidemic (from July 2018 to June 2021)
Goal 4 :
• On average participants were referred to 1.3 recovery support services —
coordination is essential, agencies must work together to provide the
Data needed support
• Only 25.2% of participants are effectively referred to recovery support
services
Collect • Multiple substance use is prevalent — in addition to opioids, participants
report using alcohol, marijuana, heroin, meth; often simultaneously
around
• Challenges such as COVID-19, turn over, and limited agency resources
forces stakeholders to prioritize established relationships, as a result the
substance use network tightens, and community responses become "smaller"
• 47% individuals in our dataset (987 out of 2104) seek help but might be
finding the network unresponsive to their needs
Goal 4 : UsingData
Collect data
use
• UW ADAI and MCPH naloxone program findings 5/2017-9/2021
Race Counts and % Gender Counts and % Housing Status
11,2ro o Number
9,1%
112,18%
99,17%
129,21%
16,3%
278 47%
�9,1% 310,52%
468,75%
374,62%
■ ■ ■
■American Indian/Alaska Native Female Male Transgender ■ Homeless Permanent ■Temp/Unst
■ Black/African American
■ Native Hawaiian/Pacific Islander
■White
■Asian
■Other
Goal 4 : UsingData
Collect
use
• UW ADAI and MCPH naloxone program findings 5/2017-9/2021
Number of Overdoses Experienced in Past 12 Was Naloxone Used in an Overdose? Where Did Overdose Occur?
Months
22,10% 20, 10%
16,9% 4,2%
12,7%
216,37%
21,12% k1k, 1
363,63% 14b
125,72%
164,78%
■ Don't know ■ Inside: Hotel/motel
■0 1 ■2 ■3+ ■Yes No Inside: Private Residence ■Outside(park,street,car,camp)
Goal 4 : Using Data
Collect data around substance use
UW ADAI and MCPH naloxone program findings 5/2017-9/2021
Substance Used Past 30 Days
Alcohol 64
Benzos / downers 40
Rx pain medication 48
Methadone / buprenorphine 65
Heroin by itself 152
Meth & Heroin together 121
Meth by itself 132
Cocaine & heroin together 18
Crack cocaine by itself 14
Powder cocaine by itself 22
0 20 40 60 80 100 120 140 160
Results from the 2021 WA State Syringe 00 ADAI
Service Program Health Survey
Susan XMgmn Aiken Newmon,01PF1;[eleb8aneo--Gmn,PhD,MPM,INSW,Sere Ghek,PhD,MPH
Key Findings
agm / #f 1 1 f 1 1 1 1 • 1n September-C AW 2I121,955 parbn mats W Washing0. 5tatrsyrirye aervicepr grams earroeled a
survey dl health Ire&i:. %and health t—needs.
• Mmereepdnd—hadosed oxthampheurrineby itsdhihan heroin hy-49{d69e veri.rs OM drncat half
Goal 4 : Data Use
le894 had used bnhdtaed tegatner(Ath'gdd&All'}Gd FbAll w rhlthird Moir oewrmrn•msr;drv;:2 H?:
eher Herein[479Q and rrrtHiarrphereminr i2g961.
}larl _ Q7 three quarter{T99b}af eesppntlene rapertnd using more Han one wbaanee n the paseweek
Strategic Response uldtanee uae rr& [ high anron rhxe,,h ae maindr as an t fm
�M P���r �§ § �9 w 4� naa.
progress
AJMtmt MIF4R96]reported using tentarryl in the pace theeernor<w thkds 01 rhese respendeln said they
had IssL toed fmvrvl'ems wrpae'fdost open 1ha14r1eerryl xas tt pill form lFae rerrreirlirq third repdrKd thr
feeuanyi they useQ wirmed4onalhf,u-�m6sL otter rriaed krwiar anodser dvg.
-MMi,whb had used KaMfti M the ya it th/ m ffd s ee rYalre likely E have had A i 6pitid M rddie ie e.•r
pea 12 r Mha then sae w11e had adr uMd kmeayd a?%A 2M p,0,95y.
1tatei of drug smoking watt higtL Abau three in lour respondents%#M had ir4mud any drug in the peat RM-
-wha a1a6 reported smoking a drug in the same period.hates of drug irrjcarg and irmkitg varied widely
Md�ry�" Collect data
u+,•qal.a.za,e Freud ap tea«/aaaeLb.�4 I
Zane
t.KAren LOOS.Colton M3Trs.Qt1mrMegLer around
A Ow zlLA a.d k L r substance use
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Evans StbDDI DfFublle Mky imd Gwrernam 2-P toe.1.1,Srd.Lk.,—ddva�av 0
2 SM.W.lder kaerarr.rChLefBeimBakken 10
Ztl lm.f LErrr-Lu, 10
'aljk rh Mrt]hodc5lrrrwry. 1L
tMason.F t e
O7pMr-nr6k MA1*W ar3.JMronnwsM Cssrh 4wdW
37ram--t--k— 12
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.tL2 S7rfQ1- 17
1mr ru*Y.hVra tmvR Na rib I'm raLSrr 2L
L1mriIWr1 L*A,EiWMAL 2A
itmrslud.tl•I.nr4 upre r2 rawwwrq•Cer12�n.ek�prtt'� 21
Update Opioid Response Plan
• Workgroup coming soon
Focus on sustainability
Expand MOUD services and access
o Mving
No methadone
• Jail MAT services improvement
forwa rd . . Adolescent SUD services
Still difficult to engage with most rural pockets of community
• Still difficult to access the most tucked away
Also: Get involved with state work! Work groups guide priorities for the
state and in turn funding. Big gaps still exist. Need rural voice! Attach
SOORP leads sheet. Use Treatment Youth as an example.
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