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Home My WebLink About930605.tiff RESOLUTION RE: APPROVE PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT APPLICATION FOR THE WELD COUNTY SUICIDE PREVENTION AND EDUCATION PROJECT WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Preventive Health and Health Services Block Grant Application between the Colorado Department of Health and the Weld County Health Department, for the Weld County Suicide Prevention and Education Project, commencing October 1, 1993, and ending September 30, 1994, with further terms and conditions being as stated in said application, and WHEREAS, after review, the Board deems it advisable to approve said application, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Preventive Health and Health Services Block Grant Application between the Colorado Department of Health and the Weld County Health Department, for the Weld County Suicide Prevention and Education Project, be, and hereby is, approved. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 14th day of July, A.D. , 1993. //�} J//0 BOARD OF COUNTY COMMISSIONERS ATTEST: =' i f/ WELD COUNTY, COLORADO Weld County Clerk to the Board EXCUSED DATE OF SIGNING (AYE) Constance L. Harbert, Chairman BY: G q K = ,- / /X p/� - Deputy dlerk to the Board W. H Webst P -Tem v APPROVED AS TO FORM: ] r, 7 Z" l_ Geoe . Baxt r .� . 7 ounty Attorney '---2____ Dale K. Hall ��/ Barbara B J. Kitirkme er er 930605 i1 / l / < An/ L� mEmoRAnDum Prow Wilk To Constance L. Harbert, Chairman Board of County Commissioners Data July 12, 1993 COLORADO Jeannie K. Tacker, Business Manager, Weld County Health Dept. From Subject: Preventive Block Grant Application Enclosed for Board approval is a grant application to the Colorado Department of Health for Preventive Block funds. The Health Department is requesting approval of funds to meet two Weld County Healthy People 2000 strategic planning goals: 1) to provide education to increase public awareness of suicide prevention, intervention and postvention, and 2) to improve methods for reporting data on suicide completions and attempts. The Health Department is requesting grant funds of $43,552.00 for the period October 1, 1993 through September 30, 1994. I would recommend your approval of this grant application. If you have any questions, please feel free to contact me. 930605 U, I / ',' / {n • Mio DEPARTMENT OF HEALTH 1517• 16 AVENUE COURT Nue GREELEY, COLORADO 80631 ADMINISTRATION (303)353-0586 HEALTH PROTECTION (303)353-0635 COMMUNITY HEALTH (303)353-0639 COLORADO July 8, 1993 Joe Carney Colorado Department of Health Mail Code HSVR-DDM-A5 4300 Cherry Creek Drive South Denver CO 80222-1530 Dear Mr. Carney, Enclosed please find Weld County Health Departments proposal for the Preventive Health and Health Services Block Grant application. Thank you in advance for your consideration. Sincerely, ((11-t- C�.,4`4'i-tea Glenda Schneider, R.N. Director of Community Health Nursing Project Coordinator 93o£os IV. PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT APPLICATION ' Fiscal 1993-94 Colorado Department of Health Project Title Weld County Suicide Prevention and Education Project Applicant's Name Glenda Schneider. R N Dirertnr of Community Health Sarvirea Organization Weld County Health Department Address 1517 16th Avenue Court Greeley CO 80631 Contact Person(s) Kathy Shannon R N Nursing curervicnr — alands crhnaidar, R N (Name & Title) Director of Community Health Services Phone (9 a.m. - 5 p.m.) (303) 353-0639 Amount Requested $ $ '43,552.00 from 10-1-93 to 9-30-94 month/day/year month/day/year Date Submitted July 9, 1993 LIMIT THE NARRATIVE TO THE SPACE PROVIDED IN THIS APPLICATION. PROPOSALS LACKING ANY OF THESE ESSENTIAL ELEMENTS AND/OR EXCEEDING THE SPACE LIMITS WIT T NOT BE CONSIDERED FOR FUNDING. SUPPORTIVE MATERIALS ARE ALLOWED BUT PLEASE BE SELECTIVE. * ONLY LOCAL HEAT TH DEPARTMENTS (including Denver Department of Health and Hospitals), COUNTY ENVIRONMENTAL HEALTH SPECIALISTS AND COUNTY NURSING SERVICES ARE ELIGIBLE FOR THESE FUNDS. 7 93Clig5 PROJECT SUMMARY Provide a brief summary of what the project is, how it will be implemented and the anticipated results. This project is a suicide prevention project which emphasizes public and agency education about signs and symptoms of suicidal thought and behaviors, and appropriate interventions. This will be accomplished by providing training and technical assistance to agencies such as employers, physicians, alcohol/drug treatment centers, and law enforcement. Training consists of defining signs and symptoms, appropriate interventions, and resources available. Technical assistance will help agencies develop staff protocols to identify at risk behavior, how to intervene, and what actions to take. Grant staff will contact target agencies throughout the county to offer services and will provide training and technical assistance upon request. Expertise of the Suicide Prevention • Coalition (WCSPC) and agencies like Mental Health will be utilized to develop the training and technical assistance. Further, the project will update the information on resources available and identify some of the gaps in services. A resource committee made up of SPC board members and others working with suicide prevention will work to identify these gaps and will promote interagency cooperation and coordination. Law enforcement agencies are key to this coordination and to suicide prevention. The advisory board to the grant will be the Weld County Suicide Prevention Coalition (WCSPC) which has been in existence since 1987. It is representative of the community and many of the community's resource agencies, thus providing a good forum for identifying gaps in services and getting the community involved in filling those gaps. The statistics for injury and suicide using firearms are staggering. In Weld County in 1991, 57.7% of all completed suicides were by firearms. Practically everyday there is a story in the media about injury or suicide to teens with firearms. This project proposes to educate the community as a whole on proper gun storage and safety. Helping families know how to properly handle firearms and keep them out of reach may help prevent a family tragedy of injury or suicide. Agencies such as law enforcement, the National Rifle Association (NRA) , and the Wildlife Association will be utilized to assist in the training and developing public education. The project goals parallel many in the Healthy People 2000 chapter seven and those in Weld County's Strategic Plan. Two goals are: To provide education to increase public awareness of suicide prevention, intervention, and postvention and thus reduce suicides, and to improve methods for reporting data on suicide completions and attempts. Others are to provide technical assistance to hospital emergency rooms and other interested agencies for the development of protocols for routinely identifying, treating, and properly referring suicide attempters, and to provide a forum in which mental health, alcohol and drug, public health and other agencies can work with corrections authorities to facilitate identification and appropriate intervention to prevent suicide by jail inmates. 930S05 PROGRAM PLANNING ELEMENTS Please answer the following questions: 1. Problem Statement What is the need? What is the evidence that the stated problem(s) is a high priority for the applicant? Please include any relevant materials or summaries as attachments. In Weld County, injury is the leading cause of death between the ages of 1 and 44. Two thirds of intentional injuries in Weld County are completed suicides and 1/3 are homicides. In 1992, 26 people completed suicide which represents 6.45% of the total deaths or 19.7/100,000.(3) The national overall suicide rate in 1991 was 11.5/100,000. The Year 2000 objective is to reduce the rate to 10.5/100,000. (6) The age-adjusted suicide rate for Colorado in 1990 was 15.7/100,000. (1) Suicide is the eighth leading cause of death in the United States(4) and the second leading cause of death among persons 15 to 24 years of age, following motor vehicle crashes. In 1950, people in this age group were responsible for less than 6% of all suicides. By 1980, they were responsible for 20%.(5) The Weld County Suicide Prevention Coalition (WCSPC) , founded in 1987, initially focused on the school population and established crisis intervention training for school staff. This has been well received and remains in demand. In 1990 the WCSPC received a Comprecare grant to educate the county's elderly population. This grant helped develop a training program for the elderly and their providers specifically to help identify people in this age group who are at risk, and refer them to appropriate resources. To date, there has not been adequate financial or personnel resources to reach other high risk groups or to effectively facilitate interagency cooperation and coordination. It is imperative that individuals and agencies providing service to high risk people need to be trained to recognize the signs and symptoms specific to suicidal thought and behavior. In Weld County, one group whose needs are not adequately addressed is the youth with multiple risk factors i.e., homeless, substance abusers, those incarcerated, runaways, and drop outs. This population frequently can be seen only when they surface in jail, social service agencies, or the legal system. It is the same population that is high risk for contracting HIV and in turn become even higher risk for completing suicide. In a survey conducted by the Colorado Department of Health (CDH) between April 1990 and March 1992, of the 661 completed suicides, 20 or 3% were HIV+ or had AIDS.(2) Another high risk group is children with access to firearms without proper training as to their safe use. Firearms are currently the most often utilized method of suicide by essentially all age groups and both sexes. "In 1970, the use of firearms began a sharp and sustained increase, climbing three times faster than other methods among 15 to 19-year-olds and 10 times faster for 20- to 24- year-olds. The vast increase in youth suicide, therefore, is associated with a vast increase in the use of firearms as a method of suicide and that increase parallels a proliferation of civilian firearms both in the number of households possessing guns and the number of guns owned."(5) In Weld County in 1991, 57.7% of all completed suicides were by firearms. (3) 9 �v�J 2. Goals and Objectives List the Healthy People 2000 status and risk reduction objectives the project is designed to affect. There are several objectives in Healthy People 2000 that are relevant to this proposal. They include 7.2 in the Violent and Abusive Behavior section. It states "Reduce suicides to no more than 10.5/100,000 people". (6) Local Weld County data was used to project trends and set goals in light of these trends. Therefore, due to the extremely high rate of suicide in Weld County (19.7/100,000) , the goal for Weld County is to reduce the rate to 15/100,000 by the year 2,000 as stated in the Weld County Health Objectives for the Year 2000. (7) "Data from "psychologic autopsies" of completed suicides highlight previous suicide attempts, inadequate treatment, medical illness, precipitous life events, family history of suicide or psychiatric disorders, exposure to suicidal behavior, family violence, and availability of firearms in the home as contributing factors. Stressful life circumstances such as separation or divorce, unemployment, or limited socioeconomic resources can also contribute to suicidal behavior. The most promising current approach to suicide prevention appears to be the early identification and treatment of individuals suffering from mental disorders."(6) Objective 7.3 states "Reduce weapon-related violent deaths to no more than 12.6/100,000 people from major causes. In 1985, firearms were the weapons used in 31,566 deaths: 55% from suicide, 37% from homicide, and 5% from unintentionally inflicted injuries; the remainder were due either to legal intervention or the medicolegal cause of death was undetermined."(6) Objective 7.12 states "Extend protocols for routinely identifying, treating and properly referring suicide attempters, .... to at least 902 of hospital emergency roam departments."(6) In addition to the emergency room, this project will assist other agencies who serve individuals high risk for suicide in developing protocols and training staff. Objective 7.18 states "Increase to 50 the number of states with officially established protocols that engage mental health, alcohol and drug, and public health authorities with corrections authorities to facilitate identification and appropriate intervention to prevent suicide by jail inmates. " Suicide is the leading cause of death in American jails. The suicide rate among inmates in county jails and police lockups is 16 times greater than that for individuals in the general population, and the size of the national jail population has been growing rapidly. The most common demographic profile of an inmate suicide victim is an unmarried white male in young adulthood. About three-quarters of the victims are arrested for on-violent offenses, with 27% being detained on alcohol- or other drug-related charges. More than half of the victims are intoxicated at the time of incarceration."(6) Weld County has both city and county jails as well as private prison facilities. This grant project will target facilitating interagency corporation and protocol establishment at the local level. State level activities will be dependent upon time and funding. 3. Model Use If applicable, explain what model will be used and why it was selected. Several years ago, this community began the process of planning and assessment using models such as APEX as a guide. This has been a community activity and is continuing today. In 1988 the Suicide Prevention Coalition conducted an agency survey across the county to assess the needs in regards to suicide issues. Law enforcement agencies, particularly in small rural communities, expressed a need for training to help them identify suicidal individuals and to provide proper referral to resources. In 1989, United Way of Weld County conducted a needs assessment which identified health care as the number one concern of those surveyed. In 1990, the Weld County Health Department (WCHD) began the process of internal strategic planning. The initial step consisted of an entire agency training and planning session. All staff were involved in defining the needs of the agency, community, and in determining a mission statement. In the spring of 1991 WCHD, in collaboration with the Weld County Community Health Coalition, undertook the process of measuring the current status of health of the people of Weld County and setting measurable objectives for the year 2000. Key indicators taken from the federal objectives, as stated in Healthy People 2000, were identified. Local data was gathered where possible in regard to these objectives. Trends were projected and goals were set for Weld County in light of these trends. For many of the objectives selected, local data was not available. Therefore, the national objectives were used until local data becomes available. This document serves as a framework for health and human service agencies in planning and programming. (7) These assessments of community need have formed the foundation for ongoing efforts in the area of suicide prevention. This project utilizes both the nation's and county's Health Objectives as guides for its goals and activities. In data presented at the second World Injury Conference in Atlanta April 23, 1993, research shows the most effective models dealing with suicide prevention include school based interventions and identifying high risk behavior and referring or responding appropriately. Garland and Zigler in a recent American Psychologist article recommend linking suicide prevention programs with delinquency, substance abuse and skills building programs. This grant project utilizes these same models. 930 85. 4. Target Population What is the target population relative to the health status and risk reduction objectives? What percentage of the target population will be reached? A. 7.2 There are three groups of providers: 1) Mental health providers deal with suicide prevention on a daily basis. We will target this group only as a part of the Coalition and as trainers and advisors. 2) The general public i.e. , employers, who deal with suicide and its signs and symptoms only periodically. They need to know how to deal with persons at risk. 3) Agencies in contact with higher risk persons, such as schools and law enforcement. Groups two and three are this grant targets for training, education, and resource identification. Another group to be targeted are the survivors of suicide. According to the American Association of Suicidology, six people are directly affected by a suicidal death, and, become at higher risk themselves. (4) This group is in part being served currently by the survivor support group, Heartbeat. Grant services will identify more resources for these people. 7.12 Provider High Risk Situation physicians chronically ill, HIV+, family violence social services family violence, child abuse human resources stressful life events employers stressful life events law enforcement alcohol and drug abusers, incarceration alcohol/drug treatment alcohol and drug abusers centers agencies providing services schools, campfire girls and boys club, to adolescents scouts, pregnant teen programs juvenile diversion adolescents with multiple risk factors media general population with its inherent risks churches general population with its inherent risks 7.13 law enforcement - Greeley Police Department, Weld County Sheriffs Department, rural police departments, private prison facilities B. Using the definition of at risk, as previously stated, the number of persons at risk and the number of agencies providing services to individuals at risk for suicide is unlimited. The clients of the program include the entire population of Weld County 132,000. Agencies specifically dealing with the high risk of incarceration, chronic disease, alcohol and drug abuse will be specifically targeted. In the year ending 1992, training with 0.35 FTE was provided to 300 persons, technical assistance (TA) was provided to 132 persons, and response was given to 101 public information requests. With the 1.25 FTE requested (1.0 project coordinator and .25 office technician) we can provide training to as many as 600 people, TA to 265, and public information response to 200 people for a total of over 1000 people impacted in the next year by the grant. 5. Action Steps List the steps you will use to complete the proposed activities. Include a time- line and an indication of the individual or agency having lead responsibility for completing each step. Steps to Complete the Process Time-line Responsible Party 1. Notify local media of grant First month Project Coordinator award and invite all interested parties to become involved with SPC. 2. Notify identified agencies who First month Project Coordinator work with high risk teens of grant resources. 3. Develop core staff training DONE SPC outline to teach how to identify signs and symptoms, interventions, and resources. 4. Identify new resources and Third month Project Coordinator update the current list. Make it available to the public. 5. Maintain and expand resource Ongoing Project Coordinator materials in written and video form on suicide prevention. 6. Develop a brochure specifically Sixth month Project Coordinator targeted to adolescents and SPC members other high risk populations to identify signs and symptoms for self and peers, where to get help, and other resources. 7. Adapt training outline will Third month Project Coordinator to meet the needs of individual providers of services to adolescents and other high risk groups. 8. Present a minimum of five Month twelve Project Coordinator educational programs to providers SPC members of services for adolescents and other high risk persons will be completed. 9. Contact ten of the largest Sixth month Project Coordinator employers in the county to inform them of training available and encourage agency participation. 9304;05 10. Provide training to three Month twelve Project Coordinator other employers. 11. Mail a newsletter to the Quarterly Project Coordinator entire coalition membership (130) to update them on the grant, activities completed, statistics, and resources. 12. Form a resource committee Third month Project Coordinator to identify and address gaps SPC members in service. 13. Improve methods for reporting data on suicide completions and attempts: • a) investigate the possibility Sixth month Project Coordinator of a tracking method b) coordinate efforts with Ongoing Project Coordinator funeral directors, coroner, SPC members hospital, and rescue squads. 14. Develop and implement Sixth month Project Coordinator strategies for firearm safety education utilizing agencies such as NRA, Wildlife Officers, and law enforcement ie: PSA, brochure, flyers in utility bills. 15. Provide three training Twelfth month Project Coordinator sessions for law enforcement agencies. 16. Offer technical assistance Twelfth month Project Coordinator in the development of protocols to the hospital ER, the county and city jails, and three other agencies dealing with high risk individuals. 17. Sponsor a provider to Twelfth month Project Coordinator, attend a national conference. SPC member, or provider 18. Sponsor the new SPC Twelfth month Project Coordinator board member training. SPC members sa Q'JU 6. Barriers/Obstacles What problems, if any must be solved to complete the proposed process? 1. One obstacle is the problem of identifying agencies and individuals who are in contact with high risk persons. 2. A second barrier is in getting the agency/individual to accept the need for recognition of suicidal signs and symptoms and the appropriate interventions. The community needs to realize the scope of risk factors (stressful life circumstances encompass many things) and understand that any agency at any given time could deal with an employee or client/customer who is at risk. 3. People are not comfortable dealing with chronic debilitating diseases - especially HIV. People are not comfortable dealing with death. These obstacles plus the religious implications and euthanasia issues make suicide a topic people don't want to discuss. 4. Another obstacle deals with the emotional issues around gun control. This grant project will try to avert this issue by only dealing with safety issues and by involving agencies like NRA and law enforcement for assistance and support. 5. In Weld County there is still educating to be done to overcome fears and suspicions about gays and people infected with HIV. Amendment 2 also adds to the reluctance of gays and lesbians to self-identify suicidal risk factors and to seek help. The Weld County Suicide Prevention Coalition has become known and respected by the community and therefore has "a foot in the door" to begin to break down the above-mentioned barriers. • 930305 7. Project Outcome Will the project become self-supporting, transferred or terminated? How and by whom? How will this process affect future activities in your area related to reaching the objectives? The Weld County Suicide Prevention Coalition is applying for a 501(c)3 status. Its goal is to be self-supporting and to continue to seek grants to supplement the volunteer time of agencies and individuals. In 1992, 800 hours of volunteer time was donated. Training and responding to public requests with this community support can continue on a limited basis. Currently we are only charging an honorarium for our trainers if they present programs outside of the county. However, without a grant, we would have to charge for all our training sessions. Additionally, the time and personnel needed to identify and train agencies working with particularly high risk people would not exist. The Coalition sponsors, Heartbeat, a support group for survivors of suicide or anyone who is a friend or relative of someone who has completed suicide. This support group is facilitated by volunteers from the Coalition. Limited printing for the brochures and regular media information is also provided by the Coalition. These services will also be continued on a volunteer basis. Without this initial funding the activities targeting firearm safety will not be initiated. Facilitation to assist in bringing agencies together to coordinate services and to assist in protocol development will be very limited. With this one year of funding, protocols will be in place in some agencies and a sample protocol will have been developed for future use as agencies request. With this one year grant, gaps in services will have been identified and the SPC and/or advisory committee will continue to pursue resources to fill these gaps. Future funding sources will continue to be pursued at the local, state, and federal level ie: Monforts, North Colorado Medical Foundation, and National Association of County Officials. 8. Community Cooperation "The Public Health approach to interpersonal violence and suicide is recent and still developing. It is a multidisciplinary process involving many other partipants. . ." (5) In Weld County the Weld County Suicide Prevention Coalition has been in existence since 1987. The agencies represented on this Board of Directors include: Aims Community College City of Greeley Faith United Church of Christ, Windsor, Colorado North Colorado Psych Care Green Thumb Family Recovery Center Bonell Good Samaritan Center Weld Mental Health Weld County Department of Social Services Weld County Coroner's Office Weld County Ambulance Service Greeley-Evans School District #6 Island Grove Regional Treatment Center Weld County Area Agency on Aging Other agencies in the Community who will be invited to participate include: Sunrise Community Health Center Rodarte Center - A Hispanic Community Recreation Center Weld B.O.C.E.S. Weld County District Attorney - Juvenile Weld County Juvenile Diversion Program Weld County Sheriff's Office Greeley Interfaith Association - an organization of area churches Weld County AIDS Coalition Colorado Wildlife Division, Greeley and Eaton Offices Catholic Community Center Greeley and other local police departments Weld County AIDS Support Groups The Suicide Prevention Coalition Board of Directors will be the starting point in helping to identify all agencies who provide work with people in high risk situations. From those identified, an advisory committee will be established to help and coordinate services. 9d'.na 9. Budget Please explain how the funds requested for each budget item listed on the subsequent page will be used. Personnel - Project Director 5 hrs/wk x 52 wks x $24.41 = $ 6,347* - Project Supervisor 5 hrs/wk x 52 wks x $18.63 = $ 4,844 - Project Coordinator $2,373.74 x 6 months + $2,445 x 6 = $28,912 - Office Technician 10 hrs/wk x 52 wks x $8.33 = $ 5,070 - Advisory Board Members 400 hrs x $25/hr = $10,000 $55,173 *Includes 17% fringe benefit rate Supplies Office supplies, xeroxing paper, etc. $ 500 Printing Brochures, handouts, newsletter, etc. $ 2,000 Duplicating Xeroxing of handouts, informational materials, etc. $ 500 Telephone Lease cost of telephone for staff for an annual period $ 100 Postage • Postage for mailing flyers, etc. , to Advisory Board members and other community members and agencies $ 500 Information/Education Materials Videos, pamphlets $ 1,500 Travel 2,000 miles x $.25/mile reimbursement + $1,000 for conference attendance $ 1,500 Meeting Cost Annually $ 250 Overhead/indirect Approved 18.37% of Personnel = $8,298 - $2,720 to grant, balance in-kind 93CC85 V.BUDGET EXPENDITURE PERIOD 10/1/93 TO 9/30/94 Applicant: Weld County Health Department Funding Period: 10/1/93 to 9/30/94 IN-KIND/ LINE ITEM CDH REQUEST OTHER(IF ANY) Personnel (Number & Title) Project Director (include resume) (.12 FTE) $ 6,347.00 Project Supervisor (.12 FTE) $ $ 4,844.00 Project Coordinator (1.0 FTE) $ 28,912.00 $ Office Technician (.25 FTE) $ 5,070.00 $ Advisory Board Members $ $ 10,000.00 Supplies $ 500.00 $ Printing $ 2,000.00 $ Duplicating $ 500.00 $ Telephone $ 100.00 $ Postage $ 500.00 $ Info./Ed. Materials $ 1,500.00 $ Travel $ 1,500.00 $ Meeting Costs $ 250.00 $ Consultant Costs $ $ Equipment $ $ Space Rental (incremental cost only) $ $ Other (specify) Incidental Overhead $a $ 5,578.00 Allowable 18.37 TOTAL EXPENSES $ 43,552.00 $ 26,769.00 • u'C"fiJ References 1. Colorado Department of Health, Health Statistics and Vital Records Division, Health Statistics Section (1992) Colorado Vital Statistics 1990, Denver, Colorado: Colorado Department of Health 2. Cook, Lane (1993) [A Colorado Department of Health study of suicide rates between April 1990 and March 1992] Unpublished raw data. 3. Hall, W. (1993) [Weld County Suicide Completions of 1992] Unpublished Raw Data. 4. McIntosh, T. L. (1990) U.S. Suicide: 1990 Official Final Data, American Association of Suicidology, Denver, Colorado 5. National Committee for Injury Prevention and Control (1989) Injury Prevention: Meeting the Challenge (Education Development Center, Inc. , D.H.H.S.) American Journal of Preventive Medicine, 5 (supp.3) , pg 194-259 6. U.S. Department of Health and Human Services, Public Health Service (1990) Healthy People 2000: National Health Promotion and Disease Prevention Objectives (D.H.H.S. Publication Number PHS 91-50212) Washington D.C. : U.S. Government Printing Office, pg 230-242 7. Weld County Health Department (1991) Weld County Health Objectives for the Year 2000, Greeley, Colorado VITAE GLENDA SCHNEIDER, B.S.N. WORK EXPERIENCE: Weld County Health Department: 1981 to present Director of Community Health Services: September 1989 to present Nursing Supervisor: 1984 to September 1989 Staff Nurse: 1981 - 1984 AIDS Coalition Chairperson: 1987 to September 1989 AIDS/HIV Coordinator: 1986 to September 1989 Charge Positions Held: Maternity Clinic, STD Clinic and Family Planning Clinic Larimer County Health Department: 1979 to 1981 Staff Nurse and Charge Family Planning Program UCLA Medical Center, Los Angeles: 1975 to 1978 Staff Nurse and Charge Nurse Orthopedics EDUCATION: University of Northern Colorado: 1971 to 1975 Bachelor of Science - Nursing AFFILIATIONS: National Public Health Association - member 1988 - 1990 Colorado Public Health Association - member 1987 to present AIDS Coalition for Education - Board of Directors 1988 - 1990 Northern Colorado AIDS Project - Board of Directors 1987 - 1989 Colorado Department of Education AIDS School Nurse Advisory Committee 1987 - 1989 CAHEC AIDS Education Advisory Committee 1987 - 1989 March of Dimes Greater Denver Chapter 1989 to 1992 March of Dimes Greeley Division 1990, secretary Sigma Theta Tau Personal Board and Care Governor's Advisory Committee 1989 to 1992 Baby Care Governor's Advisory Committee 1991 to 1992 JOB DESCRIPTION Position Title: Suicide Project Reports to: Director of CHN or Coordinator designee Date: Department: Community Health Nursing (CHN) GENERAL PURPOSE Within the framework of agency program and policy has primary responsibility for planning, implementing and evaluating services for a designated population through systematic assessment of health needs and optimum utilization of personnel. ESSENTIAL DUTIES/RESPONSIBILITIES Orients project staff to agency policy and program and to services provided by other community agencies and organizations. Collaborates with Weld County Health Department staff, other health care providers, professionals, and community representatives in ing, planning, implementing and evaluating programs for community health. Takes responsibility for continuity of patient care through planning with key personnel in health care facilities and community agencies. Develops and utilizes written protocols for the performance of activities specific to assigned program area. Develop outreach plan and materials. Provides counseling and teaching about suicide prevention. Performs outreach education and networking to agencies in the community. Responsible for hiring, orientation, and evaluation of program staff. OTHER DUTIES/RESPONSIBILITIES Performs related work as assigned or required. Involved in the budgetary process. SUPERVISORY DUTIES Has responsibility/authority for supervision of assigned personnel and programs within the Nursing Division. Accepts delegated responsibility for project administration in the absence of the Director of Community Health Nursing Services. JOB QUALIFICATIONS Knowledge: Working knowledge of community resources. Knowledge of and ability in supervision, organization and administration of program. Skill: Provides staff development through in-service educational program, individual guidance, performance evaluation and other methods. Demonstrates mature judgement in the decision making process. Ability: Ability to communicate effectively orally and in writing. Ability to establish and maintain effective working relationships with employees, other agencies, and the public. Ability to present a positive image and to promote the program publicly. 9300 5 Education or Formal Training: BS in the Human Services Field Experience: Minimum of two years experience or any equivalent combination of education and experience. Management and outreach experience preferred. Material, Equipment, Machines Directly used: Valid Colorado drivers license and use of personal insured vehicle. Computers. Working Environment/Physical Activities: Multiple sites throughout the county in attending meetings and doing presentations. Driving, walking, standing, stooping, sitting, lifting, and carrying supplies. • gs a:phdjob March 1993 93C-•73P— il*Weld County AIDS Coalition Weld County Health Department 1517 16 Avenue Court Greeley, CO 80631 July 7, 1993 To whom it may concern: The Weld County AIDS Coalition supports the efforts of the Weld County Suicide Coalition. We have collaborated in the past and we are excited that the Suicide Coalition has chosen HIV-related suicide issues as part of its focus. We will continue to provide cooperative measures around HIV educational concerns. The Weld County Aids Coalition views the Suicide Coalition as an important link in providing this community with prevention education and intervention resources for both suicide and HIV/AIDS concerns. Sincerely, (dal- &df it Jill Burch, Coordinator Weld County AIDS Coalition WELD COUNTY HEALTH DEPARTMENT 930:::05 353-0639 Weld Mental Health Center, Inc. 1306 11th Avenue Greeley, Colorado 80631 353-3686 July 9, 1993 Glenda Schneider Director of Nursing Weld County Health Department 1517 16th Ave Ct. Greeley, CO 80631 Dear Glenda: b This letter is written to express our support for your suicide prevention and education block grant. The Center has a strong interest in the area of suicide prevention and believes that additional efforts in this area are in the best interest of all the citizens of Weld County. The Center's current funding is for direct services only and we do not receive any funds for commutation and community education. Your efforts in this area will supplement the direct services that we and other mental health professionals provide to persons who are suicidal and to family members who are survivors of a suicide. Sincerely, Q - • Dale F. Peterson, NSA, Ze Executive Director Kent Jackson Michael Lazar Hazel Chick Fred Tjard n President - Vice President Secretary Treasurer at.11b,.0 July 8, 1993 Weld County Health Department Glenda Schneider 1517 16th Avenue Court Greeley, CO 80631 Dear Ms. Schneider: This letter is being written as a letter of support for the Preventive Block Grant Funds. As the facilitator for the Weld County AIDS Support Group and the Weld County Family and Friends AIDS Support Group, I strongly feel there is a need for paid individuals to provide support, assistance, education and resources in Weld County for people who are at high risk for suicide due to the HIV virus. Individuals who are affected either directly or indirectly by the HIV virus have often thought of suicide when experiencing a lack of support or assistance (feeling of hopelessness and helplessness). They often feel there is no where to turn and many times do not seek help due to fear of victimization. As a result, they experience suicidal thoughts and the risk for attempts is great. There is a need in Weld County to have a professional who can provide resource linkage to those individuals who feel suicide is the solution to a positive HIV status. The need is in Weld County and we must find a way to meet that need. I strongly support the Prevention Block Grant Funds for the Weld County Health Department. Sincerely, ate K Susan K. Sabas, MSW, ACSW Facilitator /vt 950:.85 Y N..-41341, am'Mr'•' • \Yr' ■ I I WELD COUNTY HEALTH -t- OBJECTIVES FOR THE YEAR 2000 ...,-y j ' r Q 01": S. A Public Health Planning Dochanant i • • \ . • i i • ■■ • ■■■■ or ■ \1 , Q 930;3' 5 WELD COUNTY HEALTH OBJECTIVES FOR THE YEAR 2000 A Public Health Planning Document • • • • • • OaC .n5 AK,(owLEDcMENrs . The following objectives were approved by the Weld County Board of Commissioners - _, on July 17, 1991. Weld County Board of Commissioners: Gordon E. Lacy, Chairman _ George Kennedy, Pro Tem Constance L. Hasten - C.w. ICuby - _ W.H. Webster Appreciation is extended to the Weld County Community Health Coalition for .. _- reviewing and approving the objectives in this document. • •Weld County Community Health. Coalition Members: Margo Barnhardt • School District Six • - _ Dick Bond, PhD. Educator Brian Cooke, PhD. UNC Dept. of Community Health - John Wilde Island Grove Regional Treatment Center " Joe Ferguson, M.D. North Colorado Family Medicine Arnold Foulk, M.D. Weld County Medical Society - - Kari Gills North Colorado Medical Center • " Randy Gordon, M.D., MPH Weld County Health Department - .. North Colorado Family Medicine - Robert Guthmann CentenniAl Area Health Education Center (CAHEC)' Joe Fletcher, M.D. Plan de Salud del Valle Dick Hodge School District Six -. Jeannine Ttuswell United Way • Ron Loeppke, M.D. Occupational Medicine, Greeley Medical Clinic Judy Griego Department of Social Services - : Dale Peterson Weld Mental Health Center Linda Piper Area Agency on Aging Keith Rangel, M.D. Sunrise Community Health Center - " . Mary Sanchez Monfort of Colorado, Inc. ' Gary Schrenk NCMC Foundation . - -. Mary Jo Vargas City of Greeley. - . - This document was prepared by the Weld County Health Department including the _ following people: . Judy Anderson Marian Ruge, RD Lesli Bangert, MA Glenda Schneider: RN - Shelagh Fagan, RN Kathy Shannon, RN " Randy Gordon, MD, MPH Laura Sullivan Paul. Hartlaub, MD Jeannie Tacker Wes Potter Ruth West, RN - • Weld County Health Objectives for the Year 2000 93C %!1J l %Low and Very LowBlti Weights- Weld County , 10 Lew `Lsw - 1500-2499 grits 0-1499 gms _ _ _ roltsc.e a e J - 6 YEAR 2000 GOAL: < 5% rJ 4 . - u` 2 rra�ec;ea< ratat _ ..- - A_ _G._ _�.__ __2._`^_ YEAR 2000 GOAL: R - r 1 r a r 1980 1985 1990 1995 2000 Yecr • FIGURE 2. Source: Co. Dept. of Hestth.Health Stets. Sect. - LBW = low birth weight, VLBW = very low birth weight OBJECTIVES 3 AND C��HFALIS . o Reduce the infant mortality rate to no - more than 7 per 1,000 live births. " (Figure 1) o Reduce low birth weight to an inci- ' dence of no more than 5 percent of live births and very low birth weight • to no more than 1 percent of live births. (Figure 2) o Increase to at least 90 percent the proportion of all Pregnant,women who receive prenatal care in the first. trimester of Pregnan=cy. (Figure 3) Weld County Health Objecitves for the Year 2000 Page 3 qtr qS . 'WE` DENTALOEJECIIVES . • One area often neglected in children is o Reduce untreated dental caries so that that of dental health. Dental health may . the proportion of children with • be incorrecttly considered by some a untreated caries in luxury. It is usually one of the first p ( permanent or health care items to be omitted horn the primary t is no more than 20 percent among children health budget of the family who is through 8 and no more than 15 e rgo' a financial hardship. If dental percent among adolescents aged 15.* health is lost during childhood, it cannot be restored_Obtaining information to • Loc.,d... not.r.il.b,..od objective' track these indicators of maternal and , .dea.d from child health is possible the present x..,tir Po'°�. ° year 200O°'°°°'' objectives.. time except in the case of dental health. ' • Therefore, the year 2000 objective for Weld County relating to dental health is • adopted from the national objective. As data become available, this objective. may ' . • need to be revised to reflect our local situation. • • ' l 1st TiimesterPrsnrata/Cam - Weld Camay V 1OO • . . YEAR 2000.GOAL: 907. .-- BO ‘-• ` �. . . !—Q — — -1ac_ed Rote_ — - - a 0 40 Of - 0 I f ' a� 1980 . 1985 1990 1995 Yee- 2000 . FIGURE 3. sauna: ca. Dept. of Health, Health Seats. See- Weld County Health Objecitves for the Year 2000 Page 4 FAMILY PLANNING a family are of to support families begun by teenage paramount about importance mothers. These funds were channeled paramount today regarding our san through public assistance programs, i.e. • Choices made today yhave Aid to Families with Dependent • vidual's sexual for that ty n'snab to Children, Medicaid, and Food Stamps. consequences person's have a family, lead a healthy life and in some instances, even survive in the Effective family planning and the avoid fance of unintended pregnancy can future. improve infant health. Adolescents who tenancy has become an ever- give birth tend to have a higher Teen p frequency ofpoor health outcomes. This increasing ateof sexual activitylem in this nation g adolescentsa thefactor idue ot only to intrinsic hate increased initiation n medical risks because of age, but also has ualct and age of ed. often due to socioeconomic and - 19 sexual activity has dmillion• snag behavioral situations such as low in- 1973, more than one million teenage come, low levels of education, poor• girls have become pregnant inn active nutritional and general health habits. For , is means that 1 in 5 sexuallymany women, contraception increases teens become pregnant and that there is - the interval between births a conception every 30 seconds among thus decreasing the risk for .., files adolescent females in this country. A low birth weight babies. study carried out in 1985 by the Alan Furthermore, women . , of pregnancy Institute found that the rate who plan their pregnan- :- of pregnancy among 15-17 year old • • females was 71.1 pregnancies per 1000. cies tend to seek earlier.prenatal care than 11.—."---7—'4.- This is one of the highest pregnancy r_:/'..•/,•f:-, ' .. rates in the world, reflecting the fact that .women who conceive ;;. o-:i teenagers in the. United States are much unintentionally. • P. {• less likely to use contraceptives. Fight in Fam�y planning ' ' ; ten pregnancies among this age group Family not only must r j� '` , a,, are unintended. Thee ' i rate for 15- issue of only (( �' ✓ I 19 year olds is 43.2 per 1000 live births -; • don but the 3' • • in the United States. While pregnancy insidious also increase = - ' • rates track the known number of concep- of sexually .A . . ii• <•, ' /, dons, the fertility rate records live births, • thus separating out induced abortions mined diseases ';- ; ' ,. - and spontaneous fetal loss. (STD's) including v}r� AIDS. Earlier The negative consequences of unin- initiation of - tended adolescent pregnancy include sexual inter- i• induced abortion (43% of pregnancies course in teen- i _ . . among teens age 15-17 end in abortion), agers is associ- '-_ ,; • emotional and psychological disruption, ated with an social and economic hardships for the •increase in the teen, her family and her child, and far- '1111relihood of reaching economic effects for society having multiple • as a whole. Interruption of a teen's • bets. Teens • /' schooling due to pregnancy/child-rearing account for one- ) • generally will retard the adolescent's 'fifth of the annual ,l r 12 million cases of " achievement of social and economic in the s TD' United ;.1 independence. In 1985, an estimated SSID'States. One in six $16.6 billion in public funds were used ; Weld County Health Objecitves for the Year 2000 Page 5 930J," 5 � sexually active teenagers becomes in- For every dollar invested in teen preg- fected.. The rate of syphilis infection nancy prevention, Colorado taxpayers increased 67% among 15-19 year olds save $12. Teen pregnancies in Colorado - . since 1985 and chlamydia, the most alone cost taxpayers S200 million common bacterial STD, infects 4 million annually (1).. Two-thirds of all single • people each year, with adolescent girls, • mothers age 14-25 live in poverty. The age 15-19, having the highest infection • problems of conducting a successful - rate of any age group. These diseases - Family Planning Program—particularly can have profound long term conse- . toward the objectives of reducing teen - quences, including infertility, cancer, and, pregnancy and promoting the use of in the case of HIV infection, dr+rh combined contraception in unmarried - sexually active couples 19 years old and - Weld County ranks 6th in Colorado for' younger—are multifaceted. A one dunen '`• : its teen pregnancy rate. Its 1987 fertility . sional approach is not likely to . rates exceeded those of the state for 15- succeed given the cultural, economic, - 19 year olds IColorado-46.9 per 1000; -_ • ethnic, educational and social - • Weld-15 to 17 year.olds, 34.1-and 18 to - backgrounds of the individuals targeted. -. • 19 year olds, 74.2). In 1989, Colorado's ' A successful program is one which • • fertility rate for teens aged 15-19 had - will lead these individuals to make . climbed to 535 births per 1,000 marking responsible decisions based on full • the rate's fifth consecutive annual •. lmowledge and acceptance of the cone- • increase: quences of their action. Particularly in -' • : Teenage F�e tfllty. Rate : Weaw County , = • •• 30 -• - c+ _ • a c..-.1.2 -,•- Rc. - - - - — _ - - a . - E 3° _ _ c el- - o - G YEAR 2000 GOAL — 28.0 . • C 20 • a, i0 - . . •C a t 1980 - 1983 - 1990 1993 2000 - - Yecr FIGURE 4. Sours Co. Dept. of Health: Health State. See. . Weld County Health Objecirves for the Year 2000 Page 6 93C--(.25 x teenagers, postponement of sexual _.r - _ activity is the unintended means of an and • rR preventin,onin ended sexually transmitted disease. Research supports the belief that adoles- \ - cents can respond positively to �i - • directive counseling from adults about tn."lity. Furthermore, authoritative � . `r guidance in helping clients select contra • - ceptive methods seems to improve • > compliance. Also, the creation of envi- Q' C ronments within communities that support teen decisions to postpone sexual activity are crucial. Successful • . Family Planning Programs are those • ' ,. which utilize the combined resources of . . . the community to promote sexual . • . abstinence in teens. o to resources media, include parents, clergy, etc. FAMILy PLANNING OBJECTIVES • Programs within Weld County which strive to provide family planning services o Reduce the number of teens who * using the above principles include the . _ . have engaged in sexual intercourse Health Department, Sunrise Health by age 15 to no more than 15 per- Clinic, Planned Parenthood and, pram- . . .,teat; by age 17 to no more than 40 laxly, the New Horizons Clinic for - percent.* • teens at Salud in Fort Lupton. Commu • - nity organizations such as CAPP . o • Reduce fertility rate among girls aged (Coalition for Adolescent Pregnancy 15-17 to no more than 28 per Prevention) and the Teen Task Force are _ 1,000 adolescents. (Figure 4) (Na- • working together to further define what tional Objective: Pregnancy rate 17 • • services axe needed for teens to help ' and under - 50 per 1,000 adolescents) them deal with sexuality issues as well as • the entire spectrum of adolescent o Reduce to no more than 30 percent • health needs. . the proportion of all pregnancies axe unintended.* (1) 1986 Report on Adolescent Health in Cob redo, Colorado Department of Health. o Increase to at least 90 percent the • . proportion of sexually active, - unmarried people aged 19 and . • younger who use contraception, -especially combined method contra- • ;cepdon that both effectively prevents • .Ply and provides barrier pro- • • anion against disease.* • Leal ea ex readable and *wan •doPd tint Preto wool.2000 th.year 000 eadonel obpeuve. Weld County Health Objecitves for the Year 2000 Page 7 930.:. 5 COMMUNICABLE DISEASE PREVENTION • People of all ages, races, and economic water, and basic dicnce prevention groups have a potential of developing .. education. a communicable dit.ga. or vaccine- preventable disease. These dic.•rses are In 1990, Weld County Health Department • transmitted from an infected person, (WCHD) received a total of 355 animal, or object through direct or • referrals of Weld County residents in- indirect contact to a susceptible host. fected with a reportable communicable Much progress has been made in the disk..- Prompt investigation, treatment reduction of infectious diseases in the and education is essential in preventing past 100 years through the development the spread of disease. Childhood vac- and use of vaccines and antimicrobial tine-preventable dic.asas have been drugs, and by educating the public on reduced dramatically through the. institu• dis ce prevention. don of state and local immunization - - • • laws. However, in high-risk under-immu- Even with the advent of modem disease nized groups these diseases remain a prevention some of society's practices problem. WCHD, Sunrise Community ": still cause and spread many preventable Health Center and Salud Family Health illnesses and deaths. Overcrowding in . Center offer childhood vaccines at a low our metropolitan areas and tural migrant cost to the public. Over 95% of school- -- camps, the increasing use of day care aged children in Weld County are in - centers and nursing homes, and unsafe • compliance with Colorado's immuniza- sexual practices are examples of a few • - don laws. . instances where communicable diseases - :could be better controlled through good s APPandixA for'nen un of hygiene, proper handling of food and - ` s Wit by Colorado -• . - - - : l Vecahe-avventable Diseases- Weld County ( - •4a . - H Flu Inci ant IJaaalea 4unroa Pertuaaia l.• ..mot nv\...y . .. _ - . . • Rubella Tetanus Madura Projection e� ti tiros 5525532 _ -• - - m - • N • 20 .• te • • ... ......,.. to. , , , iYEAR 2000 GCAL — "0"4. zi IL ,.....• , ,�� , 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Varis FIGURE 5. Source Co. Dept of Health. Health star. Sc. Note: H. Flu recording began 1986 Weld County Health Objecitves for the Year 2000 TT r Page 8 yam' R"'0J'- , GOI7OfT/768 Incidence - Weld County E25o • zoo \ o 150 .-2 C J \r _ a • _ r00 \\ ' r YEAR -2000 G0AL: .< 50.0 �_%\ -, • 5a -al+ ^ 7 ' - Of� N. 0 1983 1990 1995 2000 1980 Yet:- • - FIGURE 6..Source: Co-Dept. of Health. STD/AIDS Program Co. Dept- of Health.-Div- of Vit. Slats Pneumonia and influenza are two of the . Sexually transmitted diseases (STD's) are major causes of respiratory illness in _ infections which are transferred the United States. These diseases are from person to person during sexual contact. Over 50 organisms or syn- adveryparticularly severe children.in elderly persons ed.. In addition and very young Almost 90% of 'tomes are now recognized. STD's all influenza associated deaths in the to the most commonl chlSTD's , U.S. occur in people aged 65 and older. (gonorrhea and syphilis), illoa, Effective Cc3.l an to fight against genital herpes, and human pap o pneumococcal and influenza viruses are virus are among the few on the growing list. There are many serious complica- populati for nee in the adult gave 2,921 lions resulting from STD.. Pelvic inflam- popu n an. In 1990,esand w® e disease (PW), ectopic pregnancy, • influenza n s vaccines 150 p eft qty, fetal and infant death are among vaccines to Weld County residents. complications, . Warr) continues to try to educate the some of the more serious P• persons of Weld County in the impor- with the chance of acquiring human rm_ lance of receiving an annual influenza munadeficiency virus (HIV) being the vaccine, as well as encouraging high tisk • most serious. individuals to receive a pneumonia STD's affect approximately 12 million vaccine which should give lifelong year. Young people, low- - immunity. Americans a Weld County Health Jbjecnves for the Year 2000 Page 9 930205 • income, and minorities are at the highest , fected with HIV in the United States. An risk to acquire an STD. About 86% of STD's occur in those aged 15 through 29 estimated b S13 billion statistics be spent on years. Society spends over S3.5 billion evidence 1�at and statisaes are • annually in the diagnosis and treatmentHIV and AIDS will con- of STD's. Some progress has been made dime to make major o demands on our in the area of t eannent due to techno- hSealth there is no om for ye an to coma logical advances and the use of antimi- major there is of cure health AIDS, the crobial drugs. However, variant changes must be stop the spread of �system in the germs and resistance to medics- dons is expected to ,ton, infection. Vaccine development is a high priority, and there are several vaccines in In 1990, there was a 1.1 increase in the early experimental stages. Because cases of gonorrhea and a 1.6% increase many HIV infected persons don't realize - - . in syphilis in Weld County. In addition, they carry the virus, counseling and there were 70 cases of chlamydia diag- testing uc for the public is a necessity. nosed and treated in Wcg Education on the prevention of HIV is alone. Within our community,STD e have essential not only to Imown.high risk some groups that an high nity for ac- *groups, but to the general public as well. quiring STD's. The availability of STD The Weld County AIDS Coalition has set a goal of services is essential in the prevention and ou to,Weld Counnviding accurate information treatment of these diseases. There are ty. • two low-income clinics and many private - In Weld County, many health clinics offer :physicians in Weld County who are able ETV testing. WCHD offers free to treat persons with STD's. WCfID has testing a confidential. test site specifically geared testingandco and elico for HIV The need for to counseling, educating, investigatinge of 30eii visits is evidenced to by . and treating STD's. While some progress avenge of 300 De per t the •... • - • • has been made, health care workrs. Weld County Health Department HIV • need to continue to concentrate on alt • decreasing these diseases through educa- • . don, diagnosis, and treatment of all persons in Weld County. •. - - •The human immunodefici virus (HIV) is an extremely Y -• f f _ •.. cable disease that serious communi- .. linked with S historically has been : STD's and high-risk behavior ' � such as IV drug abuse. At least fifty percent of persons with By who are not :: ""••••............ . Crated will develop acquired immunode- _- : - cy syndrome (AIDS) within 10 years ■ ' • " ' :: . infection. (About another 40% will.. develop other serious illnesses t associated with HIV infection_) Many also experience societal O° • Although some drugs may there is no available cure for IV ortendb • 1 ::. AIDS. An estimated 1 minion . • {��. ." • people are in- Weld County Health Objecitves for the Year 2000 Page I0 9.3C22,5 • o Increase immunization levels as COMNIWIC•�LE DISEASE follows:` PREVENTION OBJECTIVES Basic immunization series among o who educe the proportion of adolescents - children under age 2 to at least have engaged in sexual 90 percent.intercourse to no more than 15 per- cent by age 15 and no more than 40 Basic immunization series among percent by age 17.' children in licensed child care facilities and kindergarten through postsecondary education institutions to at least 95 per . o Reduce gonorrhea to an incidence of cent. no more than 50 cases per 0,j00 • • people. (Figure 6) (National •pnettmoeoccal pneumonia and tive: 224 cases per 100,000) - - influenza immunization among . dia trachomatis infec- . institutionalized chronically t11 or o on measured • older people to at least 80 dons, as by a decrease in - • percent. the • the incidence of nongonococcal - urethritis to no more than 170 cases Paeumoccecal pneumonia and in per 100,000 people.* flea immunization among noninstitutionalized, high-risk o Increase to at least 50 percent the • n • populations, as defined by the proportion of eually • Immunization Practices Advisory • unmarried people who used a con- - • • •• Committee to at least 60 per- dom at last sexual intercourse.' .. :. . cent.. • •o ..Increase to at least 80 percent the • Hepatitis B immunization among proportion of HIV-infected d people :. high-risk populations, including - who . been tested for HIV infants of surface antigen-positive infection.' - mothers to at least 90 percent; occupationally exposed workers• •o Increase to at least 95 percent the to at least 90 percent IV-drug Proportion of schools that have users in drug treatment programs age appropriate HIV education tunic- to at least 50 percent; and home- a for students in 4th• of gh ory12th . s men to at least 50 percent. -. grade,rade, preferably as p school health education.' .: • royal dam not available and objective adopted from .. Im tnLtll7a[rotlS • - aS .pp0• ate yar t oil O1N�ves. • o No occurrence of vaccine preventable • childhood disease by the year 2000. - : .o Reduce epidemic-related pneumonia . and influenza deaths among people aged 65 and older to no more than 7.3 per 100,000 people.' • .e._, .._... va,irh nh;ecirves for the Year 2000 Page 11 930,,05 INKY PREVENTION the a 1 W la County major leading of the ages mated cause of death In addition to causingdeath, it is esti- 1 to 44. The tragedy of injuries lies in bo that i87, an ve Colorado 5f4 the fact that they usually occur without every citizen. in 1987, an average of S438 for • aging, leaving those affected little or amen no opportunity to.prepare for the cone- ' quences. Further, they strike the younger Injuries cn be d"� by improving in population diroropordonately, resulting behavior, nd modifying inappropriate work potential and lost potential by enacting policies and years. Injuries are not accidenu or ��°th de is is illustrated random events. They are preventable. through thecrashes ass in deaths the • automobile throughout the Motor vehicles are the major cause of 1980's. This decline is anaibuted to unintentional injury. Twenty-four Weld better designed automobiles,belts, less County residents were killed in motor people wearingmore vehicleseat ing l people second crashes in 1987.. -Falls were the . - ersr drinking and dritibel policies ofand employ- leading cause of death by" injury req firing requiring seat belt a law in 1987 accounting for seven d uuzn seat belt usage. - • iatentional injuries k deaths. • ge These same account for a little causes o need u to applied to other .. more than one-third of all injuries. causes of injury, .. these, one third are homicide and two suicides. • • Un/n119a J//n/uryMarti/it,,- We/a,Cown , 7o - p 6n ., - _ .ANA only Toped _ a 50 A A . oso C. �- 30 - , . - �� YEAR 2000 GOAL: v` - Total: < 20.0 =+ r a WA only cn 20 rr 10QJe �� . O� - _ tt CO el . • 0 1980 1985 .` . 1990 1993 Yea: Zo00 FIGITRE 7. Source: Co. Dept. of Health. Health Stn Sea. _ . e Weld County Health Objecitves for the Year 200O - r Page 12 - *l Weld County Suicide Rate z5 - 2a ; � te 15 - - " " YEAR 2000 GOAL - 15.0 10 ... - • _ .; • .� 5 .. - 71 - .. 1 1 • 0 1985 1990 1995 2000 1980 ... FIGURE S. Source: Co. Dept. of Health.Div. of Vital Stns. _ The Injury Prevention Advisory Board to - . the Colorado Department of Health recently released its.plan to reduce- injuries to Colorado citnens 1991-1996. This plan endorses a grass roots ap- . . proach to injury prevention. Fortunately, _ we have- a community group that recog- nizes the importance of preventing deaths and morbidity from injury, the Weld Safety Network. This group is a ' • • - . Coalition through which many of the . objectives listed here can be achieved. \ II Nit, / . - Weld County Health Objecitves for the Year 2000 Page 13 9343:305 • WJURI'PREVENTION OBJECTIVES • Unint— entignal • • o Reduce deaths caused b nodal injuries to no more y than 20.0 0 Reduce the suicide 15 per 100,000 late to less than per 100,000 people. (Figure 7.) nai Objective:by 2000. 1 (National Objective: 29.3 per 100,000) per t 0)(Nationa! 10.5 • Per 100,000) ° Reduce nonfatal unintentional injuries • Child and na • so that hospitalizations for this Abner 100,000condition are no more than 754 per o Reverse, to less people. than 25.2 per 1,000 children, the rising incidence of o Reduce deaths caused by motor - maltreatment of children younger vehicles to no more than 10 per than age 18. (Figure 10) - • 100,000 people by 2000. .. _- -_ per lure 7)(National Objective: 16.8 o Reduce physical abuse s totted at )' a male partners to no more o Reduce work-re than 27 per 1,000 couples.* in death to no m than 4 resulting • tow�„ Doc ar.ir.bre and peter;100,000 full-time x..ba. p..,_ °' aado aj o from (Figure 9) time workers. --'�"stam, the year 1000 ,.;,nd ob tdv... • • Web'Gamy Occupations/in/wit/oar/4'y ;; 4420 L. C. Agiadhrm . • ;a �,_-7 Construction �mw,etwnq J00 I Tranap, ®c. Pub. um. wnTrade g� Prni.cdon,overalloverallrota — . • - u - 200 • ci C C • C C O 100 m • YEAR 2000 • •. GOAL < 4.0 • iz c 1982 1983 1984 1985 1986 1987 1988 1989 1990 'it-- FIGURE 9. Souse Co. Dept. of Health Health Shea Sect. - Weld County Health Objecitves for the Year 2000 ^r:r Page 14 9:93C'S 5 • • • • ChiId/lbuse Rate - Weld Count _ - 60 . . . 50 - -fesk � • , • - . . ,/J TN . G • r• . - ._` 30 _ _ - , _ a. 2oaa cow 2s:2 . - - , • N _ . . ma - r 10 • " a 1985 .. 1990 1995 -.2000 - 19817 Yew'. :: FIGURE 10. Sources:•Weld County Dept. of Social Serviw . -.Centers for Disease Control, Atlanta, Georgia ter r...,,,.ra FTraltb Obietitves for the Year 2000 Page 15 9 C" ; CBRONIC DISEASE PREVENTION Coronary Heart Disease is a major public strategies: health problem in the United States. This clicestcP continues to kill more than 1.Patieat-based strategies which seek to 500,000 Americans annually. In help those with the highest blood chokes- addition, Coronary Heart Disease costs • terol levels (over 240 mg/di).the U.S. economy over $500 billion annually. Heart divan«• is the number 2. A population approach which aims one single cause of death in Weld both to lower cholesterol level of County. m tz1 individuals and reduce the average Coronary heart disray ys result of cholesterol level throughout the popula- tion. . deposits of cholesterol along artery walls. 'This • cause in7 o restrictsdeat blood of flow and may The first step in both of these strategies beyond the site of reduced blood flow in is elto increase Screeningaw is snbes of cholesterol by the coronary arteries. A.desirable blood levels. best performed by cholesterol level in adults is below 200 one's primary care provider.o However, . cholesterol screening is also done by the mg/di but the average cholesterol level for U.S. population is 210 gm/dL For Health Deemer and nt er Colorado es these.reasons we need two kinds of Medical ducati about u l other ssureies. .• Education blood pressure and • • • f Age-Ad*ri'ed Hest Disease Marta/By- Weld Co. , . • zoo • a c \ c — 150 - - Ca C \�_ r_ C .. y \J C \ \ • O too L. 3..-., .. C . YEAR 2000 GOAL: • �, 12t < 75.0 a `- --- • n DC - • a - C C . 0 • • 1980 1985 Inc � 1995 2000Y ear FIGURE U. Source: Co. Dept. of Health. Health Stun. Sect. - Age adjured to 1940 U.S. population standard Weld County Health Objecitves for the Year 2000 Page 16 9asC::"�5 ‘\ Age-Adjusted Cancer Modally, Weld COWRY 120 — - =.=.acted 2 tow _ — 90.0 — — YEAR 2000 GOAL — - — an a . C 60 _ — .. - 20 - • 1995 2000 1990 o taco 1985 •Yam Dept of Health.Health Shu. Sect FIGURE 12. Age a:adjusted U S u►anon standards Age to 1940 � •-� abort the latest txommendations for the o screening for all kinds of cancer. We cholesterol level reduction should occur • strongly encourage adults to follow byin physician offices and is. offered the current U.S. Preventie Services walk Adult the Health optics. at its Well - and rural clinics. . Force Guidelines.of death in There are 30 million people over.the age The second leading wa of 65 in the United States. 60 percent of Weld in Weld in Count-y, was cancer. m to 1988929.1 in s per 100, 00 people caused -these are hearing impaired enough function deaths 100,000 over interfere with their ability age 65. This e of 1062.9 normally. For the general population, in is low compared to the per 100,000 for of hearing impair nacioaal rate U.S.p is currently 120 per 1,000.cs1 the same age group strar It becomes impo?�.• therefore, that The most important risk wand • •• health care provtde� teach chews all egycancer for coronary heart use of to- dance reof loud noises• hBusinessescliisthe is ducts.an h fiber • must also be aware of noise level standards dietproducts. A low-fat, g ' ear protection for exposed also appears to reduce risk for colon and provide a Screening should be done to canoe egy to reduce the employees. death from cancer is to educate . .._ ,.� nt„eLitves for the Year 2000 Page 17 9 C:c;J identify and treat those with hearing loss. Current data indicate that 23% of persons aged 65-74, 33% of persons aged 75-84; and 48% of persons age 85 and over have a hearing impairment m. Screening is available through private physicians, University of Northern Colorado and the Weld County Health Department. I. Public Health Services report "Populace,' Strategies for Blood Cholesterol Reduction." 2. 1989 Vial Seat:soca report ' , 3_ U.N.C. Department of Audiology Einar a Cancer Mons/11y- Weld CountyFema/es , . - _ - - 20 - II C. YEAR 2000 GOAL - 20.6 G GI 10 47 . C • a • 1980 1985 . 1990 1993 200O ' Yew FIGI: RE 13. Source: Co. Dept. of Heath.Health Stara. Sect. Weld County Health Objecitves for the Year 2000 Page 18 e.3 ,;.;,:5 CHRONIC DISEASE PREVE S ION . OBJECTIVES - - . o Reduce age-adjusted coronary heart dicrace deaths to no more than 75 - - . per 100,000 people. (Figure 11) (National Objective: 100 per 100,000) . Cancer o Reverse the rise in cancer deaths to - • achieve an age-adjusted rate of no - - more than 90 per 100,000 - people.(Figure 12) (National Objec- • tive: 130 per 100,000) a Reduce breast cancer deaths to no ... • : - • - - more than 20.6 per 100,000 women. ' -(Figure 13) Health Screening • o Increase to at least 50 percent the " - - -proportion of people who have received, as a minimum within the . . appropriate interval, all of the - screening and immunization services - and at least one of the conncelinv " - - . _ _ � - • services appropriate for their age and ... gender as recommended by the U.S. . e Preventive Services Task Force.* • Other •o Reduce significant hearing impairment _ l l 0 r ��.4 'y;: - to a prevalence of no more than 82 / ti - •:per 1,000 people.' h = ' • Local data not available and objective adapted eon -- ` ` ' : 4 r. •.. Bedew People 2000 tie year:000 national ablectiva. . _ ...,".• '_ {� . Ty FL of /• Jail Weld County Health Objecitves for the Year 2000 - Page 19 910�.r J SUBSTANCE ABUSE PREVENTION Each year 340,000 persons in the U.S. die Colorado law states that it is unlawful for prematurely from smoking-related any person to knowingly furnish illnesses. Weld County averages about tobacco products to any one under 18 80 smoking-related deaths per year. It years of age and that it is unlawful for is estimated that 30 percent of all cancers any person under 18 years of age to are caused by smoking and that 85 • purchase tobacco products. Neverthe- percent of all lung cancers axe due to . less, in a survey conducted in 1989 in cigarette smoking. Colorado, including Weld County, youth Since the mid 1950's, overall smoking aged 11-15 met no opposition 44 out of rates among 1 5s have stea l 83 times when they asked store clerks to . declined- The most recent figures for lem using cigarette vendisell them cigarettes. ngg mac had nhino es.b Colorado indicate 25% of the adults A.bill introduced b • smoke cigarettes. Smoking prevalence in . from Greeley was by bymthiss�y�anr's • Colorado has decreased by almost one legislation and signed by Governor third (36% to 25%) since 1981. •Romer to increase the fine to $200 for Cigarette smoking is a habit usuall sale of tobacco products to youth, and , • • acquired during childhood or adolees- 550 for purchase by minors. cence. Ninety percent of all smokers Colorado has the 12 • start before age 20 and 60 percent before of drinking and driving highest the e 31 • • 1ence age 16. In 1986 alone over 1,250,000 arcs that participated in the Behavior children in the U.S. started smoking Risk Factor Survey. Three times as cigarettes. many males (6%) as females (2%) report The addictive properties of tobacco driving after "perhaps having too much ' • rapidly take hold in the young user. • i° " within the past month. More than half of the high school seniors Every year motor vehicle accidents cause • who smoke have made at least one about 30 deaths in Weld County. In 1990 serious, but unsuccessful, attempt to quit. it increased to 38 drnhn, a 52 percent • • l,s ^ - •.. • .) .n • c • ' -IA. Y • y• A 'r i �j _ •.e =7 -4, Weld County Health Objecitves for the Year 2000 Page 20 9302.95 • people killed, 16 SUBSTANCE ABUSE PREVENTION increase. Of the 38 ��'� . died in n alcohol-related deaths. For the • OBJE past 20 years driving under the influence o Reduce cigarette smoking to a preva- of alcohol has accounted for nearly half fence of no more than 15 percent of all fatal accidents in Weld County. among people aged 20 and older? The Weld Safety Network seeks to re- o Reduce the initiation of duce substance abuse and its effect on Rdcby children cigarette auh so our citizens. In addition,' there are pro- thasmokingt more than 15 and grams for educating our children to thatno become regulartn 15e percent e smokers have by decrease s their initiation of subs are tance age 20? abuse. • These programs by school districts, 4-H clubs, law.en- forcement. agencies and other community - o Reduce deaths caused by alcohol • - related motor vehicle crashes to no groups. _ University ofm nityNor Hithern Colorado more than 8.0 per 100,000 people. recently a of Community (Figure 14)(Nanonal Objective: 8.5' . recently received a grant from•the Office • r 100,000) of Substance Abuse Prevention to .per reduce substance abuse in rural areas of - r amiableand ,�;.�. v° from our county. _ • . " Healthy P,00lC= • the year^.D00 nsaoeaiobiSC0 • acobohelated MWA Manley- Weld county 20 • a . . _ - 15 e- .. . C C O - O 10 - - a V • YEAR 2000 GOAL - 8.0 U G . y 5 -8 0 0 1985 1990 1995 2000 • FIGURE 14. Source: Co. p Co. epto of of Health. Div. of Highway Safety 30.7)5 Weld County Health Objecitves for the Year 2000 Page 21 ENVIRONMENTAL HEALTH Weld County is primarily an agriculturally A large portion of the residents in Weld based community and, therefore, water is a fundamental riori disposa depend upon cigr sewage of safe drinking water and ty. Sources disposal systems. Reducing ground unpolluted ground water must be pro- watereco contamination from individual be tected. Monitoring ground water quality ltsh� disposalsystems can accom- tected. and developing strategies to mitigate any systems primarily by determining nmm� which contamination will protect and are d improperly erin those syst or improve the overall quality of ground ailing and by correcting those systems. water for the future. Assuring that domestic water sources are safe will help ten, Institutions such as board a day care cen- reduce the potential for water borne mci' schools, and an and care illness in the County. facilities provide environment condu- cive to the spread of communicable dicnces. The prevention of. disease becomes increasingly important in these 1 settings as the proportion of our popula- �.. y; lion • : • S 4 spending time in such facilities � \ increases. • • Community outreach and education programs can help change behavior and C `_ j -� - `' ultimately the environment in which we r ==- i live. Education of children in -environmental issues will lead to the development of ecologically sound- _ thinking future policy makers. • IA I� ! !IIMI;jIg • isran .� � ° " There is a lack of sufficient data with • regard to environmental programs in Weld County. Therefore, it is difficult to quality is a specify objectives that have a Working to improve air qua definable outcome fundamental concern of the people of theatx this time. One of Weld County. Developing awareness goals measurablefo the nee 10 years is s and involvement in the Clean Air Colo- define health outcomes that rado Program will lead to an improve- are indicators o of d environmental health merit in the overall air quality. The and to develop data bases to measure Clean Air campaign provides a strategy threose outcomes. The present definite target improving the overall air come the present lack of de price s- in the region. Citizen participation tf quality come and consequently are process oriented. campaign provides a basis for reduction of air pollution. Waste reduction and recycling are essen- dal to seduce garbage and lengthen the - life of present landfills. Greeley and • Weld County launched a pilot recycling program in April 1991. Private industry is showing interest in continuing a recycling option for the people of the county. Weld County 13ealrh Objecitves for the Year 2000 page 22 930:35 9. • EWIRONNIENTAL HEALTH O13JECIIVES o`Improve the quality of groundwater " . • used as domestic drinking water • supplies in Weld. County. o Reduce groundwater contamination . from individual sewage disposal systems. o Reduce the occurrence of - water-borne illness from drinking " water in Weld County. o Improve overall air quality in Weld County by increasing participation by citizens in the Weld County Clean .•.- Air Campaign. ` '� ----- .„,c,,,.:-... i - o Reduce exposure of the public to air \\� - _ . contaminates by increased awareness VI and cooperation with air pollution •' :a= ? control efforts. - ri� 3 �`�y�� " ., j _ Pry o. Reduce the occurrence of food-borne e---v=,� `illness caused by public food - . _'_ -r- ( -' service establishments and retail markets. o Reduce the total solid waste gener- G 4.0i. r _ axed by Weld County by developing I ilniu . • an increased participation in recycling _ . . and waste reduction programs. o Reduce the potential for environmen- ifa \ tally caused diseases or injuries in . childcare centers, schools, and board + ?�.# i As ="' fie.'''=t, ! al: and care facilities. _. = r I- vA k 3 i . r Ina w '1 1 1111111111110111111111 .. 'J DATA AND SURVEILLANCE SYSTEMS To measure progress in meeting Weld SURVEILLANCE AND DATA SYSTHI,IS County's specific objectives, local data is necessary. Many of the Weld County objectives have been adopted directly o Identify, and create where- necessary, _ from the national objectives. Where county data sources to measure • there is no data specific to Weld County, progress toward each of the year 2000 the national objectives have been Weld County health objectives.adopted with the understanding that when local data becomes available, these objectives may need to be revised. - To obtain data on the local level, federal and state assistance in the form of technical expertise and funding will be necessary. Presently, there is . legislation at the federal level to enable • states and localities to meet the Year 2000 Objectives. Part of this fund- ing will be devoted to developing • local data sources so that progress can be measured. In addition, much of our data presently comes from the State Health Department through their Divi- _ • sion of Health Statistics. With further de • - velopment of the data capabilities of ' - Weld County Health Department and the linkage to the Colorado Department of Health, mote expertise in this area will be forth coming. Only if we are able to measure the health status of Weld County citizens will we be able to know if programs are - effective in meeting their purpose. Therefore, it is most urgent that reliable data systems be developed. This • • will, in the long run, improve efficiency . and help- identify the best use of limited preventive health care dollars. • • Weld County Health Objecitves for the Year 2000 Page 24 9 e.:' , NOTES: + Unless otherwise noted, Weld County Objectives are the same as national objectives. + Rates based on 1980 census data and ' projections. These Projections overestimate Weld County Population compared to 1990 census data. Therefore, rates may be underesti- mated. -+ Charts on Weld County data were - developed by Dr. Paul Hartlaub. Data sources: - Colorado Department of Health, Division - of Statistics -. Colorado Department of Health, STD/ AIDS Program Colorado Department of Health,.Division of Highway Safety - Weld County Social Services • The Centers for Disease Control,.Atlanta, . Georgia Healthy People 200O . U.S. Preventive Services Task Force: Guide to Clinical Preventive Services Adolescent Health In Colorado Report 1986 - Colorado Deparunent of Health • Weld County Health Objecitves for the Year 2000 Page 25 • APPIEINIDI71 A telt Colorado Board of Health • Tae 91 CONDITIONS • REPORTABLE BY ALL PHYSICIANS AND HEALTH CARE PROVIDERS IN COLORADO • • a�..�bAsh* ".n,.,..a....,,,,,,,.1 - a1e�""°•re••+ra(.p„e _"'n►"p'eyw.n.......Aar K/n�e�en��edeleted ewe M ryjr(•)J�✓n erie nel eerie elf w entenedr swami ela/,n...�ne„ eereen eh "� �1Vnne�(ese M�ln 1�--�M1.��nlfY • .. • • Vaccine-Preventable Diseases • Oi01dhn+e(2M1 • • • NeprieeB(7d Idonephilue rn•ne"e disease(24h1 (2(h) )e(rnvs.Gle illness'00 bon(241• Men e(2M1 • gnat cementer pal • . • Foodborne, Enteric, and Liver DiseasesTeein•ad) " . . .. Raodiun rs 41 _ . NeefA.NesA lfap.oyi pol . . - - - . . CL°Prbifncwia.it(7d) - N4edeetirpeelRtl•t7a) • - • - e�ns.e e•nm Lionel pol • - _ ORWPOUTBRPa1C.S(2 • _ `-'��7cs(74) - - .. - '••eR ease inelndinl had paieonin • Minded'pd) - • • Hepatitis A•(2N11 = - .: TriAisaie•(7d1 - - •= ltapedtia ae(7d1 r• . T7pMid Pen Roy . .• •• ' Sexually Trinsmitted Diseases • MDS eb MIV Ia4rioe(74) - - • • t7lenaeid na) _ Grannie anima pa) • - •• • Canaeeaeal Petrie Infgnnary Dyer(24111 ) e'nleaeloR pol . . . . - . • • - OaeaeeMa(7d1 • s71ii1fa out,(r.Y.ee/r yla1t241 • Zooaotic Diseases •- Amin aiee•pd)• - .. - Anone(2M/ - • Peanut'l) _ - s�,l�.-nal oPe.-nay. -.Rt mMe rstMPse val • lhennt Inge(7rpee..11 rsw) -Lyn Ohn.e(74) . Tdn.eeMa on IPara Pa.r•(70 40 tiRW(2w1 • ' .Typye1rse11 - _ .. • Men ingitis/Encephalitis • epeelits•(74) Anew�seeninine•pdI - .1dn"Reenmy Caen(7") . . • • .. � •• . Hammen influences tiu ele(241 '_ (�eeit1ae11dpp�y _. • • Other Important Reportable Diseases modes CO • Krona Snouts*(7d) - Lepton's tansy Dine pal Smeller(7.4h) pn Mena T.oes�na s7a..e(7a)• . • a�S7n6en,(7d) . - 'RreYloe(l(2AR1 _ • Environmental, Occupational,and Chronic Conditions _ cs.wr.avn,.(3adl •Bun(Melt rwne(wal . Sr: l Cant Janet(31202 .. • ._ .. sbm defect(TIM M9 • - 1417 hempen n�nel nom,) - • • ALL ILEPOITS MUST INCLUOt _ ite _ 4e4 neret TO MOST A CAtt CONTACT: - . 2'renr'e nil uuna�il req `wlanr/l � dpnnete r'eee�etw aurae 4. neeellessnasa inn r��neeeene'eeea♦� dg4'e�e�.rx.ln �~�� 410 L.7ln � . eene thsaCelreWOO • Weld County Health Objecitves for the Year 2000 • 26 • 9 e:G5 Hello