HomeMy WebLinkAbout2024/09/17 - BOH Special Packet MASON COUNTY
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MASON COUNTY BOARD OF HEALTH Special Meeting
September 17,2024
10:00 A.M.
Commission Chambers
HEALTH411 North 5'Street
® Shelton,WA 98584
Meeting ID: 857 5928 6231
Passcode: 332166
DRAFT AGENDA
1. Welcome and Introductions Chair
2. Approval of Agenda—ACTION Board Members
3. Program Expansion for Substance Use Mobile Outreach Christina Muller-Shinn
4. Other Business and Board Discussion Board Members
5. Public Comments
6. Adjourn
If special accommodations are needed,please contact McKenzie Smith at(360)427-9670 ext.589 or
insmithAmasoncountywa.gov
Mason County Public Health
415 N 6't'Street,Bldg. 8,Shelton WA 98584,
Phone(360)427-9670 ext.400 Fax(360)427-7787
MASON COUNTY
Public Health & Human Services
Substance Use Mobile Outreach of Mason County
Home Service Program Expansion Proposal
Proposal:
Incorporate home service as part of the Substance Use Mobile Outreach model to
increase alignment with Mason County Public Health and Human Services (MCPHHS) policy of
striving to make programs and services accessible to all Mason County residents by meeting
them where they are.
As part of Mason County's commitment to combat simultaneous epidemics of
overdose, bacterial and soft tissue infections, sexually transmitted diseases, HIV, and viral
hepatitis by adopting a syndemic approach, MCPHHS proposes to incorporate a home service
model to expand current Substance Use Mobile Outreach activities to improve health
outcomes of some of the most marginalized members of our rural community. This is an
integral part of the clinical service expansion funded by the WA Department of Health
Syndemic grant, which seeks to reduce barriers to accessing lifesaving services.
Since 2017, MCPHHS has offered harm reduction home services for overdose
prevention education, naloxone distribution, wound care supplies, and linkages to care; this
proposed expansion would allow a broader scope of services and increased access to
wraparound services.
Home service will involve Mobile Outreach staff making appointments with
participants one day a week and delivering service interventions at the participants' locations
via a county vehicle.
Services offered will be the same as existing Mobile Outreach
programming, with the addition of clinical services, which are currently in the
planning stage. Staff will provide harm reduction, naloxone, hygiene, and wound
care supplies; STI/HIV/Hepatitis C screening and linkages to follow-up care; and
referrals and/or warm handoffs to prevention, substance use disorder or mental
health treatment, medical, and broad social and recovery support services. Once
MCPHHS's full syndemic clinical program is implemented, additional services may
be added under the clinical supervision of Mason County's Health Officer.
MASON COUNTY
Public Health & Human Services
WHY?
Many parts of Mason County are very rural, which presents significant barriers to care
for individuals with limited transportation or mobility challenges.
Expanding the program to include home service would allow us to reach individuals
who have been categorically more medically vulnerable, at higher risk of overdose, and may
have the least connection and access to treatment and social services.
These same individuals would likely benefit the most from MCPHHS's clinical services,
and by increasing engagement with them, we can facilitate direct linkages to those services.
In expanding the program to include home service, MCPHHS would follow the lead of
other agencies and programs that have found this to be a very effective model for mitigating
the challenges of mobility and the challenges of people experiencing behavioral health
challenges, especially in rural areas. Several Mason County behavioral health programs utilize
home visits as a standard component of their programs, as do neighboring county harm
reduction programs.
MCPHHS will partner with other established community programs with similar service
models and a complimentary scope of services to reduce unnecessary duplication and
increase seamless linkages to care.
Of 43 surveyed participants, 79% said the people they know who would like to utilize
harm reduction services had difficulty getting to Mobile Outreach sites as they currently are;
all cited transportation and/or mobility issues as the reason. It should be noted that of the
participants who regularly engage in services, over half also reported having difficulty getting
to sites, with lack of transportation being the reason.
WHO?
Participants will be primarily individuals with transportation and mobility
barriers who use drugs, experience complex health challenges, and are
chronically underserved. This is likely to serve elderly and isolated individuals
more reliably than other models; additionally, this form of engagement will
address participants' concerns about the visibility and stigma of accessing
services in our small communities.
MASON COUNTY
Public Health & Human Services
The following are testimonials from current participants about current barriers to
attaining services and how expanding to include home service would improve the program's
accessibility:
"I have a problem getting out sometimes. Public transit is hard with my mobility issues."
"Rides, people don't have rides."
"That would be awesome. You would have tons more people."
"Home visits would be really good. Buses are so periodic. It's hard to get back if you miss one,
then you're stuck for hours."
"There's people in their 60S who can't come because they can't get up & go."
"If you guys did home service that would make all the difference in the world."
"That'd be really cool for the people who don't have a car."
HOW?
The funding comes from the WA DOH Syndemic grant, which is expected to last five
years and fund operations for the Substance Use Mobile Outreach of Mason County and the
clinical service expansion.
MCPHHS will pilot the program using a phased approach. Initially, it will expand home
service by operating one day a week. Depending on the program's success, this may be scaled
up. MCPHHS will leverage existing partnerships if needed to increase capacity.
MCPHHS staff will adhere to Community Health's Field and Home Service Policies and
Procedures, as well as the additional Home Service Policies and Procedures that
detail additional safety training requirements and precautions. The Home Service
Policies and Procedures have been reviewed and approved by Mason County Risk
Management and Deputy Prosecutor Tim Whitehead.
MASON COUNTY Revised 3/1 /24
Disseminated 3/19/24
Public Health&Human Services
POLICIES & PROCEDURES
Community Health Field & Home Services
POLICY: Mason County Public Health & Human Services strives to make programs and services
accessible to all Mason County residents by meeting them where they are; it is a department priority to
protect the safety of staff delivering services at locations outside of the organization setting, including
public settings, home visits, and street-level outreach.
PROCEDURES:
I. Before Field or Home Service
A. Staff complete all relevant safety trainings and/or certifications required by their
programs, contracts, and/or grants and provide documentation to Community Health
Manager for retention in personnel file.
B. All services delivered outside of the organization settings at Mason County Public Health
& Human Services (415 N 6th St, Shelton,WA 98584) or Mason County WIC(3101 N
Shelton Springs Rd, Shelton WA 98584) are scheduled in advance and documented.
C. The safety of any plan to provide service to an individual in the community is carefully
assessed before scheduling the planned service.The number of staff and other
resources needed to facilitate safety should be considered, including but not limited to:
a) The extent to which staff members are familiar with the individual, the individual's
environment, and other people likely be present in that environment.
b) The extent to which staff members are aware of the individual, environmental, or
other risk factors that might contribute to unpredictability.
c) The time of day, season, and so forth during which services are provided.
d) The nature of the service to be provided and the individual's likely response to the
service or task to be accomplished.
D. Ensure proper documentation of the day's schedule and locations/addresses:
a) Outlook Calendar
b) Department In/Out Board
II. During Field or Home Service
A. Staff will travel to the destination in a Community Health or Mason County Motorpool
Vehicle unless pre-authorization to use a personal vehicle is obtained by the Community
Health Manager or designated back-up.
B. Staff will bring their Mason County Identification Badge, business cards, and County-
provided cellular phone. Public Health & Human Services-branded garments should also
be worn as appropriate.
C. Staff will mark their status as Out on the department In/Out Board, indicate Return
Time, and document their location when working outside the office setting in the Notes.
D. If staff are delayed from returning to the office by the expected Return Time:
MASON COUNTY Revised 3/1 /24
Disseminated 3/19/24
Public Health&Human Services
POLICIES & PROCEDURES
Community Health Field & Home Services
a) During business hours 8:00 am—4:30 pm: Call Mason County Public Health &
Human Services front desk Ext 400 to notify clerical staff and have the In/Out
Board updated to reflect accurate Return Time and Notes.
b) After hours: Call or text Community Health Manager or designated back-up.
c) All incidents that trigger safety concerns and/or require intervention by law
enforcement, Emergency Medical Services, Crisis, Co-Responders,the Designated
Crisis Responder(DCR), and so forth must be reported immediately to the
Community Health Manager or designated back-up so that the incident can be
properly documented and reported to the Human Resources Department.
III. Emergency Procedures
A. Inlury and Illness Incident Report
a) This form must be completed by every Mason County employee who experiences
an occupational accident or illness, whether or not injuries were sustained.The
purpose of this form is to ensure immediate documentation and communication
of an accident/incident to the department, Human Resources, Risk Manager, and
others involved in general safety and health standards.This form must be
completed within 24 hours of the accident and submitted to the supervisor, copy
should be forwarded to the Human Resources Department. Human Resources
must receive the completed report within seven calendar days from the date of
accident/incident to comply with new OSHA regulations and documentation
requirements.
B. Incident Reporting Form
a) This form is used to report damage to county property OR damage to a non-
employee's property sustained on county property or at a county work site OR
injury sustained by a non-employee on county property or at county work site OR
workplace violence incidents.
Policy Procedure
The term "home service"
encompasses any home or location 1. From here on,the term "home service" includes all programming and
served during this Mobile Outreach of locations served for this program component, even if the location is an
Mason County pilot programming agreed-upon public location and not an actual home.
component.
1. Staff will utilize a Mason County vehicle for all home service activities.
2. A travel first aid kit will be kept in the vehicle.This kit includes
Mobile Outreach home service will adhesive strips, gauze pads, a large wound pad,triangular bandages,
utilize a Mason County vehicle. adhesive tape, exam gloves, eye wash, eye pads, antiseptic wipes, first
aid and burn cream packets, triple antibiotic ointment packets,
scissors,forceps, and first aid instructions.
1. Two staff are required for all home/location service visits.
2. Staff may consist of two MCPHHS employees, or one MCPHHS
employee and one employee from a partnering agency that has an
Inter-Local Agreement or Memorandum of Understanding detailing
home service partnership and has adequate liability coverage (see
below policy, "Adequate coverage will be maintained to cover
Staffing minimums are two MCPHHS and all partnering agencies" below).
individuals.
3. If two trained staff members are not available, home service will be
canceled for the day.
4. An Inter-Local Agreement and/or Memorandum of Understanding will
be produced that details the personnel of partnering agencies riding in
a county vehicle,the scope of services, and the appropriate coverage
for a certificate of insurance.
1. MCPHHS is adequately covered via county-wide risk pool insurance.
Adequate coverage will be 2. MCPHHS will be adequately covered to provide all clinical services
maintained to cover MCPHHS and all offered in the home service program: HIV/viral hepatitis/STI antibody
partnering agencies to cover
testing(scope of clinical services TBD based on implementation of
programmatic activities for liability syndemic clinical services program, health officer approval, and
reasons.
provider's level of experience/comfortability).
3. All partnering agencies will carry their own liability, professional
liability,vehicle, and workers compensation.
Updated 9/9/2024
1. The required training must be completed annually by all staff
participating in the home service program.The required training is
listed below.
2. MCPHHS management will ensure adequate training records and
compliance annually; will forward to Human Resources for retention
in employee's personnel file in MUNIS.
3. The following trainings will be taken by all Substance Use Mobile
Outreach staff annually:
• Situational Awareness
Staff will attain additional safety • De-escalation
training to reduce adverse or . Marty Smith training—modules include:
dangerous situations annually.
o Creating a Culture of Safety
o Centering
o Personal Safety Techniques
o Show of Strength Techniques
o Dealing with the Aftermath
o Safety During Outreaches
o Working in Emergency Rooms
o Working in Correctional Settings
o Keeping the Inpatient Unit Safe
o A Safe Office Space
1. The Syndemic Home Services folder in the Public Health secured
network will contain a document logging participants or locations
deemed unsafe,which will be password-protected.
2. If a staff member identifies suspicious or potentially dangerous
behavior and/or environment, and a safe environment cannot be
ensured to the best of staff's ability, services will be ended, and staff
Substance Use Mobile Outreach staff will leave immediately.
will utilize all training and experience
to avoid potentially violent situations. 3. If a staff or volunteer feels threatened, they will immediately call 911
for assistance.
4. If a location is deemed unsafe, staff will no longer visit it and will log
the location. Participants must meet staff at an agreed-upon public
location for future services.
5. If a participant is deemed unsafe, staff will no longer make
appointments with said participant, and the person and contact
information will be logged.
Updated 9/9/2024
1. Participants will call the day of home service between 8:30 and 11:30
am to schedule a home service visit via staff phone and detail what
supplies and (possibly clinical services) referrals/connections to
resources they need. Intake questions will be asked at this time.
2. The "unsafe participant or location" document will be kept open while
the staff takes appointments. Staff will cross-reference that list for
every appointment made.
3. Staff will determine the route based on location and number of
participants.
4. As a safety measure, staff will enter the route, addresses, contact
Mobile Outreach home services will information, and anticipated arrival time in red on a secured MCPHHS
conduct services using the domain (Outlook Calendar).
procedures as follows. 5. Staff will then assemble harm reduction and clinical supplies and
appropriate referral/connection to resources for each participant.
6. Staff will keep a live GPS tracker(with an emergency alert/panic
button) on a person or in the vehicle as an additional safety measure.
**see following Policy, in progress**
7. Staff will leave for the home service route and change each stop's
color or status upon completion on the secured domain to allow
management to monitor safety.
8. Staff will call the next scheduled participant to give them an ETA when
leaving an appointment.
1. GPS tracking information will only be accessible to MCPHHS director
and management to ensure the County is protecting personal health
information/HIPAA compliant.
2. **Confirm that GPS records are not disclosable under the Public
Record Act.
3. GPS equipment will not be used to observe and/or monitor employee
a
performance for performance management or to be accessed as
GPS tracking this Policy is still being documentation in the employee evaluation process. The County's
MCPHHS
opped and researched by designated personnel may review data from the GPS equipment
MCPHHS and Risk Management** concerning investigations from reported incidents, employee
misconduct or security violations or incidents.Any discipline that may
be imposed against the employee because of the misconduct
investigation shall be in accordance with the applicable provisions of
the Collective Bargaining Agreement. Should an incident involving
employee misconduct be observed during the review of GPS data,
discipline resulting from the incident shall be consistent with any
applicable provisions of the Collective Bargaining Agreement.
Updated 9/9/2024
4. The reception equipment will be securely located within the premises,
under the absolute control of the IT Department and Department Head
or designee. No other staff will be permitted access to the GPS data
without authorization in writing by the Department Head or designee.
The recorded data is subject to all applicable statutes under the Public
Records Act.
Updated 9/9/2024
SUBSTANCE USE
MOBILE OUTREACH
PW-
FIVE YEAR REPORT
11/2018-12/2023
L PARTICIPANT BREAKDOWN
• 749 Unique individuals served InmTnt ~
• 2236 Engagements ,;.�-+ ►
Each participant was exchanging for an average of 3.7 people
• 8% of engagements did not receive syringes. Of these, 57% '
received naloxone p
• Total syringes exchanged: 1,113,824
• 19% of individuals received a Behavioral Health referral
21% of individuals received a Recovery Support referral (mostly F `-
medical and dental) �a
.GI
DEMOGRAPHICS
• Age
• >10% 18-25
• 29% 26-35
32% 36-45
• 23% 46-55 >
• 12% 56-65 �+ _
• >10% 66+
Race f,
72% White
,
• 23% American Indian/Alaskan Native
• > 10% each Asian/Pacific Islander, African American, and Q�d
Hispanic/Latino �o= % •
Gender AT
• 47% Female ?y�
• • 53% Male ,
A •
SITE USAGE
• 20% Belfair
24% Skokomish
• 55% Kamilche
RISK FACTORS, BEHAVIORS, AND NEEDS
17% Experienced or knew someone who experienced an OD in last 30 t
days
• 54% Of visits received naloxone
• In 2023, MCPH distributed 2,643 naloxone kits, and received reports of
444 successful opioid overdose reversals--most of this was from Mobile
Outreach participants
45% Of participants were new to MCPH naloxone program and/or
received training
• 72% Of naloxone engagement's were for refills
• 56% Of visits received fentanyl test strips
56% Of visits received wound care supplies
Over the last several years, the County has invested heavily across all sectors to address this epidemic at
every level. These programs include the law enforcement co-responders, crisis response, overdose prevention,
arrest diversion with LEAD, increased substance use disorder and mental health services in the jail, re-entry
services, intensive case management and access to medications for opioid use disorder—just to name a few.
The Substance Use Mobile Outreach's specific goal is to keep people alive and to help prevent the harms
associated with drug use: communicable disease transmission, bacterial and soft tissue infections, and
overdose, while providing a direct connection into intensive harm reduction case management and
behavioral health and social services.
This program addresses tertiary prevention, directly aimed at reducing morbidity and mortality.
The Substance Use Mobile Outreach program primarily works with people in active use, who may not be quite
ready to work with treatment programs or are unable to access them.
We are often the first line of contact people have when entering the system. However, several of our
participants are not actually in active use but need our other services, primarily naloxone and linkages to
care.
.........................................................................................................................................
We asked some participants to share what this program has meant to them or how it has been impactful:
"[1 feel safe] with you guys. Nowhere else. You're kind. I can tell by the tone of your voice, the way you look at
me. You truly listen. You take the time to listen. You don't judge me; you help me when I need it."
"[1 feel safe] with you guys. You're really helpful and nice, make sure I get what I need. The thing is that you're
nice, that's what brought me back."
"The wound care nurse was impressed with us—I say "us" cause you helped so much—about how well we took
care of my wounds. It isn't infected even though I've had them for over a year."
"I was clean for ten months after thirty-one years of using. That's a miracle. I did relapse but that's ok, I'm
trying to go to treatment now but for the right reasons. I'm waiting until I'm ready cause I don't want to waste
resources. I tell everyone that the exchange is who got me into treatment. You struck up the conversation
about it and helped get me there."
"Well, I can say that I spent last night at a store's parking lot just so I wouldn't miss you."
"You've helped me help a lot of people who didn't feel safe coming."
Christina Muller-Shinn
Program Coordinator
cmuller-Shinn@masoncountywa.gov
360-463-7949
Substance Use Mobile Outreach
Home Service Program Expansion
Melissa Casey
mcasey@masoncountywa.gov
Christina Muller-Shinn
Cmuller-shinn@masoncountywa.gov
Presentation overview
•Background
•Proposal
•Justification
•Safety considerations
•Policies and Procedures Review
•Next steps
•Illicit BOH feedback
Background
•MCPHHS’s Substance Use Mobile Outreach program began in 2018
•849 unique individuals served•241 in 2023
•Of 43 surveyed participants•79% said the people they know who would like to utilize harm reduction services had difficulty getting to Mobile Outreach sites as they currently are •all cited transportation and/or mobility issues as the reason
•Of the participants who regularly engage in services, over half also reported having difficulty getting to sites, with transportation being the reason
Proposed service expansion
•Incorporate home service as part of the Substance Use Mobile Outreach model
•MCPHHS has offered harm reduction home service for overdose prevention education and naloxone distribution, wound care supplies, and linkages to care since 2017; •Would allow a broader scope of services to be delivered to the community •Would increase program participation•Engage people who are not currently accessing overdose prevention, behavioral health, and social services programming
•Home service will involve Mobile Outreach staff making appointments with participants one day a week and delivering service interventions at the participants' locations via a county vehicle.
•The services offered will be the same as those provided in the existing Mobile Outreach program, with the addition of clinical services (currently in the planning stage)
•Funding is already secured through DOH Syndemic grant, FPH Illicit Substance funding
Why home service?
•Reduce barriers to accessing services, especially for people with transportation and mobility challenges
•This model has been successful with our partnering behavioral health agencies
•Improved service equity throughout the county
•Expand services throughout the county without creating a fixed-location “focal point” that may cause concern among neighbors
•Continue to foster positive relationships with the community
•Difficulty finding appropriate locations
Safety considerations
•Staffing minimums of two; if cannot meet minimums, services will
be canceled for that day
•Additional annual safety requirements in Home Service P&P,
building upon MCPHHS Field and Home Service P&P
•P&P utilized OHRS protocols and other agencies with shared populations
and similar risks
•P&P developed by MCPHHS, County Risk Management, and County
Prosecutor
•Additional safety training will be led or guided by MCSO
Next steps:
•Finalize pending items on P&P (with Risk Management)
•Brief the Board of County Commissioners on 9/24/2024•Once approved, MCPHHS will approach tribes and other partners with an official proposal for partnership/MOU
•BOCC has already approved the purchase or lease of a vehicle for the expansion
•Implementation can start as soon as staff can complete training and safety measures are attained
Feedback
•Questions, concerns, comments?