001Heavenly Father, we thank you Lord as we come here to look at the business of this human services department. Lord, please help us to keep our minds straight. Oh Lord, as we think about and guide us, oh Lord, that we might be able to give some advice where necessary or where we can for the betterment of the citizens of Union County, North Carolina. Lord, we thank you for the leaders, these directors, Lord, and the staff. Lord, to do the daily work, Lord. We thank you for allowing us this opportunity. Lord, in Jesus name. Amen. >> Amen. >> Thank you, Mr. Ford. I'd like to start this tonight with the approval of the minutes. Has everyone had a chance to read it? Do you have any questions? We have a motion. >> Motion. >> Thanks, Ashley.
002>> Thank you. Do we have anyone second? >> Second. >> Thank you very much. So, the minutes have um passed. Um next up, we'll want to approve tonight's agenda. Has everyone had a chance to read over it? Any motions to approve? A motion to approve. Thank you. >> Thank you. Um getting Yeah. Any opposition? Sorry. And so it is approved. Thank you. Um, I want to take a few minutes before we get started actually, and this is not on the agenda, but I hope that this is okay. We'll see if it is with everyone. We have two new people tonight that are joining us that I'd like everyone to meet. And I think it'd be great if we took a moment if um if y'all are in favor of this to introduce ourselves to them
003as well, to our two new board members. So the first um is Eric Clifen. Mr. Clay. >> Hi. Good evening. >> So he is our new um uh community member. Very nice to meet you. Um the next is Matthew Dr. Matthew Childs. >> Thank you very much. He is our new psychologist. >> Very nice. >> Thank you. We're great. We're very >> very grateful. Um it >> Good evening. My name is Jackie Morgan. I'm the human services business operations director at the front of the house, the back of the house, and some of the cuts of the house, IT, um business processes, QI, things of that nature, and some for programs like accreditation and prepared. My name >> is Janet Payne and I am the executive director of the human services agency. So, I have
004the good pleasure of being able to work and support all of these teams. Um, I will also say that two of our directors, Stephanie Star, Tracy Collie, are not able to be here tonight. And, uh, Tracy is responsible for public health, and Stephanie is responsible for community support and outreach, which includes, um, senior nutrition, the Wig program, several of our uh, emergency assistance programs and, um, and outreach as well as education in the community. Hello, my name is Ashley Lance and I am your social services director. I do all of the social services and we will get into that when we have coming and being a part of this other person. >> I'm Brandy Smith and I am part of the consolidated human services board. I'm Susan Marciniac. Uh, I am a volunteer on the
005board as well and I in in the role of other >> Matthew Childs. You're talking to me, I guess. I'm a psychologist and I'm a therapist and I work with adults and older adolescence. I have an office in Charlotte and I have an office on Main Street in downtown. >> Thank you. I'm Earl Ford. I'm a volunteer board also and I'm under the veterans. I'm a veteran of the United States Air Force and I'm going to get some on the board as a consumer. >> I'm Amy Dicki and I'm also a volunteer on the board serving as the chair. >> Hi, I'm Michelle Marano. I'm the director of veteran services. >> Hi, I'm Eric Claflin. I'm the deputy chief of EMF at Union. I live in Waxaw. Lived here for about five years. >> Good
006evening. Uh Craig Coash from the physician. At least I was being voted on tonight. So it's might be shortlived. Uh but I'm a general surgeon and I generally work out of Matthews but with no bond. >> Hello, I'm Teresa Torres, the director of transportation. Oh, you want >> Hi, I'm Laura Gardner. I'm in uh Union County Transportation. I'm an employee and I'm one of the presenters tonight. >> My name is Brandon Herb. I am the operations manager for transportation. Uh >> Jason Gurian, emergency preparedness coordinator for human services. Committee appointment supervisor with Indian County Public Health Ash nursing director with public health. >> Craig Greenley, lead nurse uh for the communical disease and work with Megan learning the whole new role here. >> Um next up on our agenda is the executive director. Good evening.
007Tonight we have one item that I would like to put forth for your consideration. Uh you have in your packet an application from Craig Kalash who would be applying to fill a second term as uh the physician position. And what I'd ask you all to do is consider whether or not you would like to make a recommendation to the board members to reappoint him. Do I have to step out? >> Uh, no. You just can't vote. >> If you want to step out, you can. Um, if you Amy, I'll let that be your call on that one. >> No one opposes to Dr. Kash staying in. >> And I'd like to open us up with a recommendation that we do put him through to stay. >> Sorry, you're not getting out of it, Dr. Sorry.
008>> Any opposite? just congratulations on your new >> All right. Thank you. >> Excellent. I I don't have anything else right now. I do have a couple of updates that I'll do when we get to the update portion just for some of our different programs. And I would also say that I do plan so we we did just pass or we didn't the board of county commissioners passed the budget. Uh and so we just started our new fiscal year as of July 1st and we will be bringing forth some budget report information uh for human services as a whole in the next board meeting. I wanted to be able to close share that information with you as well. So, um, but very appreciative to them and to the county manager obviously for their support of
009all of our programs and, um, it is, uh, never easy to allocate scarce resources and and make the most of them, but they do an excellent job and we're very appreciative. >> Thank you. Before we move on to the next section, I did want to draw attention that we uh Jill James has been serving as our nurse and she has submitted um her resignation that she is going to have to leave us and so that will leave a position open for a nurse. We also have two slots for consumers, a dentist, pharmacist, um, optometrist, physician or psychiatrist, and then the new nurse opening. So, I wanted to make everyone aware so you can help spread the word in the community for those positions. And then we will go next to our division report. So the
010first report is regarding the measles tabletop exercise and that will be Jason Durion providing this update for you all. >> Jason, do you have a mic? >> I don't need a mic. >> Yeah, you do. >> Janet. All right. >> It's for the people at home watching. >> Is there anybody at home watching? >> There is. >> Oh, wow. I apologize to that. Uh if you haven't gotten the packet yet, there's one down there at the end over by Ashley. Uh you guys can take one of those absolutely riveting stuff that is in there. I have divided it. There's three sections. The first section is a brief synopsis of what we did in the measles tabletop exercise. The second part is the actual afteraction report after the measles tabletop. And then the third part is
011all the slides that you guys are going to see tonight. There's only 64 of them. This should only take about two and a half hours. So, uh just just bear with me. Just kidding. All right. So, I I do appreciate the opportunity to speak with you guys tonight. Uh I will be sharing the results of our measles tabletop exercise that was held on July 9th. Um and some of the key lessons that were learned. This is part of our ongoing commitment to keeping Union County prepared for public health incidents uh and public health threats. This exercise was done using the federal model, which I won't bore you guys with, but the federal model that we utilize for all exercises and utilized the uh the 15 nationally recognized public health preparedness capabilities. We tested five of
012those capabilities during this exercise. I'm sure we tested more, but I only wrote about five of them, so uh we won't talk about those. So the exercise simulated a excuse me a largecale measles outbreak in Union County beginning with a family who traveled from El Paso, Texas um which is a current hot spot for measles complexity. Uh we had over 20 agencies that participated in our exercise uh from the county from community partners and and you guys will see that here in in just a few minutes. We utilized four different phases which again I'll I'll I'll elaborate on here in just a little bit. Uh and the whole point was to test our current capabilities and come up with some some plans to uh to make it better. All right. So these were all the
013participating excuse me agencies that that took place. Obviously the big ones Atrium and Novant were both present. Um, as far as emergency services go, we had Union EMS, Monroe Fire Department, Waxaw Police Department all participated. Uh, Union County Public Schools and Union Academy both being well obviously Union County Public Schools is the largest educational facil or a group in the county and then Union Academy being the second one. Uh, we were thrilled to have them as well. South Pedmont, Wingut University, and then a host of other community partners, uh, specifically daycare centers, childcare centers that that were um that were involved in this. So, that's the entire list that that showed up. Um, these partners not only contributed to the exercise, but are critical in carrying out any of our our improvement plans moving forward.
014And obviously, they're they're people that we're going to have to work with should a measles outbreak occur here in Union County. And when we look back at this exercise, it's clear that some of these partnerships really shine. Like we have great relationships with with certain partners and then there's other ones that we need to build and and work towards strengthening those relationships. Uh so this was the overview here. Again, there was a scenario trigger with the family who returned home. It was a vaccine hesitant family um or an unvaccinated family who returned home from El Paso, Texas. The situation quickly set in motion a coordinated response involving not only public health and other entities within the county, but quickly involved Union EMS, Monro Fire Department, Waxaw Police Department, all of those people uh you know
015quickly had to have a um a part in it and then obviously the school systems and daycare centers that were involved. Also, the simulation covered the entire arc of an outbreak from the first case all the way through containment. And we did this, what do we do, five, six hours, something like that? Six or seven hours. So it it was it was really condensed, but we did the whole gamut of of an outbreak. The the basis of the outbreak came from Megan and I attended one as um evaluators in Meckllinmberg County in April. And once we returned from that, uh Dr. Keener strongly encouraged us uh basically Von told us that we were going to do one here and he wanted it done before school went back in session. So with the assistance of Megan
016and Daniel Pena who's the backup preparedness coordinator, we really put this thing in in high gear pretty quickly. And um the the results that we got was was was fantastic. first of all the response we had from the community uh our partner agencies and then just the the conversations that were had at the at the uh at the table. So this is the timeline that we utilized uh the four-phase approach. Obviously the first phase is the return home. They come home from El Paso. They're within that incubation period. They're going about their normal everyday experiences. We had a family member who worked at Wingut University. We had a uh a child who attended a daycare center. another child who attended a Union County public school and a father who worked in a high-risisk environment at
017u one of the chicken processing plants in town. So, a lot of exposure opportunities for those people. Obviously, they didn't know they had measles, so they were just freely spreading it, you know, around the community. Uh phase two really covered days 4 through 10 and phase two is when it really started to ramp up. It was the discovery phase. This is where people started um uh you know arriving at urgent cares. Uh EMS was called to one residence. Um a a family member was arrested, had to be taken to jail. So now we're introducing the jail into this whole thing. And then uh phase three was the peak phase. I think this was the most challenging one for us because this is where the media gets involved. Uh the schools get involved. You start dealing
018with a lot of absenteeism. you start worrying about continuity of operations plans for not only Union County but other businesses that are out there. And uh then phase four was the was day 28 plus that's our aggressive public outreach campa uh campaigns uh working with quarantine orders and uh contact tracing efforts which obviously is a huge challenge. So each one of these phases individually tested our ability to adapt, escalate and respond as needed. the um the the exercise work that we all came together as a group. I think there was uh 68 of us. We all came together as a group. We discussed what the phase was going to look like. We discussed some of the top or some of the highlights of that particular phase and then they were broken up into groups. So
019we had the public health group which included a lot of our um public health staff. We had the community partners group which was EMS, uh, fire, law enforcement, our daycare centers, um, and and our school systems. We had the healthcare group, which included one representative from Wingut who handled the health care, uh, at Wingit and then the hospital systems. And then we had our executive team, which was predominantly Union County, our legal team, our directors, emergency management, and most importantly, our public information officers. They were all part of that group. So once we got done with the big group setting, we broke into smaller groups. We had individual uh challenges and um uh injects that that they were presented with. And then once that was done, we all came back together and we did a
020report out. And during that report out phase, our exercise facilitator, Mr. Kevin Staley, um had questions that he would that he would pose and he would tie things together, right? So a community partner probably face this. How does that affect the executive group? how does the executive group decision face uh you know the public health group. So we we we tied all those things together during during those large uh those large group sessions. So again we tested the core capabilities. There's 15 core capabilities that I have to live by. Everything that we do in public health preparedness response revolves around the 15 core capabilities. Um we tested five of those. Uh the first one's emergency operations coordination. All right. This is the activation of the emergency operations center, a unified command structure and then resource
021uh coordination uh amongst not only us but our our partner agencies. The second core capability that was tested is emergency public information. All right, this is the messaging that goes across all of our agencies, all of the other agencies that are out there um in in multiple languages. And then the big thing is countering misinformation that that may be out there on social media or in in uh traditional news media. Non-farmaceutical interventions, school closure decisions, isolation protocols, restrictions on visitors and movement within healthcare facilities. Obviously, you know, that's that's a huge thing that we have to uh deal with. Uh information sharing. This is information sharing between public health Novant um atrium within the county outside the county. So who gets what information? How much are we allowed to share? How much do we have
022to hold back for for uh you know for HIPPA reasons? Uh and then the last one is public health surveillance uh case detection. The big one for us is contact tracing, epidemiological investigation processes. you know, contact tracing for something like measles is is very very challenging and and uh you know, this was this was something that we really focused on during this. So, in order to understand where Union County is as far as our um uh concern for measles, you have to understand where uh we stand as far as our vaccination rates versus the national average and the state average. And I think that Megan's going to go into more of this. And I'll tell you right now that some of these numbers are a little bit off. I I saw Megan in the mail
023room a little bit earlier and uh she actually mentioned that the 2024 numbers had come out and she'll tell you about that when she does her presentation. But you can see that the Union County rates are well below the state and national averages. So measles requires a 95% vaccination uh rate within the county in order to achieve herd immunity. And in the fall of 2023, we were just over 90%. So, we fell well short of where we needed to be for that herd immunity. Um, and our ex our exemption rates seem to be more than doubling or over doubling since 2020. If the current trend continues, uh, exemptions could reach 13% by by the time the 2025 numbers come out, which is which is astronomical and rather rather alarming. Where we're seeing the most of
024this is with our kindergarten exemption trends. Uh over the past four years, both medical and non-medical vaccination exemptions amongst kindergarteners have risen sharply. 103% increase in exemption rates is strongly tied in in my opinion to misinformation and growing vaccine hesitancy for various reasons. Um these exemption clusters oftentimes will will follow um uh groups either schools or religious groups and sometimes even neighborhoods. So that increases the likelihood of sustained transmission. It's not just one off here and one off there. You're getting a lot of people who are um unvaccinated in in certain areas. This is why our proactive outreach, education, and engagement with parents, schools, and community leaders is so critical to maintaining this herd immunity. So with those risks in mind, uh and with the results, we're going to show how the vaccination gap could
025directly impact our ability to respond. And this is going to bring us to the next slide which is our capability analysis analysis summary. All right. We did just focus on Union County. So if there was a gap within one of our partner agencies, we discussed it, but that's for them to fix. We were just focused on Union County and what the county government can do in order to uh address some of these um uh gaps in in in our operations. So the first one's our continuity of operations. uh staffing plans are inadequate for extended operations. Isolation protocols for essential employees are are currently incomplete at a county level. And then remote work capabilities are obviously limited for key functions. You can't be a nurse in public health and work remotely. It it just it doesn't
026work. Um you know, you I can't do my job remotely. Emergency management, you know, transportation, they can't do their jobs remotely. So, we need to address some of those things and figure out how to uh continue operating at the high level that the county is used to even with an outbreak like this. Some surveillance network gaps. We're seeing a larger increase in the non- novant nonatrium standalone urgent cares and doctor's offices and they're not getting the same attention that you know the Novants and atriums are. Novon Atrium, you know, they have epidemiological officers. They have infection control officers. Some of these standalone, you know, buildings, we don't have contact with them. We don't communicate with them. So, that's going to require Megan and I going out there and physically talking to these doctors and administrators
027to bring them on board so that we can have that open line of communication with them. Uh, vulner vulnerable population protocols. So, the the jail outbreak containment procedures are undefined. Medicos who are our new jail administrative um or our new jail nursing staff um were not present during this. They were invited. They just uh we we didn't see them during the exercise. Uh protocols for homeless populations. Obviously, some of our homeless camps with a lot of people who are are vulnerable. Um you know, getting out to them and getting information to them. And then, uh quarantine enforcement mechanisms are kind of unclear. you know, how how are we going to enforce these quarantines if people don't want to stay within their homes? And then last but not least, we have some technical limitations. Our CAD
028system, getting information to the CAD system, it doesn't lack the capability of flagging potential. It just there's there's no mechanism to go from the health department to the 911 center currently. There's no protocol to flag some of those addresses. We did during COVID and then it kind of went away. So, we need to revisit that so when we start having some of these communicable diseases, they get out there. Um, and then, you know, just as a side note, we also have a um, you know, with Union EMS, they have uh, a different system than the CAD operates. So, seeing some of the history and flags at those addresses for them isn't possible. So, we need to address that. So, so our our paramedics are are just as safe as every other responder going out to
029these addresses. So, what are our corrective actions? Obviously, coupe planning is number one. Continuity of operations plan. Now, I'll tell you that public health has a coupe plan in place. It's a requirement that I have for our uh accreditation that we have a coupe plan in place. Jackie and her staff developed it 10 plus years ago uh over the past couple years. We just built upon it. So we have one for public health. It is not for human services. It is strictly for public health. The county is currently working on addressing the continuity of operations plan which again Jackie has taken point on for our human services team and um hopefully that will be turned around sometime soon. But we really need to operate or we really need to figure out what our coupe plan
030is so that if we do have an infection within the county we can continue operating the way that we are. Again, healthcare integration uh engaging healthcare and urgent care uh networks through our annual training and exercise participation. just getting out there and communicating with them and having those open lines of communication. Uh we are working for technical upgrades figuring out a protocol to flag those addresses in CAD and then remove them from there once the uh the threat is gone. And then we're looking at a community engagement. How are we going to target these uh high-risk populations? How are we going to target the the uh the vaccine hesitancy that's out there? One of the topics that was discussed, if you remember during COVID, Dr. Keenir was was very forward thinking and was out there
031in the community talking to some of these um underserved uh populations and and trying to you know get them to u understand where the health department was coming from um addressing any vaccine concerns they had during COVID and I think that's the method that we really need to look at doing with uh with measles also. So our response simulation again revealed both strengths and weaknesses. We have a lot of strengths. All right. Our number one strength here is that this county has more coordination and communication within its walls than any other place that that I'm associated with. There are 13 counties that we meet with on a monthly uh monthly basis. Uh and and my counterparts don't nearly have the communication with other departments that I have. We have an excellent working relationship with our
032public communications team. We have an excellent working relationship with our emergency management staff. And that makes these these these problems seem I don't want to say trivial, but it's much easier to integrate public health into those because of those relationships. Those were built years and years ago. I'm just trying to help cultivate those even further. Uh I' I've got good relationships with them. Jackie started this this program 10 plus years ago. She started those relationships and we've just built upon that ever since. But my counterparts in other counties that surround us, they don't even know who their emergency management coordinators are. They don't have they don't have conversations with them. They don't have dealings with them. Um they're public information officers. They put out all their own stuff. So we we really have a um
033you know a good a good structure there. Um public trust is our biggest thing, right? A lot of public trust was eroded during COVID. Um and it's going to be hard to get that back and we have to do something in order to get out into the public and and gain that public trust back from our community. I think a lot of our vaccine hesitancy, especially with new kindergarteners, stems from that COVID pandemic that we had. So, working to get those um those public health um uh the trust back up again is key. And public health has done a lot recently to do that. Since Tracy got here, we have we have focused a lot more on going out into the community as opposed to having the community come here. We're doing way more outreach
034events now, I think, than we have since since I've been here for 5 years. And I think that's really important to get out there in the community to start building that public trust. All right, that's all I have. Uh, does anybody have any questions or comments, statements? >> Yes, sir. >> I think this was very that's some very good information. I just wanted to ask, you mentioned something about misinformation and I wanted to kind of get an idea. Has there been misinformation? Going back to co I know we had a lot of misinformation or disinformation during the co time frames. So I was just you mentioned something in your presentation about misinformation. >> So a lot of misin there's a lot of misinformation there out there about vaccines in general. Okay. And it it typically
035ties back to and and I'll let I'll let the CD team talk more if they want to, but a lot of it ties back to the autism rates and how the autism rates are are are growing. Um there's a lot of conversation between uh vaccines and the growing rates of autism. So I think that's where a lot of the hesitancy comes from. Um you know and then you know quite frankly we're we're vaccining we're there are more vaccines that are given now than than when you and I were growing up right. Um and and a lot of that a lot of people are are taking pause and saying, "Okay, you know, maybe I don't give my child 36 shots within a year or what. I don't know what the vaccine schedule is, but you know,
036spreading those out a little bit." But the biggest one that that I heard that I've heard of is is the link between or the the alleged link between uh autism and um and vaccines. you're making that >> I would say another thing is um like makeup of vaccines, manufacturing processes, chemicals, a lot of people are very aware of the chemicals of really everything that they ingest. Um so I think that is another reason that kind of people take pause of it. Um, but also they I mean there's other things to keep in mind um that you know are also problems like food >> and and a lot of the misinformation also comes from social media. You know it's >> most of it. >> Yes. Yes. I mean it's it's funny. So >> Dr. My wife
037and I sit on sit on opposite ends of the political spectrum and she and I can be scrolling through the exact same social media channels and she's seeing one thing and I'm seeing something completely different. And until the public understands that all of these things, your Google searches, your your, you know, your your social media searches are geared toward what you've looked up in the past, right? And they're not looking up scholarly things. They're looking up Dr. Google, all right? Or you know, Dr. Phil, not a real doctor, but they're they're taking information from non-credible sources >> and it's very biased >> and it's incredibly biased. So, that's where that misinformation comes from. Dr. Kener did such an amazing job during COVID getting out there in the community and having these one-on-one conversations with political
038and spiritual leaders who the community trusts. you know, they oftentimes don't trust the government, but they will trust their spiritual leaders or their community, you know, their community activists. And he went out there, he had those connections with those people, and we wound up seeing a greater number of typically underserved communities coming in for their vaccines, uh, their co vaccines. I attribute a lot to Dr. Keener and his outreach. So, if we can do a lot of the same things, you know, we can hopefully bridge this gap. to run into you're going to run into a little bit. You you brought up that the co so the venues are much different like like the delivery method is much different messenger RNA versus the older vaccines which were much safer messenger RNA a lot of mis
039you know information that was out there like what do we know about them and but the lay person doesn't know that all they hear is vaccine >> so they're combining them together when they're very very different and I kind of think that to get over that vaccine because you know autism was what 20 15 20 years ago was brought up and then debunked and then now it's being brought up again. But I think part of that is just because people are starting to look into it because of messenger RNA vaccine not not understanding that the older vaccines have a totally different delivery method >> but also 20 years ago the delivery methods for for you know there wasn't social media the getting the information wasn't as easy as it is today. Absolutely. >> Right. It's
040not accurate information. It It's a lot of garbage. Garbage in, garbage out. But >> they're taking it as the gospel. >> Yeah. But again, they're just saying vaccines, vaccines. They're not all created equally. >> Correct. I guess I would say >> correct. And again, that's that's part of our job to educate the community >> that it is a different type of of vaccine and and it is historically safe, but we have to get out there and educate them. >> I agree. along those lines and understanding trying to meet people where they're at and give them accurate information. Would the community engagement include if you were going to follow an alternate pathway right to it? Because I think part of that becomes the follow through and the timeliness of an alternate pathway, you know, um my
041kids do all have autism. They are all vaccinated but they did not follow the vaccine schedule in getting it because of seizures from the vaccines you know so it took a lot of work on my part you know to still finish it all out you know >> but maybe not do all of them at once right you know and and that's part of that public education and >> you help people with that education we welcome anybody >> even if you wanted to get one vaccine >> so you want to talk about the rest. We happily do that at Union County Public Health, >> but not all um community providers do. I mean, that's what we talked about. >> No, but but that that's why it's important for us to get information out there and and
042not just to the you know, not just to the historically underserved populations that we have in the county, but to the community as a whole. Get that information out there because Dr. A may say, "No, you need 36 vaccines on on day one. >> They'll let you go." >> And Yeah. And and then, you know, Dr. B says, "Hang on a second. We don't need to do that. we can we can spread it out like you you know we can spread that out over time but getting that information out there from a trusted source uh is is is I think something that you know that we need to do and and and you know that starts with us. >> I just want to piggyback off that what Amy said. I think some outreach will have
043to be discussed with the hospitals or the two providers because a year and a half, two years ago, letters were sent out and if you didn't ha you didn't follow the CDC schedule at the time, you were done and you were let go and families left family practices. I have a friend that went out on her own and started a um outside DPC clinic and the clientele coming saying that they are not seeing pediatric care. We've been trying to hit it from the state level as well because of that because we now have more families not seeking pediatric care and we've tried to bring this to attention that we can't have providers dismissing pediatric patients because they want an alternative schedule for whatever reason. So >> that's a tough conversation. I mean from from my
044office that that's that's something that's going to have to two seats down can stop. >> I mean if it it's not part of the conversation nothing budges. >> I I agreed agreed but even if we can just get the information out there to the community and say the these are options and that we will see you and if you want to take one vaccine and then discuss the other ones with our with our nursing staff or our pharmacist or or whatever with our one of our physicians you can do that. Um, you know, it's I >> personally I feel that's a parent's right, but you know, you are you are true. If if they're getting dropped because they're not following that that vaccine guideline, then that is something that needs to be addressed. But that's
045unfortunately that doesn't come from my office. So >> that only increases the vaccine hesitancy. >> It does. It does. And our numbers are going in the wrong direction. And the longer they go in the wrong direction, the harder it's going to be to write the ship. And you know, we had uh there are several communities and several organizations that were that were part of our measles exercise that are traditionally vaccine hesitant and they were there and it was made very clear that we're not trying to change your mind. We just want you to know what happens. One measles case is not like one COVID case. One measles case is not like one Vericella case. One measles case is a huge deal, right? It's it's and you know this, right? It's it's a massive deal. So
046just having one case because we have an entire, you know, school or or daycare center that's that's, you know, vaccine hesitant, hasn't done it, creates a massive problem down the line. So getting them to understand that, getting that education out there to them is one of the things that we're really trying to focus on. >> Along the same lines though, it's our insurance companies and Medicaid who also are are stringent on that, right? it it's it's more expensive to not follow that if you didn't know that like you you have to pay for some of it yourself >> you know they don't just willingly separate out things you know >> um and whether that's co-pays or you know the they won't pay for it at certain time I mean like it it did cost more
047money to do that you know and so maybe if we could just get information out there on our vaccine clinic on just different ways to accomplish that. >> Absolutely. Listen, we we have a we have a wonderful vaccine staff here, immunization staff here. They have a lovely new uh quarters upstairs that they're operating out of. Um you know, I'm I'm I'm sure that we can get that information out there to them. But but compiling that data and compiling that information and getting things out there with people who are knowledgeable and will will answer their questions, both pro and con, right? What's the pros for holding? You know, what are the cons for holding? I think that's important. >> I have one last question. Absolutely. And that is with the increase in exemption rates at the
048school, is there any conversation on what warrants an exemption? Because currently you just have to say that it is right like >> um so right now there's legislation even to propose philosophical um exemptions versus religious exemptions um only. What's that? >> Other states have the fill up. >> Yeah. Yeah. Yeah. Um and so I was talking to Dr. Keenir once and he had a conversation with the lawyer that wrote the the law for exemptions and his concern was if we change it, it will be for more accept wide acceptance of exemptions whether that be philosophical or otherwise. And and the unfortunate part is with the exemptions is it it oftenimes doesn't affect that family. It affects the herd immunity which affects that 5% who can't get it for for one reason or another. And you
049know those are the people who who who suffer from it. Yeah. I mean >> which is also my family. We have common variable immune deficiency. >> So I mean you're the 5% that can't get certain things and and that's the one that's being affected the most. And you know, you go back to the misinformation people you talk to, they're like, "It's it's just measles, right? It'll go away." But they don't look at the long-term effects of what what occurs. The kidney issues, the reproductive issues, you know, other things that can come down the line when, you know, 40 years from now because you contracted it because you didn't want to get, you know, your parents didn't get you a vaccine. So, we're we have a huge uphill battle. There's certain things that we can fix
050very easily. Okay? We we can we can fix the continuity of operations plan. We can fix that for the county. We can fix the technical issues. The vaccine hesitancy is going to be tougher to do, but we we have to start to at least level off those numbers and get them back in the right direction. Anything else? All right. Thank you very much. That's right. Um well, thank you all for inviting us to come and talk about transportation. Um transportation department is one of the six departments in human services. Um as I introduce myself to form Laura Gardner, I am the fiscal and compliance supervisor and that includes safety and Brandon who's also going to speak during this presentation. He is the U manager over operations which includes our dispatch team and our many drivers
051which he'll go over those numbers later on. Um so and uh we report to Teresa Torres. She's the director of transportation. So the mission of transportation is to provide our residents with reliable and efficient services in a safe and cost-effective manner. Um we live by this mission. Um reliable and efficient services. We maintain our vehicles to the highest standards. We are very strong on um meeting on time performance and we have very clear communication with our passengers. We are very safe. Transportation has their own safety officer. Um and they are responsible for our training program. They're identifying hazards and they're looking at ways to reduce risk. and then in a cost-effective manner. You're going to um find out later on the presentation a little bit about our funding sources. Transportation is very fortunate to have
052a lot of different opportunities um to get reimbursed for their services. >> All right. So, let's talk about who can ride on Union County Transportation. So, um any resident of the county is eligible to ride. Uh those that are ages 0 to 15 uh can ride as long as there is a parent or guardian that is accompanying them. Um if you are 16 and over, you can ride as an adult. U passengers must be registered with Union County Transportation. Um I know that Laura is going to go over later uh the registration form and u some different ways that we can access that. Uh and currently there is no cost uh to our passengers. We have uh like Laura mentioned, we have um state and federal funding that covers most of the cost. Uh and
053she'll talk about that later as well. Um so uh transportation has been very intentional in trying to get out in the community and advertise uh our services and and who we are and who we serve. Um we we want to figure out what that unmet need is and try our best to meet it. Uh we have created uh cards like you'll see in the bottom left there. uh that gives our our main transportation uh phone number. It gives a QR code that will send them to a link uh to register. And then on the in the right corner there, you see a uh for the writer's guide. And this writer's guide is for anyone once they are registered. Um it includes information uh regarding our guidelines, our policies, and just general information. Um there's also
054a QR code for that as well. So registering with us is very easy. Um if you go to the Union County website, uh there is a form in the trans under the transportation department. It has five sections to it and um it only takes a few minutes to fill out. It's basically looking at information that confirm your residence, understand your mobility issues if you have any um emergency contact information. It does ask you to review our policies and um and then basically submit the form. Once that form is submitted, our office staff is looking at that uh reviewing the information. They're contacting you and within like 24 48 hours, you can call up and um ask for a trip. Um it's very quick service. And Teresa is actually working with Jackie to set up some
055kiosks in the human services building. so that when um residents are coming in to go over DSS services or public health services, they can go to that kiosk and they can actually go through the form and sign up for our transportation services. Um so, but it is very easy to do. All right. So, where do we take passengers? We take passengers to medical appointments. Uh we take them to work. We take uh students to school at SPCC. Uh we transport uh older individuals to adult daycarees. We we transport people to recreational opportunities. We take people shopping. We take people to uh nutrition sites to get nutrition. Um we also go into Charlotte. We go to the VA in Charlotte. We take uh passengers into Charlotte for medical appointments. And then we also go to the
056VA in Salsbury. Um, so just some general information. Uh, staff-wise, we are staff of 48. Most of the most of the staff is drivers. The breakdown of that is we have 16 full-time drivers. We have five benefited part-time drivers. And then we have 13 part-time drivers. And then our 12 member office staff is made up of admin, safety, dispatch, supervisor, and and management staff. And then we also have two fleet workers. Uh these are individuals that come in on the weekends on Saturday and they wash wash our vehicles for us. Um as far as our fleet goes, we are a fleet of 28. Um 23 of those vehicles are ADA accessible, meaning that if someone has a walker or a wheelchair or needs a ramp, they can access the vehicle and get a ride on
05723 of those 28 vehicles. Um we have minivans, we have transit vehicles and then we have what u we categorize as LTV which is similar to what you see in that u in that picture above there. We have 20 foot and 22 foot vehicles uh LTVs. U and then we also have a dedicated mechanic which resides at Patton Avenue. Uh this position is listed in the facilities and fleet organizational chart. And then we are also uh committed to uh being environmentally friendly. We have began the process of converting all of our vehicles to uh bofuel, meaning that they run on propane as well as gas. Uh those vehicles will run they'll start out on propane and if we run out of propane then it will transition over to gas. Uh currently we have about a
058third of our fleet now that has been converted and then every new vehicle that we get, every vehicle that we replace out will also be um converted to propane. Uh and we have a fueling station now at our headquarters over at Airport Road. Um we have a um a fueling pump out there where our drivers can fuel before they leave or after their route. They can fuel on site. And then we also have a site where they can fuel out in Marshall. Uh so one of my when you're looking at operations, one of my uh main priorities outside of making sure that we're safely operating on a day-to-day basis is making sure that we are as efficient as we can possibly be. Um we all know that, you know, the the more efficient that we
059can be, that just means the more people that we can serve, the more opportunities that we have to help. Um we try to maximize our resources, our time, our vehicles. Um so what this chart does is it's a breakdown of the last three fiscal years and you can see uh without going into a lot of detail break it down for you here uh our trips have consistently been going up uh they have gone up to from about 303 trips a day in 23 to in 25 they're about 329 trips a day. Um so that steady increase of trips is uh definitely something that u we take pride in. Um and then our wheelchair trips have also um substantially gone up. Um those went up from 14,000 plus in 23 to now 16,000 plus in 25.
060Um so we are doing right now we are doing about 350 trips a day. Um our drivers are out operating about 180 190 hours a day and they are driving almost 3,000 miles a day. Um, so it we are a very dynamic transportation is very dynamic and um for anybody that knows anybody or has anybody that is interested in transportation uh please let them know that that we are here to to serve them. >> Yeah. I just um wanted to point out something on this slide. Um, you see that we provided 81 I'm going to do the fiscal year 24 amount. 78,000 trips that we provided trips in the county and around that year in 12 months. That year we only cost the county $484,000. Um, our payroll for our 48 staff is about 2.2
061million. That's just our payroll. That's not our other costs in our budget. And so to see that we only cost the county then at the end of the day 484 for that that is because we have so many funding opportunities that we can use. Um the next one. So um this chart there's not a lot going on in this chart except to say that is all of our grants and funding opportunities that we have to us. Um Teresa who has been with the department for nine years has been um has grown in her knowledge on all the grants that are that she can write and get funding for. And I know Jason was mentioning other counties and talking to them and finding out that they don't have other good relationships with other departments. Well, we've
062met with other transit agencies and we found that they don't have a really good knowledge base of all the funding opportunities they have. um because we have all this funding, we're not charging our passengers anything for those trips and we're really saving the county in a lot of ways um in providing those operations. Um on this chart, one of the biggest grants that we have, it's our 5307 grant and um with our capital portion of that for five years, we're going to get about $4 million. And so that capital planning requires a lot of coordination with our facilities department procurement to figure out how we're going to spend those funds. But most of that funding is going and then and then you know we have a lot of initiatives of course as all the departments
063in human services do. One of the biggest initiatives we've had that's actually covered a number of years is our routing schedule platform. Um we've been working on that for a number of years. We just went live with that July 1st. This is a very incumbency platform and uh so but this is going to help us once it's up and running in all the different ways. It's going to really increase our efficiency. Um we're also working on with all that funding we're getting for the capital grant. There's a lot of strategic meetings on how we're going to use that funding and um be cost effective with that. We're also looking at satellite locations for our vehicles for overnight storage in the county. And then one of the big things that we're doing is continuous involvement in
064regional, state, and federal transit and the initiatives going on. If you go to the next slide. So um Teresa and Janet actually went to DC to discuss legislative matters uh with some elected officials last uh fall. And that's just really important that uh we have people here in Union County that are going out and um having those discussions with those um people that are making the rules. Um and part of that organization that went to DC, that's part of our NCPTA. That is a organization that is an advocate for transit agencies in North Carolina. There's 95 transit agencies that they represent. They do advocacy, educating, training. They also do a awesome conference events once a year of which Teresa is a co-chair for that event. And if you look at that top picture, um the
065event in May had a big rodeo which they allow bus operators to compete against each other. And so there was about 90 plus drivers from around the state that competed. We actually were able to send six of our drivers. They performed very well. And there's a picture from a previous year where our drivers did um place in the competition. Um the middle photo actually is just to highlight Brandon because Brandon was one of the judges. He's actually laying on the ground watching this uh large fixed route bus uh go through some tennis balls. Just making sure everybody was uh on the up and up. Um, and then, uh, another picture shows one of the our our vehicles, the kind of obstacle course they went through. And then, um, I know Brandon mentioned we work very
066heavily with our public communications department. One of the lower pictures is one of our, um, passengers, Miss Kinlaw. She's very involved with transit advocacy, and she's um, one of our go-tos when we're doing like any kind of public communication awareness videos. And so that's a clip from a video she was in talking about our services. And then the last picture on the bottom is our propane tank, which is actually just a really big deal deal for us. And it's one of the grants Teresa wrote that we were able to get that uh propane tank. We're saving on fuel costs. And uh we got 80% coverage on those costs because of the grant that she wrote. That's basically it on transportation. Do you guys have any questions? I wanted to ask a question. Um, since Medicare
067or Medicaid rather came into play with the transportation, some of those increases are many of those increases in the rides from uh Medicaid clients. >> So, um, so we did have an increase. I can't specifically exactly what the increase was, but I know that um we have increased our residents that are have Medicaid coverage on both the direct Medicaid and the brokered Medicaid side and um it's definitely uh we work heavily with the DSS department on those clients and um that funding opportunity actually is uncapped and so definitely if they have Medicaid coverage too that we try to use that as our first funding source. I have a question. Um the grants, can you describe what some of the grants are? Are they federal and state? Are they combination or? >> Um so some of
068the grants. So there was one grant up there that was called the rope grant and that's through the state. Um and that covers uh employment trips uh trips of clients going from a rural part of the county traveling in that area. Then we also do um you. >> Oh, I'm so sorry. I'm sorry if you can't hear me. Um, oh, thanks, uh, Brandon. Then we have, um, other grants that are specifically that have been written to cover our trips that we provide. Like the first six grants listed are basically to cover our trips. So, we develop a trip cost based on what we've done historically. And then, um, in the grant, we use it to cover those trips. And so, um, we also have, uh, grants that cover our capital. That's a state and federal
069grant. And then, um, and then we have a couple other grants that cover our payroll, our administrative payroll or, um, some of the management payroll in the department. >> But are they like public funding? Is it public funding? Is it What is the source of the grant? Who's who's giving the money out? So it's um through the FTA. Are you talking about the Federal Transit Administration? Yes. So a lot of those grants are with the Federal Transit Administration that um the grant is written. In some cases, we are a direct recipient on that funding. In other cases, the funding is going through the state level and then we are a subreient of that funding. There's other funding that goes to our regional planning organization and we're getting at the funding. Um, in almost all those
070grants that are listed, um, there's different ways of accessing that funding and getting reimbursed for that funding. So, it does require a lot of leg work to get at that funding and then get reimbursed and which like I was kind of mentioning before, we we actually with another transit agency, we met with them and we found that there was a lot of funding opportunities they were not utilizing which meant that they were providing trips and then their uh their county was covering the cost to those trips because they didn't have a lot of they weren't accessing some of the funding sources. in addition to the federal funding um just because funding is a benefit so I want to make sure that we give a shout out also uh the state provides one of the funding
071sources which is rope um and that was listed there and that is from the state legislature versus federal dollars specifically and that's something that actually had been removed a couple of years ago and they reinstated it so that's a very good thing um we could utilize more at at the state level, but obviously there's a lot of competition for for that funding. And then the other funding source that we utilize is home and community care block grant, which is actually part of the Older Americans Act. So, it's specifically for people ages 60 and older. And I think those are the only nonfederal Right. Yeah. >> I just I just have a question. Do you guys have a no-show rate? Like when you go to pick up people and they're not there? Yes, we started a
072a no-show fee um last August. Um it's $10. Um depending on the situation, it might be waved or the current clients like we don't charge Medicaid clients. Um there's other type of clients we might wave or look at the situation and um not charge that fee. right now being in our new platform. Um, as we work out some of the pieces of the platform, we're not charging a fee right now either, but we expect to reinstate that. >> You know what the rate is of like the no-shows of people that Is it daily? Is it multiply? I don't have the rate off hand. I can I can share that next time. Um, but us and all the other transit agencies have a high no-show rate. >> Yeah. And it's annoying because it takes rides away
073from other people, right? So if we're going to provide a service, we want people to be able to use it >> and it still counts as >> and we have multiple ways that we that we try to avoid those shows, right? So uh we have an IBR system that will call the passenger the the day before and remind them they have a trip and remind them where they're going, what time the trip is, uh when to be ready. Uh and then our drivers also have the ability on their tablet to uh call out to the passenger when they are in route to their house or when they are at the stop before them. Uh so we we do everything that we can in our power uh to make sure that the pastor knows that we
074we're coming, that they have the ride with us, that we're on the way. Uh because like I said, we don't we don't do no shows for a money grab or uh like you said, it's it's more about the seat and the opportunity that that person took that someone else could have had. >> If you have a repeat offender, are they still allowed to utilize the service? Are they told they can't utilize the service anymore? >> So once you get three no-shows, um you can be suspended for up to 30 days. Um and then it goes in severity from there. Once you're off suspension, if that continues, then it increases up to losing your privileges. >> I think that's good. >> Yeah. >> When you say trip, is that door to door or is that a
075route that y'all run? >> It's door to door >> or curb to curb. Um door todo if it Yeah. But >> and are there limitations on the time? I know in the past, and it maybe it wouldn't fall under y'all, but there had been um discussion on ways to get some transportation options, you know, within the county. Um and I understood then that there might be a problem if you had a late appointment in Charlotte, right? Like a a 4:30 doctor's appointment. Can you get someone home from it? >> No. So >> yeah, so uh our our operating hours are from 6A to to 6P. Uh so we we try to get every one of our drivers back to base or uh finish with their route by 6 p.m. So we have to be strategic
076in uh how we stagger driver start times, right? because we don't want to flood the market at at at 5:00 a.m. 6:00 a.m. pick people up and then have nobody uh you know in the late afternoon or early evening to be able to pick people up to take them home. Um so we're strategic in how we uh stagger the driver start times. We have to be mindful of driver hours. We only have a certain a lotment of vehicles and a certain a lotment of drivers and hours in the day. Um so we um we take people into dialysis um as early as 5:30 in the morning. Now, um we uh pick up the latest person that we pick up is 510 and that is from Tyson. Um but said those those real early morning and
077those um early evening trips are are trips that we take on as a kind of case by case basis. Just depends on where they live, how far they're going, um what they need. >> And I will say like the dialysis and the medical offices know what our times are. So, they're very good at giving our passengers the times within our time frame. We are missing. There is an unmet need. Um, that's just a hard nut to crack to figure out what that is to be able to say we need to extend our services. >> Thank you. [Music] All right. Good evening. Thank you so much for your time and the opportunity to share this information with you tonight. Um, for those that have been here before and done this, we do this each year. It's
078a more comprehensive update. um of the rates of communical diseases for our county. Um and it it is based off the calendar year and the information that I'll be presenting to you tonight um is from the calendar year 2024. Here's just an update or overview of um the reporting categories that we'll be reviewing tonight. And um the annual review of communal diseases, it um again just provides a comprehensive overview of the reportable infectious diseases um within our jurisdiction. Um and it just kind of highlights some trends, emerging threats. um we go over some um key uh key public health responses and then um just some insights on the burden of disease, the effectiveness of surveillance and control measures that we um implement. Um I'd also like to point out that we get all of the
079information from the North Carolina um disease data dashboard. um that's updated annually and um you will see that a lot of the um information we have we are reporting case rates in this presentation um which are the number of cases of diseases occurring in a population during a specific time um and indicates how commonly diseases are reported um for our j jurisdiction and then there also be reference to the incidence rate and that's the number of cases of disease in a spec specified population. It's usually expressed in per 100,000 um and it indicates the risk of disease in a specific population. So your your case case rate is going to fluctuate a lot with census whereas your incidence rate kind of highlights the actual risk um in a population. And while both values carry great
080significance, we're only going to um just for consistency because it's what we've reported in the past, um we will report mostly um case rates and can only compare um the incidence rates for previous years. I try to put both on there and it just looks a mess. So um that's for everybody's benefit. Um but the data dashboard is public facing. So if you have any interest in incidence rates from past years um please feel free to reference that. Um so for our entic um food and waterborne illnesses you will see that there were notable fluctuations in several of the entic diseases um compared with historical averages. And for the historical averages, we go back um for five years. Um rates of campleacttor, cryptosperidiosis, ecoli, salmonella and vibrio infections were all above average. Um this, you
081know, could be due to um reflections in environmental, behavioral and reporting factors. Um campator and salmonella remain the most commonly reported bacterial um interex and you know the their um increases just underscores the need for continued efforts in public safety education food safety education. Um our environmental health staff does a great job and we collaborate a lot with them um to to provide some of that. Um also with each case that we get we review that information um with those patients. So hopefully they're not um recurring infections. Um also outbreak prevention. There was a salmonell outbreak in a child care center. Um and that contributed two cases but also with those two cases would not you know obviously there's 20 other cases that we're looking at um as compared to the 5-year average. Um so
082it's been really important to get that information out um to those those positive cases. Um the rise in cryptosperidiosis also may suggest um seasonal exposure risk um recreational water contamination. Um I will say that we did not have any epidemiology um linked cases um which means just not a common um common link or common resource source. Um vibrio also that's um usually associated with raw or undercooked seafood. We always screen for that. Um, we did have a couple of we did have in 2024 a recall for oysters. Um, so we get that information out um to all of our distributors and environmental health um is really great about going and ensuring that those those lots are u disposed of. Um, in contrast cases of Legionella, Shagela and cycllospores were lower than average. Um it could
083be attributed to um you know more stringent build building maintenance for Legionella and then changes in travel patterns for vaccine preventable. I don't think it's a surprise to anyone. Um we did experience an increase in case rates um compared to previous years. This trend um is cons uh concerning and signals a potential shift in immunization coverage and population immunity. Um you know transmission dynamics within community um travel um are all considered um potential contributors. Um as noted on the slides increased incidents were um was a big big in ptasus. we did have a significant outbreak not just in Union County but across the state as well. Um big increases in pertasus. Um and but we kind of expected that um and that particular outbreak started at a public school um began in 2024 and then
084it just ended um earlier this year in 2025. Um overall rise in vaccine preventables um really emphasizes the continued importance like Jason mentioned before um education ensuring timely access to immunization uh immunization services um and we are really good about um looking at our schedules and ensuring that access. We've also even this year increased our number of outreaches where we're administering vaccines in the community. um and we'll continue to work hard for that um outreach in the future. Um also strengthening partnerships with healthcare providers, schools, community organizations are all really vital um to addressing that vaccine hesitancy and improving immunization rates. Um this is a little bit harder to read but um just kind of give some information. Also this is um available public facing with the respiratory surveillance dashboard but um kind of gives
085some information about the patterns in the flu season. Um this season showed distinct temporal and severity um features. We saw a marked spike in deaths um and influenza-like illness um really started kicking up in um early February. And I will say um just because the flu season runs a little bit differently, this information is um the 24 25. So um a lot of that information will be current for this year. Um but high severity um as well. This gives a little more information more broadly about respiratory um v virus surveillance overall respiratory burden um with u with really substantial activity from multiple viruses at different points in the season. Um and this makes a huge difference especially with um demand on health care. Um you'll see that in December there were several weeks where RSV
086um also even um had outweighed positivity than influenza. Um and again these are vaccinereventable diseases. So that MPV or or um RSV the purple >> um that is um oh goodness >> it is >> human metabo yes I was going to say it's right there but yes it's a metanuma virus. All right. And for our um direct contact respiratory for TB I'll go into a lot more detail on the next slide. Um but as you can see we had um a pretty active TB year um with active cases. Um and for Green Bay strep we did have an outbreak at a long-term care facility. There were four um four infections included with that outbreak. Um we were able to work really quickly with the long-term care facility and get that outbreak contained. Um but that
087did contribute some to the increase. Um invasive group a strap you'll see a lot with um we have seen with wounds um also um IV drug use. did see um an increase in number of infections last year from IV drug users. And so with the active um TB cases, one of the biggest reasons that that is such a heavy lift with each active TB case we get on average it takes about 40 hours um to to complete that investigation and get that patient started on medications and that's just for the initial response. Um these active cases we do um direct observed therapy for every well we try to do every dose that um besides the weekends but um initially we go out to the house um every day for the first um initial phase of
088that treatment and then afterwards we do um telea visits with with patients to observe that therapy. Um through those six cases, we had 333 contact investigations. With those contact investigations, we do offer testing for each of those patients. Now, not everyone um because that testing is optional. Not everybody opted to do that testing. Um I would say about around 160 actually decided to opt for testing for that. And then some of them are lost to followup as well. Um for TSTs and IGRAS um TSTs is tuberculin skin test and the IGRAS are corology so blood testing um for T latent TB. For high-risisk we did 704 tests. So for um the contacts listed sometimes we have to do two tests. one when we are initially notified and then um 8 to 10 weeks after notification
089just to ensure that that is a true negative and they haven't converted in that that period. Um low risk is considered like those that need it for school or for employment um and we offer that service as well. Um out of those cases or even those that are reported so we do LTBI's also reportable um and we evaluate those cases. So anybody who has or is identified to have tuberculosis um we rule out active TB. So we do chest X-rays and screening for symptoms um and if they are not active it's latent meaning they are not infectious to others um and they are not symptomatic themselves. We offer treatment for everybody who is identified with LTBI and that is also optional. they are not required um to do treatment. Out of those cases, 63 were
090um initiated, 21 were completed. Now, some of those um cases, 30 actually carried over to um 2020 this year, so 2025 and then we'll report those out um this year. 12 incomplete treatment. Sometimes people do not complete treatment um because of symptoms. Some people are it just does not suit their lifestyle and they decide not to continue with that. Um we do everything that we can to ensure um treatment. Sometimes we do have to change therapy. Um if it's due to symptoms um and then the others either declined treatment or lost to followup. um treatment not indicated. Typically that's with um people who are identified with LTBI and they say, "Oh, I was treated for active TB back in 1989." Um we do our best to get those records and ensure they were treated appropriately.
091Um but for that population, we would not recommend retreatment at that point. Uh this year illness spread by insects and animals like malaria and Lyme disease did not show any significant fluctuation. Um the noted increase was in dingay. These um were both travel related cases. Um I think you know just that alone just kind of highlights the the importance of education. Again, if you're traveling, um it's going to be really important to get that prophylaxis. Um because when they are infected, when they come home, that presents, you know, potential for spreading. All right. Um we did not have any um events of Cretzville Jacobs disease. um menitis we did have um an increase in cases um no outbreaks we didn't have any noted secondary cases so with um the menitis cases each event we get
092we collect contacts we do offer post-exposure prophylaxis so antibiotics to prevent um infections to those close contacts and so we did not have any secondary cases um related to any of those um CR um these These are basically drugresistant organisms. Um these organisms have a um mechanism to actually break down the antibiotics. Um so we have a close eye on those. It's really um important to do surveillance especially for long-term care facilities. Um, we did have most a lot of those were contributed to um either hospital stays or long-term care facilities. And we work really closely with long-term care facilities to make sure the um control measures are implemented um infection control. Sometimes we go in and do um assessments for the long-term care facilities as well. Um with the menitis, I did want to
093mention in 2024 we had a notification um for our region there was an increases and penicellin resistant strains of menitis. Um this was caused by naserum and ninjitus serroup y which is a very common strain of um menitis and then um this resulted in discontinuation of ur utilizing cypro um as a prophylaxis to close contacts and this um in our region it was Cabaris um Gaston Iddard Lincolnburgg Rowan um Chester Langster and York County so South Carolina was impacted as well. Um this was a change in our routine recommendations and through that we sent out notification to local providers and then we monitor every single person who that um that con every contact um just to make sure that they are treated appropriately because people do seek postexposure prophylaxis from their primary care provider. So,
094you know, when those things are not when we know that, you know, they're not using best practice for um and some people some providers don't know, they don't get the memo. Um so, we just reach out to to reiterate that information. Um in 2024, we did have seven um outbreaks of other communicable diseases. This um included respiratory illnesses, gastrointestinal illnesses, vaccine preventable diseases. Um those were the most common causes of outbreaks. Um again the protessis was one of them we did and this included different um different places as well, long-term care facilities, schools, um childc care facilities as well. It just kind of highlights the importance of doing ongoing surveillance, rapid case investigation, community engagement. Um we have a really great goo group of um CD nurses. We also have a really great relationship with
095our community um community partners, our CCHC nurses um so we can get that that education out there quickly. Um, and you will note COVID outbreaks are still reportable, not individual cases, but we do have um, and that's primarily long-term care facilities. All right, sexually transmitted infections and bloodborne diseases. Um, good news, chlamydia gorrhea rates went down a little bit. Um also um congenital syphilis and primary syphilis rates um did decrease a lot of that um we can attribute to a lot of the education and for those that remember the 2023 update those cases were skyrocketing um and so those trends are also reflected really throughout the nation in North Carolina. So, um just kind of highlights the importance of education. Um getting that information out there. Um you know, some of the rates that we
096did have an increase in um HIV with newly diagnosed um patients. and then hepatitis um B. Some of the hepatitis B, a lot that we've seen personally um and kind of make notes. A lot of it um especially the chronic are from um other countries. Um, so those that don't have access to routine vaccinations like we do in the US and the big news, our immunization review. Um, total vaccine administered did increase. I think last year it was um, a little over 6,500. Um so our benchmark report is run every October. Um and these benchmark reports are for ages 24 months and below and this is for both internal clients and countywide. And when I say internal clients I mean for our child health patients um that we are their medical home. Um we we
097have patients um for our child health clinic. We see u Medicaid um uninsured. We are the safety net for uninsured children in Union County and so primarily um that's what we do our outreach for. Um at this age children have received a bulk of their routine childhood vaccinations including protection against most all vaccinereventable diseases including MMR and vicella. Um and then I would say this is a notable and well decline decrease. Some of these patients, especially the um internal patients, they did have um declinations on hand for um those patients. And then county residents, we do provide um outreaches. We provide um education. And then we do have some providers that reach out to our um immunization coordinator just to get some information. Um and we send out for really countywide, we also send out
098postcards um to remind patients. We try to do that um at least once a year, hopefully twice a year if we if we get to it. Um but just to remind those parents your children are not up to date vaccinations. While um you know the causes of decline um decline declining [Applause] vaccine coverage um you know we've discussed it. It's complex and multiffactoral. Um but you know contributing factors may include reduced access to health care services um vaccine misinformation and then um as mentioned just the shift in that public perception regarding disease risk. Um you know risk versus benefit for vaccinations are is a hot topic right now. Um so until some of that perception shifts, I think we're going to continue to see those um you know declining coverage rates. Um we do offer
099vaccines for um underinsured, uninsured at no cost. Um so that is to um you know increase access to vaccinations and lower th those barriers. Um you know lower vaccine coverage. We it poses significant risk and is a great public health concern. Um that reduced comm uh community immunity, increased the risk of outbreaks um which really impacts those that are not they're not able to get vaccines. Your three-month old children um they are not eligible for MMR and even under abnormal circumstances. So um even if we were in a point of outbreak, they still would not be eligible for those vaccinations. We've already talked about some of the implemented um strategies to address these action um these issues, expanded outreach and enhanced reminder or recall systems. Um we work on that and then um collaboration with
100those healthcare providers and targeted community education. This is just a little bit about some of the outreaches and specific um efforts that we've done. Um last year we continued to offer STD testing for uninsured males. Currently the state does um offer free testing for females for gorrhea chlamydia um syphilis and HIV. Um also MSM they are eligible for free testing. uninsured males, they offer HIV, syphilis, and gorrhea. So, there is an out-of- pocket cost for chlamydia. Um, and we were able to use some um funding for to ensure testing for that um those uninsured um heterosexual males. Um continued um using preferred testing. So, IGIGRA is the the blood testing which um tests for the TB antibodies. Um we offer that testing for high-risisk patients at no cost to them. Um unfortunately that funding has
101um expired and so we're working on ways to kind of help um fund some of that testing. Um so more to come on that outreach events. Um we did hepatitis A flu and COVID vaccinations at the end county shelter. We did do a a significant TAT vaccination outreach divis vaccination rate um rates for childcare providers. Um so overnight well it was 96 childcare providers across the county. We we did it in clusters. Um so we went out to each um childcare provider that opted for us to come and visit. Um we did health education um other health resources. We did blood pressure screens um and help connect um those childcare providers to lowcost um medical homes. So those that did not because a lot of of a lot of those population is they're very vulnerable.
102They work with children but also they do not have health insurance. Um so that creates some barriers to healthcare access for them. Um vaccine lookup for school age children at multiple community events. We usually try to go out to many of the back to school events just to make sure parents are aware that we offer these services. Um they're aware of the vaccine schedules and how they can get the vaccines. Um this year we're kind of shifting some of our model models to actually go out to these events and provide the vaccinations um which will be something we continue to carry over to the um years and um continued utilization of our mobile unit. um that that unit was purchased during COVID um to help provide access to testing and vaccinations. Well, we've kind of
103you know tried to use it in other ways um to decrease barriers for service um vaccinations. We did um STD testing um which was really wellreceived. um also continue to collaborate with Union County Public Schools and um we attend their school health um meetings and provide guidance anytime they have communicable disease. We have a really great relationship, great communication with Union County Public Health uh public school. Um and I mean it's just really great because anytime they have any concerns um we have very fluid communication with them. All right, some key threats for the 24 24 um CD um program. We did have the major sign it was a significant ptasus outbreak um ongoing H5N1. Whenever we get notification if if we have notification of a an exposure to H5N1, we do monitoring. So, we
104reach out to those patients, screen for symptoms um throughout their monitoring period, and then report back to the state um for any symptoms that have been reported um or arrange testing if they if they report any symptoms. Knock on wood, everybody's been asymptomatic. Um basic bicylum shortage um and the management of syphilis um treatment. So um for syphilis patients the but for pregnant women they cannot receive doxycyc you can't get that during pregnancy. So we have to um manage that stock and inventory um and prioritize pregnant women with basic. Um Salmonella outbreak um there was Craig, do you remember what county that was in the Salmonella outbreak? We did have a few positive cases of Salmonella. I think it was from Cabaris County that they had um they had a celebration and they ser it
105was a foodborne um outbreak that um we had some response to and then um like I mentioned before we had those resistant cases um and an increase in meninja coakal disease um also the measles outbreak which I'll go over a little bit I figured everybody would appreciate a little overview view of the response so far. Um and then there was another wave of impop spread. We did have one case um last year from impas in 23 we had no cases. Um so there was another little wave that we had to respond to and educate with. All right. And so for the measles outbreak, I won't bore you with the details. It's all there in your packet. Um, but I'm sure everybody was aware that there was a case in North Carolina. Um, we did have
106one resident um that was a contact of that case. Um, with those cases, we do assess um so if we get a close contact for measles measles patient um we do assess for immunity. So the first step is to look at vaccine records or um any other proof of immunity. if that person is not immune, we do active monitoring. So, we reach out to that person every day through their monitoring period. Um, and then if they report any symptoms, we do arrange for testing. Um, for those that are immune, it's a passive monitoring. So, we give them a list of symptoms. You monitor yourself through that monitoring period. Um, obviously give their give us give them our information in case they do have any symptoms. Um, but then if it's No news is good news
107in that case. Um and then for um luckily there were no secondary cases um reported from that visitor. Um they were not from North Carolina. They were here visiting. Um but they went basically everywhere they could while they were here. They went to a water park and ice cream and um another little fun park. So they were busy. Um but luckily no secondary spread. Um we've also noted um an increase in measles um contacts through travel as well. Um we've had probably a total of five exposures so far. Knock on wood. Um and we're really good and diligent. And for most other communical diseases, we're able if they're lost to follow up, we send them a letter and close it. Um, for measles, we actually have to deliver, hand deliver those letters out to the
108house before we close them out as well as to follow up. And then I won't harp on this a lot, but as we mentioned before, um, vaccine coverage rates, um, and we get this information from the North Carolina, um, kindergarten immunization data dashboard, that is also public facing, so you are welcome to look up this information. Um but they just updated that last year. So in 2021, vaccine coverage rates for kindergarten age children was 95.5% um which is above what's considered her immunity. This year we're at 88.6 which is really really concerning. Um conversations that I've had with school nurses so far indicate that it will most likely be lower for 2025. Um, so, you know, in our efforts to kind of combat some of that, we're we're really working hard at getting information, education,
109um, anywhere that will have us. >> And that is it. Thank you so much. Any questions? >> Yes. First I want to say thank you for this wealth of information. Um I appre I applaud your those outreach efforts but when it comes to the board I kind of liken it to like insider trading for like say Congress per se. So we hear all this great information and I don't know the answer for the question I'm getting ready to ask you or Janet but is there any way that I mean for the regular lay person I mean I know this is recorded making has stuff to record it but there's some we get a lot of wealth of information but the lay person u how can they get some of this information so they might be
110able to help their families to be knowledgeable about what's going on in Union County >> right and that's one of um we have worked in the past um at providing a um and we still are, not that we've halted any of that, but we're working on doing um a communal disease dashboard for our county specifically that would be updated monthly. Um it would it would would provide just in time information. So, we're we're working on getting that um and it would be, you know, it would be on our public health page that providers, parents, um schools could go on there um to really look at what's circulating most commonly. Like I say, most >> most of the the the homes, like I said, long-term care homes or whatnot, they might have the information, but for
111the regular lay person, maybe there was some type of conduit where this information could be placed out there more for the public to see. You said only thing people see stuff on like when it came to infant deaths before, right? >> And I asked the question, oh, why is it so many in this ethnic uh minority which has such a larger rate of infant deaths? So, and then we we said bas the question answer was maybe it's education or lack of education rather, right? >> So, I was wondering how could we >> or one thing that we're doing in addition to the information on the Union County.gov website which on the public health page, we have a lot of this information along with the dashboard, but there's educational material there as well. And the county
112has a newsletter that's for the public. It's called the Union County Horizon and it is a weekly newsletter that goes out and it has different educational components um about immunizations, about water safety, about lots of basically all of the county departments um you know it's it's different material each week and so this type of material is something that is covered in that horizon newsletter as well. obviously at a very high level, but if someone then was interested as a as a teaser, right, then they could go to the website and get much more detailed information. And then beyond that, if anybody actually had questions, our team would certainly be happy to speak with people oneonone. >> Absolutely. >> I think y'all are doing a lot for outreach. >> Say that out loud. >> I think
113y'all are doing a lot for outreach. Say it into the microphone. >> I still didn't hear what you said. >> She said you said that Union County Social Services is doing >> public health public health public health especially. >> Oh yes. I was telling them I was like I kind of need to share this with our clinical staff because we work together every day but a lot of them don't know what I do. This is what I do in a nutshell. Any other questions? I know it's a lot of information and that it's very nuanced but also multi multiaceted. So, um I'll be happy to speak with anybody any >> It's getting late. I want to get but I am curious the state trend in the wrong direction with vaccines as well. >> Yes. Yes.
114Absolutely. >> Yeah. This is not something that is isolated to Union County. I can assure you. And knowing what we know about the kindergarteners, do we know if some schools have higher populations for it? >> Yes. Yes. And that's also um in the in the North Carol in the uh kindergarten dashboard, you can actually break it down to school at school level um to see what percentage each school has of coverage. >> Thank you. >> The website, right? >> It is. Yeah. and and just to kind of give a little more context of some of the outbreaks. So, we took that information, we've built a heat map. Um, and so our goal is to do some targeted outreach for those areas. All right. Thank you so much. We have no other questions. We'll move on
115to announcements followed by public comments. I know we've all been here a while, so I'm going to keep this really quick. Um, business operations, one of the things that Jason mentioned earlier was the coupe. Union County as a whole is working at the enterprise level on a continuity of operations plan. And so I'll be working with the directors in the departments and programs to set one up for Union County human services. So we'll have a coupe for Janet for human services as well as ones for each of the departments. Social services and public health are both required to submit those to the state. So, we will continue to work on that. The county deadline is 10:6 and we've got a soft deadline of the end of the month for our draft. So, that's underway. Um,
116the opioid settlement funding um project, Janet has asked me to work with um several of our other our um my colleagues to work on that for human services and for the county. So, planning started on um for that actually really kicked off in August. We've been talking about it in July. The first component we decided to focus in on was lived experience surveys and that's for individuals with lived experience in the opioid use disorder space as well as their family members. I did bring some cards and I can leave those with you if you'd like to take some. We are certainly looking for people to respond. There's a QR code, there's links for the survey and there's also hard copies in English and Spanish. So that is the first piece and then we are going
117to be doing a um listening session with people with lived experience through our treatment courts at the end of this week. So there's a lot of things happening in that space. It started in July and August and we'll run through the end of the year um for the planning components of it with monthly meetings. And then I would be remiss if I didn't share with you human services is a work family and unfortunately in my shop specifically in business operations this month we did uh lose a a staff member and so I want to take a minute and acknowledge him. His name is Juan Pacera and he was my human services supervisor that led our language services team and he passed away unexpectedly on the 23rd. So he was as I always said a light
118in simple languages. He was a tremendous team member and led um a lot of great projects and initiatives and was always jumping in and helping and I don't think there was a part of our agency that he didn't touch. So I very much appreciated him and miss him greatly. So I'm going to provide a couple of updates for community support and outreach. Um, first of all, with senior nutrition, I know that we mentioned at our last meeting that we had municipalities who had joined into the effort to fund the waiting list. And so, I'm pleased to provide an update that as of August the 4th, we have 358 people on the waiting list. Um we continued to vet that proactively and um in July we were able to contact 51 seniors and so we started
119with the municipalities who offered funding and those are all now completed and then moved on to clients who would fit into our hot mill routes and we will be taking 110 people off of the waiting list from the municipalities um as well as the additional funding that the county has provided for food this year. So that is is very encouraging. And we're also going to be modifying routes to ensure that the smaller routes have more clients and some better use of the volunteer time in that space. Um they also all the participants have gotten farmers market vouchers which is a positive benefit to everyone who participates in senior nutrition and just something that's worth shouting out. Um, also within our wig program, I definitely want to give a shout out to to that team. Our
120agency has been awarded the premier level of the USDA WIC breastfeeding award of excellence, which is really awesome. Yes, we are one of 56 WICK agencies nationwide to receive the premier award this year out of over,900 agencies in the United States. So, that is pretty cool and a high honor. Um, and that award highlights local agencies that operate highquality peer counseling programs and demonstrate exemplary support for breastfeeding families. The award is at uh gold premier and elite levels and premieres mid-level award which we like any level award cuz that's still really awesome. Um, and we actually had previously won the gold level award in 2021, but this year we qualified for the premier level because our exclusively breastfeeding rates met the required percentage. So, it's based off of a tiered system effectively. And uh, in
121that space, we also continue to exceed our case load requirements and got an additional $24,000 in funding due to that work, which is awesome and necessary to be able to maintain the volume. Um, and then just a a quick shout out to uh the Christmas bureau. We had an innovative campaign this year to uh raise money for teens, so Christmas in July. And we raised about $2,000, which was just a different type of campaign to begin awareness for the Christmas bureau earlier versus starting it in November. Um, and we do also have a school supply drive that's currently underway to support our foster children and other clients needs, but any, but primarily foster kids. Um, and then for crisis assessment, I think this is important to mention as well, our funding for energy assistance is
122on hold until the state budget is passed. We did get a small allocation of $10,000 in July for that and that was extinguished in 5 days. So, uh there is not any energy assistance um funny funding to be utilized at this point. My fellow citizens, this 750 and I'm going to be really quick. So, in the social services world, we are mostly staffed and I believe that deserves a hand clap. There are only a few vacancies in economic services and in social work. and I believe there's only one open in the behavioral health collaborative. So, I'm stoked about that. Um, I am not excited to share with you some of the same news that Jackie uh shared. We've had a really rough month in human services. Um, specifically, social services unexpectedly lost one of our
123senior social work supervisors. Um, and the tragedy of losing a staff member, especially one that was completely unexpected. um hits really hard with your teams. It impacted our transportation department also um because her sister works there. So, just keep our staff all of human services in your thoughts and prayers as we learn how to navigate without those two people. Um last week was the social services institute in Hickory and that is our annual training and come together uh conference and I'm excited to share that Union County DSS/human services presented several times um at that institute and had amazing um feedback that uh we got from all the participants in our presentation. So I was really proud of them for that. Um the current big priorities in social services going on right now is that children
124uh the child and family services plan which means that all of our foster children will be moving to one Medicaid plan through Blue Blue Cross Blue Shield Healthy Blue. they had previously been split up across the state depending on what uh LME MCO they belong to and it was a lot more difficult to navigate especially if you placed a child outside of the area where their plan was. So this will be the whole state blue cross blue shield Medicaid healthy blue. So we're working to get that implemented December one. And then the other big thing we have going on is uh called PATHNC and that is a statewide child welfare information database. Uh Union County will roll into that database in October. So we're currently going through all of our training to prepare for that
125transition. Um the last two things are a couple of uh things I've been asked to participate on. I'll be speaking in September at the North Carolina Department of Health and Human Services child welfare workforce workforce development event. Um so I'm excited about that to talk about um how we've done as far as growing social workers in the state of North Carolina where there are gaps and what our needs are. And the last one is I was invited by federal department of health of human services and the state DHS to participate in human services emergency response post disaster and that'll be in Colombia coming up. Last thing, September 2nd, I'm having knee surgeries. So I'll be virtual for a few months cuz they won't let me drive, which I think is is not cool. And I'm
126going to be stuck in my house going crazy. So, just know when you don't see me at the next couple of board meetings, I'll be on YouTube watching all of you. Thanks. >> Total new surgery. >> I'm getting a brand new ACL. And I told him to get it from someone who is much faster so that I will win every onelegged race around. We'll see if that works. I I can't keep a straight face. I'm sorry. The later it gets, the more more giggly we get. Um, I would like to say that our office has successfully applied for and received a grant from the North Carolina Division of Military and Veterans and Parents in the amount of 18,288 who dollars, which is fantastic for our budget. Um the only negative part to that is we
127have a quick return on spending. It has to be spent by the end of September, but I do not feel like I will have a problem with that. Um the other thing I want to uh announce is that Robert Turner and I were recently invite a court training put on by the judicial center and a group of agencies in Union County. and our our the plan is to start a veterans treatment court much similar to the um drug treatment court that they already have. So that's our announcements for today. Thank you. >> I don't have anything. You had my announcement. >> 18,000 mutual >> nothing for the other >> whatever we decide within the grant. >> We will move on with public comments. We do have someone tonight. We have Michael Eva. Is that correct?
128>> Hi, good evening. Again, my name is Michael Eve. Um, I live at 247 Marin Drive in Indian Trail here in Union County. Um, I wanted to come tonight um, well to introduce myself to all of you. Uh, I am the new community engagement manager for the Community Shelter of Union County. Um, I also serve as a governorappointed council member uh and the chair of both the North Carolina Council for the Deaf and Heart of Hearing and the North Carolina Statewide Independent Living Council. Um, ultimately I just wanted to come and say, you know, if there are opportunities where we can collaborate and partner, I would love to have those conversations with you. Um, for context, the community shelter, we're the only homelessness emergency shelter service provider in the county and the councils I serve
129on, uh, we are state councils where we advocate and advise, uh, the state on how we can improve existing or create new services uh, for people with disabilities that impact people with disabilities. So any way we can partner and collaborate um so that way we can more effectively serve the people of our community here in Union County and statewide, I would love to have those conversations with you. Um any way that I can be resource to all of you, I would love to have those conversations as well. Um so again, I just want to introduce myself and any way that we can collaborate and partner, I would love to to do that. >> Can I have a business card? >> Sorry, >> telephone number. >> Oh, yes. Uh, Ashley has all of my contact information,
130but I can >> All right. If we have no other things, then I'll make a motion for adjournment. >> Second. If no one is opposed. Thank you all the experience survey. Uh I think break down >> share them if you know anybody that might have them and we're going to have a family. >> Good job. You did great. Oh my gosh. [Music] >> You walking out >> except for also good. >> Okay, perfect. And should be two eyes