President Bass welcomed those in attendance to the Bermuda Run Country Club. He thanked Dennis Harrington and the staff of Davie County Health Department for making arrangements for the meeting. Dennis Harrington was called upon to introduce Larry Hayes, County Commissioner and Member of the Davie County Board of Health, who welcomed everyone back again to Davie County.

President Bass thanked Tim Green for taking the meeting minutes for Tom Bridges who was at the NACCHO meeting in Houston, Texas.

CALL TO ORDER - With the executive committee constituting a quorum (utilizing proxies), President Barry Bass called the meeting to order at 9:00 a.m. (See Attachments, pp. 2-3, for NCALHD Attendance Roster)

APPROVAL OF THE MINUTES - The motion duly made and seconded to approve the June 19, 1997 meeting minutes with correction. The motion passed unanimously.

TREASURER'S REPORT - President Bass reported that the Treasurer's Report for July 1997 would be made at the August 1997 meeting since the bank statement had not arrived in time for the report to be prepared and presented.

President Bass recognized Joy Reed who presented a request that the NCALHD facilitate the New Health Directors' Orientation Program as it does with the State Health Director's Annual Meeting each January. The rationale being that the state does not have an efficient mechanism to receive payments and disburse funds for these special projects. President Bass recommended that the NCALHD Treasurer set up a procedure as is done for the State Health Director's meeting. Hearing no objection to this arrangement, President Bass said he would see that this arrangement be put into place.

ANNOUNCEMENTS - President Bass had the following announcements:

1. Jeannie Kirksey's mother, Connie Holler, died in an auto crash and funeral will be tomorrow. A moment of silence was observed for Jeanne and her family.

2. Letter sent by President Bass on behalf of the NCALHD to the Turning Point Initiative in hopes of getting Robert Woods Johnson Foundation funding for this project.

3. President Bass signed a letter on behalf of NCALHD regarding the Health Services Management System (HSMS) agreement. This document is now with Dr. Ron Levine.

4. Encourage local health directors to sign up for the Public Health Leadership Training program sponsored by the CDC.

5. Health Promotion Symposium will be held in Greensboro next month (August 12-14) in conjunction with the NCALHD meeting on August 14th. Also the NC Association of County Commissioners annual meeting will be held August 14 - 17, 1997 at the 4 Seasons Koury Convention Center.

6. President Bass has forwarded a copy of the resolution in regards to the retirement system which as been accepted by the NC Association of County Commissioners. (See Attachments, p. 4 for RESOLUTION)

7. Received a letter from Mike Smith in regards to support of the Institute of Government. He requests that local health directors will urge their legislators to support financial/capital needs of the IOG.

COMMITTEE REPORTS

HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported that the Alliance meets later today at 2:00 p.m. at Bermuda Run Country Club.

He said that the Clinical Surveys completed by many local health departments found some diversity but that the Alliance could assist all local health departments in negotiating with HMOs to contract for clinical care and offer state wide coverage. He thought that there was some advantage in using CPT and ICD-9 coding for billing purposes and many local health departments are moving in that direction. A meeting is scheduled with Qual Choice first and Partners next on July 31, 1997. Jody Vogelzang has prepared a proposed clinic fees schedule to use to begin negotiating with HMO's. (See Attachments, pp.5 - 6 for Clinic Fees) Dennis Harrington made the motion that we at least accept interim fees proposed in handout for negotiation with HMO's relative to clinical care in local health departments. Dennis Retzlaf seconded, and the motion passed unanimously.

MANAGED CARE & REIMBURSEMENT - Dennis Harrington reported that Managed Care & Reimbursement Committee did not meet in July. He recognized Nan Rideout who gave an update and a survey. (See Attachments, pp. 7 - 9 for Health Director's Survey - Topics for Technical Assistance) She asks that local health departments complete the survey and return ASAP to Stacy Bumgartner, NC Office of Rural Health, fax 919/733-8300.

INCOMING/OUTGOING HEALTH DIRECTORS - President Bass recognized Danny Staley as the new Health Director of the Appalachian Health District. Carl Tuttle, retiring Health Director of the Appalachian Health District was also recognized and praised for his years of dedicated service to the NCALHD and the State of North Carolina.

HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - No report.

# INSTITUTE OF GOVERNMENT LEGAL ADVISORY - No report.

MATERNAL AND CHILD HEALTH/DENTAL - Janice Patterson reported that the MCH & Dental met at the Forsyth County Health Department on July 15, 1997 and discussed the following issues:

1. Children's Access to Health Insurance: Request from Tom Vitagliano for representation on a committee to explore ways to enhance children's access to health insurance. Dr. Ann Wolfe reported that there are anticipated future funds for this project. Dr. Harold Gabel has agreed to serve from the MCH/Dental Committee and would encourage others to serve.

2. Covenant for North Carolina's Children: Paula Wolfe, who is with Covenant with North Carolina Children, requests $ 100.00 for children's' advocacy activities. The MCH & Dental Committee felt this to be a worthy organization, but was unsure about making a recommendation to contribute. The committee thought it best to get further information about this group or yield to a motion from the NCALHD about the requested contribution. Apparently the NC Association of Social Services Directors did contribute funds to this group. No motion was made.

3. The MCH Streamling Update & Discussion: Four health directors responded to Dr. Gabel's request for input about streamlining activities. Most of the comments were positive with several questions about specific issues. MCH Audit Tools are available upon request from your regional consultant. The committee discussed the goal of this process. It is to take mandated requirements to "bare bones" levels and still meet Medicaid Title V, Title X, etc., and quality standards of care. Private physicians' offices who do not provide mandated services and bill Medicaid are actually committing Medicaid fraud. All submitted concerns were discussed and addressed.

A life-long history form has been turned over to Dr. Joy Reed and multi-disciplinary committee has been convened with a target date fall '97 for completion. The goal would be to carry this form to all services, however the MCH Committee by its makeup can only address MCH issues.

The decision to teach breast self-exams to all clients is an agency specific choice. The practice of using clinical judgment was supported by the report of the Preventive Service Task Force. This can be an add-on requirement specific for each department. This again was an effort to reduce requirements and allow each department some discretion.

The question of "pregnancy intendedness" continues to be controversial. The committee recommended reduction of 5 answer choices to 2. each agency should be sure clients are not being asked the same questions by different disciplines and that records and information are used in an efficient manner. The HSIS screen will not advance without data for intendedness.

Child health programs are working on the acceptance of a 0 with a line to indicate no problems noted on the child health check list. the only areas that require quantitative data are vision, hearing and measurements (ht., wt., B/P).

General comments included to use patient flow analysis to decrease waiting times and look at how waiting time is being spent. One Health Department is trying a program called "Shop the Services" where people actually go through the service and critique what is good and bad. Dr. Gabel urged continued efforts to reduce paper work.

A memo will be sent out about scaling down requirements in Children's Special Health Services. These children have private medical homes. Requirements will be reduced for kindergarten and day care physicals. Newborn screening requirements on the contract addendum are being revised. Except for a few days after birth, the damage from these problems cannot be prevented. There is a follow-up system in place on the state level and except for sickle cell this will be dropped. Continue to ask PKU question on Women's Preventative Health and Maternal clients as they may have the disease, be diet controlled and need counseling. Information regarding the amount of child health history which must be completed before billing initial visit will be out soon. any new streamlining issues should be addressed by Dr. Wolfe.

4. Seal the State in '98: Project is scheduled for February 1998. Most people have either attended the meeting or have received mailings on this. All Health Departments need to consider taking the lead in this project. This is voluntary and someone from each agency needs to be designated as the contact person. Health Departments will be asked to triage children for sealants.

5. Interpreter Services: Some agencies have been charging for this service. this is not a billable service but MCH recognizes the problem affects all programs. There is a great need for interpreter services since some counties serve large non-English speaking populations. The committee suggested a future educational round-table on how counties have worked to meet the needs of clinets from other cultures.

6. TANF-Pregnancy Prevention Funds: The NC General Assembly has been concerned about out-of-wedlock births. Legislation of $ 1.6 million to be spent through DSS and State Health Department in Family Planning Programs. The intent is to prevent out-of-wedlock births. A proposed distribution of funds was presented by Dr. Kevin Ryan which placed money in counties based on the number of these births during the 2 years of '94 and '95. (See Attachments, pp. 10 - 11 for TANF funds distribution) This is not categorical moneys and is not distributed according to the equity formula. This is not replacement funds for reductions in block grants received last fiscal year. Ten counties represent 40% of TANF clients so the moneys would be following these numbers. Some discussion on how these funds could be applied at the local level. Some issues need to be resolved with DSS regarding accountability and limited funding. DSS wants clients off rolls of TANF. Any ideas about how we will work with DSS to accomplish this goal, please direct to Dr. Kevin Ryan. Motion was duly made and seconded that the NCALHD accept the TANF allocation formula as presented. Motion passed.

POLICY & PLANNING (Legislative) - No report.

Other legislative reports: Dr. Pam Horne reported that the Public Health Authority Bill cleared the House Human Resources Committee

STATE & LOCAL RELATIONS - No report.

# STATE HEALTH DIRECTOR'S OFFICE - Dr. Leah Devlin reported the following:

1. Reorganization Bill also got out of the Human Resources Committee yesterday with a favorable vote for it, and will be heard on the House floor by end of next week.

2. Public Health Authority Bill very important to support. This will enable you to keep your funds in your agency.

3. SB 455 is a Bill that deals with HMO requirements. We will ask your support on it. There is language in it that Dennis Harrington has worked on that HMOs would have to collaborate and cooperate with Public Health. This has very broad applications. Dennis Harrington said that this amendment will have to be added on the floor -- did not get added in Committee. That HMOs cooperate with core public health services, not on clinical services. Such areas as outbreaks, care coordination, etc.

4. Blue Cross Blue Shield Conversion Bill: Would like to thank Deborah Rowe for her efforts to keep us all informed. Deborah Rowe reported that many other groups have joined us on this concern, but we need to continue to have public support.

5. NCPHA September 10-12 in Winston-Salem. Please note announcement in mail.

6. Delton Atkinson has resigned effective August 15, 1997 to move to the National Center for Health Statistics. He will be located in Research Triangle Park. This will be an incredible loss for all of us and you do have some time to express your appreciation to him for all he has done.

SPECIAL REPORT FROM BARBARA PULLEN-SMITH

Barbara Pullen-Smith was recognized to discuss some issues concerning Hispanic population. (See Attachments, pp. 12 - 13 for Services to the Hispanic/Latino Population) Many of issues relate to policy and a number of them relate to resources. The report was an attempt to document these issues to lead for further consideration and discussion at a later date.

The Duke Endowment may loosen its traditional funding to consider funding more directly to local health departments who propose addressing this problem. More specifically Duke Endowment is interested in improved access to care and continuing education for health care professionals or curriculum improvement program. The brochure given out today also includes other things they are interested in, such as outreach and case management. (See Attachments, pp. 14 - 16 for Immigrant Health Initiative - Duke Endowment Request for Proposals) Grant will be a two-phase program. Application deadline for planning grant (two dates) are September 15 and December 15, and will be $ 25,000 and $ 10,000 for each planning grant, and after that, the second could be much more significant ($ 100,000+). The opportunity is certainly there.

In terms of follow up, Barbara Pullen-Smith would like to propose a forum for discussion in policy between state and local health departments to address these issues that public health is facing. We really need to know what the current needs and practices are. A more comprehensive assessment would be very helpful. Suggestions are welcomed.

President Bass thanked Barbara Pullen-Smith for her report and then charged the Policy & Planning Committee to coordinate with the Office of Minority Health on this issue. To have them review it first and come back to NCALHD with recommendations. There may also be a tie in with Managed Care & Reimbursement Committee as it may affect the Medicaid population. Bill Smith will contact Barbara Pullen-Smith to get this process underway. Each department should evaluate application to the Duke Endowment for funds.

TECHNOLOGY - No report.

Some discussion was centered around e-mail capabilities. The motion was duly made and seconded that someone from the State Center be designated to monthly test e-mail capabilities of local health departments to ascertain the reliability of the e-mail network and a report will be made each month. The motion passed.

NOMINATIONS & BYLAWS - No report.

EDUCATION & AWARDS - Gail Brown reported for Leonard Wood that Carl Tuttle received his retirement clock. Carl Tuttle was then recognized and thanked by President Bass for all his many years of service to public health.

ENVIRONMENTAL - The committee met on July 16, 1997 at the Davie County Health Department. Terry Pierce shared the following:

1. Legislative Update: (Malcom Blalock)

* Food & Lodging Bill - 2nd reading today

* Preliminary Site Evaluation legislation to be decided by ERC in the fall.

* Lead Based Paint bill stymied in House committee

* Sanitizing of Lodging Utensils bill - going to become law

* Public Water Set aside funds - waiting for EPA approval of plan

2. Temporary Registration Period for Sanitarian Interns: Terry Pierce sent letter to David Rust, Chair of Board of Sanitarian Examiners expressing concern that the Office of State Personnel uses the date of employment to determine the time limit for Intern eligibility. The R.S. Board use the date of registration, not date of employment. David Rust contacted Mel Crocker re: this discrepancy. Mel Crocker indicated that he would send a memo to the Regional State Personnel Offices that would clarify that the date of registration should be used.

3. Proposed Swimming Pool Rules and Survey Results: Jim Hayes shared results of survey sent to LHD re: proposed swimming pool rules. Dealt with 4 issues:

a. Retrofitting existing pools with dual (double) drains

b. Fencing that would restrict entry of small children

c. Increase lighting of pool deck & signs to 10 ft candles

d. Convenient access to telephone

Results:

* not going to require double drains -- cause structural damage

* consider 2 lower standard of lighting -- 10 ft candles too bright

* no negative comments re: fencing and phone requirements

- requirement for pre-opening inspections were viewed favorably but could not be performed with current manpower.

4. Restaurant Rules Review Committee progress report: Doug Urland gave an excellent progress report of the of the Restaurant Rules Review Committee. Most current draft is being prepared for committee members with deadline of July 25th to submit to State. Registered copies will be sent to LHD ASAP (2-3 weeks) 3 main issues: Transitional Permits; Appeals; Grading System

a. Transitional Permit - committee could not come to consensus, left as last year's report.

b. Appeals process: (1) must request in writing within 7 days; (2) 30 days for local response; (3) appeal to state level Appeals Officer within 7 days; (4) hearing in Wake County; (5) decision within 7 days.

c. Grading System - retains "ABC"; 10 pt. scale; A & B blue color C would be "Provisional" (red color) 30 days to raise to greater or equal to 80, or suspend.

Also,

* provision to not post B for 15 days if last 4 grades average 90 or above.

* training good for 3 years, then new training curriculum to be approved by DEH

5. Environmental Health Division Report (Malcolm Blalock)

* Authorization changes to be published in State Register and sent to stakeholders -- comment period through September 30.

* Weekly Recreational Water Sampling be conducted -- notices posted in newspapers and beaches/swimming areas if fecal coliform count > 200.

* White Paper / Position Paper Committee to develop a document to state public health position re: where state level EH programs should be located and why - Don Yousey represents HD.

* Thanks to Dennis Harrington and wife Brenda for providing the meeting space and a very lovely dinner at his home.

EPIDEMIOLOGY - Committee met July 11th. Dr. Walter Linz gave the following report:

1. Rabies continues throughout the state. Buncombe County had its first rabies case 2 or 3 weeks ago. In Davidson County some bats that were found in an apartment complex where children had been handling them. Rabies vaccine is in very short supply and will be difficult to come by. It appears that we may have to lobby manufacturers. You should have received a letter/memo via e-mail a few weeks ago about the fact that bats appear to be the most prominent vector for human rabies. This information originally came from Dr. Lee Hunter and is to be used locally by health directors to incorporate in a letter to local health care providers.

2. Good news from the General Assembly is that all the moneys for communicable disease are essentially in the budget. The Senate version has an additional vet and some extra moneys for the state communicable disease veterinary section. The House decided to double the amount by putting in two new vets instead of one vet.

3. The major topic was the proposed communicable disease rule changes. Dr. Newt McCormack should have sent you a memo regarding the proposed changes on the salmon colored Communicable Disease Report Cards. The pertinent changes include delete reporting 8 diseases but to add 8 others on the card. The proposed changes are as follows:

Delete: amobiasis; blastomycosis; Hepatitis non-A non-B; leprosy; viral (aseptic) meningitis; mucocutaneous lymph node syndrome (Kawasaki syndrome); Reye's syndrome; and report isolates of E. coli 0157:H7

Add: cryptosporidiosis; ehrlichiosis; arboviral; enterococci; vancomycin- resistant, from normally sterile site; Hemolytic-uremic syndrome/ thrombotic thrombocytopenic purpura; hepatitis C, acute; streptococcal infection, Group A, invasive disease; toxoplasmosis, congenital; vibrio infection (other than cholera)

The Epidemiology Committee questioned about whether toxic shock syndrome should be added

but decided that it is not capricious at this time.

Major change though being proposed was that for every disease on the list, the laboratories will be required to report them directly to the state, and the state will report these to local health departments as it pertains to locale. That is something that other states have already implemented. It is anticipated that initial implementation will result in some confusion over matching reports until the reporting mechanisms can be worked out.

Also some changes will be made in the language used in Hepatitis B in schools and how to appropriately address a child who is potentially a hazard to other children.

There will be a few other changes with Tuberculosis which are generally technical in nature and again the Epidemiology Committee felt very happy about that.

After meeting on all these issues the following two motions were presented from the Epidemiology Committee:

1. Motion: That the NCALHD fully support proposed communicable disease rule changes as drafted by the Division of Epidemiology. Motion passed.

2. Motion: That NCALHD are committed in supporting the creation of resources to implement the new rule changes. Motion passed.

July 30th the Commission for Health Services will meet to address these issues. Walter Linz will send a letter to the Commission in support for these rule changes.

HEALTH PROMOTION - Dr. Harriet Duncan presented the report for Curtis Holloman:

At the request of the NCALHD and the ANCBH, Project ASSIST has developed a manual which NCALHD was not able to vote on in June meeting. Manual, "Entering the Clean Air Zone" promoting smoke free environments through voluntary programs. The manual was distributed for review by the Health Promotion Committee members. Motion from HP Committee is that the NCALHD endorse (be a co-sponsor) the manual and also have its name placed on the front of the manual (at no cost to the NCALHD). Motion passed.

VISIONING COMMITTEE - President Bass made the following report:

The Visioning committee met on July 15, 1997 for 6 hours. Those in attendance included 12 health directors and Dr. Leah Devlin. They reviewed the configuration for the delivery of public health services task force report as a basis for the committee. The Vision Committee then identified 4 particular areas/issues that are most critical: These are 1. Structure 2. Governance 3. Services and 4. Funding.

The Vision Committee also agreed to develop a white paper regarding the direction where we want to go as a public health entity -- as the assurer of health services for the state of North Carolina. What is proposed is to develop a Consensus Conference involving every health department in the state of North Carolina. As much as possible, it will be an effort to make it an inclusive process where everyone who provides local public health services has an opportunity to hear and speak. It is hoped to take as many different existing documents, such as the Task Force Report , the Public Health Study Commission recommendations, recommendations from the Health Care Reform Commission a few years ago, and the IOM report on the Future of Public Health. Also the report (core public health services) from a previously convened (a few years ago) Consensus Conference which the NCALHD participated with the State Health Director. The new Consensus Conference will take all this type information that is currently out there and give it to an identified expert for review and response. President Bass said that about 5 - 6 names have already come to mind. He said they are reviewing who will facilitate the Consensus Conference. An objective of the Consensus Conference will be to develop a strategic plan developed from the majority of participants. It is expected from the outset that there is not going to be unanimity from everyone in terms of how to proceed, but it is hoped that a basic agreement will arise on where we want public health services to be going, and how that integration is going to occur.

The Conference is being planned for this September. August is the target date to have everything internally lined up in terms of setting up the Consensus Conference. A 5 member committee consisting of Dr. Devlin, Dennis Harrington, Dr. Fred Pilkington, Bill Smith, and President Barry Bass will be responsible for contacting the presenters and for doing the leg work on preparing the Conference. Again, it is going to be an open process which everyone can participate.

Since an expert will be called upon, the Vision Committee may call upon a substantial commitment from the NCLAHD funds. Tentatively, it is expected that the Consensus Conference may convene one to one and one-half days and cost upwards of $ 10 - 20,000 (the expert may cost $ 3,000 - 5,000 per day). The planning committee will be informing NCALHD membership over the next couple of weeks as plans get underway.

LIAISONS & OTHERS

NCPHA - Deborah Rowe wanted to remind everyone about the NCPHA annual education conference to be held this September in Winston-Salem. NCPHA needs your attendance/ participation and financial support. She has also made arrangements for the NCALHD meeting room for Tuesday, September 9, from 1 - 5 pm in the Adams-Mark Hotel. Five breakout rooms have been reserved for Tuesday morning for any committees who want to meet. So far, only the Environmental Health Committee has reserved a room. Remaining rooms will be on a first come, first served basis. Depending upon needs, committees may be able to share rooms over the morning time frame. Rooms will be offered at no cost to committees. Look for NCPHA brochure which has been mailed out to members only. A block of rooms have been reserved but everyone needs to make reservations ASAP.

Yesterday, Deborah met in Wilson with the Editorial staff for the NCPHA journal which is to come out in late fall. They are planning something different for this publication. Topics will include: "Protecting Water Ways"; "HIV in North Carolina" - we're seeing declines in rates and Evelyn Blankenship will write this article; "Laboratory Essential Services" -- recognizes the opportunities that the lab provides us; and "Update on Rabies". Also, there will be a pull out section of the journal for policy makers that will contain an article about Environmental Health and its importance to be included in Public Health. This section can be taken out and given to legislators, Board of Health members, County Commissioners, and other individuals who may be influential on the outcome in the organization of Environmental Health services. Dr. Trenton Davis is writing this article. NCPHA will be calling on you to share this article with the policy makers in your community in the hope that the article will convince policy makers to assure that Environmental Health stays in the public health family. Also, Deborah and the Editorial staff request input from you about any other topic in the journal.

Office of Public Health Nursing and Local Health Services - Dr. Joy Reed reported the following:

1. The "Telephone Triage" workshop was a tremendous success with 146 nurses in attendance statewide. The speaker, Polly Johnson, spent a fair amount of time discussing issues of agency and individual liability. She emphasized that the agency can protect itself by having a system in place to support nurses doing triage. that system should include:

* the purpose of triage (general consumer information, referral, crisis intervention, and/or advice for home treatment - with risk to the agency increasing for latter purposes)

* defined policies, procedures and roles of personnel

* written nursing protocols which include standing orders for any medical advice (several models, formats and examples of these were shared and will be sent to participants)

* documentation system

* mechanism for monitoring the system

2. Staff Changes in the Office: As of July 1,1997, the Office of Public Health Nursing and Local Health Services has a nurse consultant, Faye Hoffman (transferred from the Division of Health Promotion), who will be available to provide broad administrative ("across programs") consultation to local health departments. In addition, through an agreement with the School of Public Health which "frees up" 100% of Patty Cunningham's time for distance education initiatives, the School will hire a CE Specialist to be outpaced on OPHNLHS to carry out the responsibilities of Patty's job description (particularly the "Introduction" course and the PHN Leadership course.) although we are currently contracting with Hazel Moore in this position, we hope to have the position filled with a permanent employee within the month. finally, the position of Office Assistant for Local Health Services (formerly held by Albertha Adela) has now been filled. Robin Fore, whom many of you may have spoken with since she has been in the position as a temporary employee, has been hired on a permanent basis.

3. The first offering of the new "Orientation for New Health Directors" will take place in Raleigh at the Brownstone Hotel on August 28 - 29, 1997. On Day Two, the leadership of the NCALHD is strongly encouraged to join the new health directors for lunch and focused sharing on the topic "What I Wish I Had Known when I Was New." Registration information for the entire orientation and for the Day Two lunch will be sent next week to all health directors.

4. On Monday, July 21 the State Health Director's Office will be offering a teleconference on "Water Quality and Health" targeting health directors, medical directors, NPs, and PA. employed by local health departments and private physicians in the coastal region. The session will be held from 7:00 - 9:00 pm at New Hanover regional Medical Center/Coastal AHEC, Beaufort County Community College and PPCC District Health Department. Flyers were faxed to all coastal counties within the last two weeks. (See Attachments, p. 17 Surface Water Quality and Health - A Panel Discussion) In addition, for those who would find it easier to travel to Greenville, we have been able to add at the "last minute" a site at the Brody Building (a previously scheduled class for that night was canceled allowing one of the faculty to broadcast from that site).

5. Brochures and related information for the CPT-4/ICD9 Coding workshops to be held September 2, 3, 8, and 9 are going out this week. (See Attachments, p. 18 for ICD9/CPT4 Coding) Thanks to support from the Division of Maternal and Child Health, the workshop will be provided at no cost to local agencies other than the purchase of the manuals used with the course ($ 20/set.) Please note that the content of the four sessions is NOT duplicative; each session builds on the previous one and adds new information, so attendance at all four is necessary. The Public Health Management Team is working on development of an overall plan for implementation of CPT-4/ICD9 coding in local health departments which should be available by the next meeting of NCALHD.

6. The Final Report of the focus groups on the role of consultants has been presented to the DDT (Devlin's Divisions Team - Peter Andersen, Steve Cline, Mike Moser, Barbara Pullen-Smith, Joy Reed, and Ann Wolfe) The team is preparing a letter to local agencies and consultants identifying the actions which are and will be taken as a result of this important feedback. That letter should be ready to go out within the next two weeks.

ANCBH - Dr. Pam Horne had the following report:

The ANCBH is continuing with its training programs to local health departments, however they have found that training often needs to be individualized for many local boards of health. These were the result of requests from the local boards of health and the health directors. ANCBH welcomes the opportunity to tailor make these training sessions for local boards and they need only request it of the ANCBH.

Recently the Nash County Board of Health has assembled a model plan involving a health educator from their Health Department who will package the training materials into an on-going training resource for future applications.

The first "Academy" will be offered at the Blockade Runner, Wrightsville Beach on October 10 - 11, 1997. Board Certification will be offered to all local board members attending the basic orientation session conducted on that Friday afternoon. An additional 150 credits will be offered to those completing the whole Academy. This will identify them as Board Leaders. Board Leaders will be expected to help others become educated to become board of health advocates in their communities.

The Academy starts with a Leaders forum on Friday afternoon at the Blockade Runner. Seventy-five rooms have been reserved and over 100 are expected to attend the Academy training. Dr. Horne needs to know if more rooms need to be reserved, so she needs to hear from interested counties. The Leaders Forum provides an opportunity for Board Chairs to work with their Health Directors. A reception will be held, followed by a banquet to honor those board members achieving Board Leadership status or for becoming Charter Members of the Academy. ANCBH would like for this certification to influence county commissioners on appointments to local boards of health. Individuals holding these credentials could be viewed as a sign of their commitment and caliber to which they would honor their appointment. This could serve to strengthen local boards and their presence in their communities.

On Saturday morning, they will open with a presentation on the Future of Public Health lead by Dr. John Durant, who helped in the Future of Public Health project and served on the Institute of Medicine's committee that wrote the book. He and Dr. Hugh Tilson co-authored a sequel on the Future of Public Health, phase II.

Dr. Roper, former Dean of a School of Medicine and is the new Dean of the UNC School of Public Health. He has agreed to speak that Saturday morning. The Consensus Conference discussed earlier by President Bass would be wonderful to inform Board of Health members on its goals and progress. This could provide them the opportunity to learn how local health directors see the role of public health in the future.

Concurrent sessions will be hot topics developed from what has been reported from out in the field. Over the past year, Dr. Horne said she had contact with over 400 local board of health members during local training and at the annual meeting. Many of the topics came from their input. Board Members will be involved throughout all the sessions to allow them to talk about how they are dealing with these issues in their counties. It is hoped this will allow them to develop networks and to identify models which work. Topics will include:

* Update on Tobacco Regulations, moderated by Anne Dillinger, IOG.

* Intensive Livestock Operations, moderated by Milton Health. IOG

* Helping Your Commissioners and Your Health Director with the Budget, led by Lee K. Allen, County Commissioner from Craven County. He has been very committed to Boards of Health and was very instrumental in getting the NC Association of County Commissioners to withdraw their legislative goal allowing for the dissolution of Boards of Health. It is hoped that a number of County Commissioners will serve on this panel in addition to Finance Directors and Health Directors. Perhaps the discussions will help to get local health department budgets expanded.

* Evaluating and Hiring a Health Director, led by Kim Newsom, State Regional Personnel Office. Dr. Reynolds from Durham County Health Department's Board Chair will also share their many experiences and hiring issues. Also, Beth Saylor, Board Chair of the Appalachian Health District will be speaking.

* NC Restaurant Rules, led by Michael Rhodes. Dr. Jesse Meredith, who has chaired the Health Services Commission for the past 28 years has requested to be on this panel. Also on the panel will be Wayne Able, a restaurateur and Board Chair of the Burke County Health Department; John Coble, Board Director of the NC Restaurant Association; William Hill, EH Supervisor from Craven County; and Tommy Jarrell, Richmond County Health Director. That whole committee is probably ready to meet right now.

* Forging New Models for Community Health. This session will be looking at the CLECO system, Public Health Authority Model, the Guilford County Model and the Gaston County Model.

Robert S. Strothers, a County Commissioner for many years and Dr. Jesse Meredith will speak on the politics of experience during lunch on Saturday. A repeat of the morning sessions will convene in the afternoon.

Dr. Horne hopes to have a large turnout from local health directors as well as local board of health members. Please feel free to call her for questions.

In the future, plans are to consider alternating the Academy in a western location.

NCSOPHE - Susan Hokaday, with NC SOPHE and staff member of Davie County Health Department made the following announcement: NCSOPHE plans to hold its annual meeting on October 22-24, 1997 at the Sheraton Hotel in New Bern, North Carolina. While the agenda is not completed CEU and CHESS credits for Certified Health Educators will be offered. NC SOPHE has a committee looking into holding future meetings on alternating years in western locations to make it possible for more to attend. NCSOPHE expects to have between 125 - 150 members at this year's meeting.

REGIONAL REPORTS - No reports.

OTHER BUSINESS - In light of Jeannie Kirksey's mother's passing a motion was duly made and seconded that flowers paid from Presidents Discretionary line be sent on behalf of NCALHD to Jeannie Kirksey. Motion passed.

ADJOURNMENT - With no further business, President Bass adjourned the meeting. The next scheduled meeting of the NCALHD Executive Committee will be held on August 14, 1997, 1:00 pm, at the Holiday Inn 4 Seasons, Koury Convention Center, Greensboro, NC.

Respectfully submitted,

Tom Bridges, Secretary