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2012 Model Practice Application (Public)Application Name: 2012 Model Practice Application (Public) : Mohave County Department of Public Health : Public Health Nuisance Program Funding Applicant Name: Mrs. Rachel C. Patterson Application Title: Public Health Nuisance Program Funding Please enter email addresses you would like your confirmation to be sent to. rachel.patterson@co.mohave.az.us Practice Title PUBLIC HEALTH NUISANCE PROGRAM FUNDING Submitting LHD/Agency/Organization MOHAVE COUNTY DEPARTMENT OF PUBLIC HEALTH - ENVIRONMENTAL HEALTH DIVISION Head of LHD/Agency/Organization PATTY MEAD Street Address PO BOX 7000 Practice Contact Person RACHEL PATTERSON Title ENVIRONMENTAL HEALTH MANAGER rachel.patterson@co.mohave.az.us Submitting LHD/Agency/Organization Web Address (if applicable) http://co.mohave.az.us/ContentPage.aspx?id=127andcid=467 Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice Mohave County is located in northwest Arizona with a population of 200,186 (U.S. Census 2010). With a land area of 13,311 square miles, it is the fifth largest county in the United States. This practice addresses the funding sources for the public health nuisance program that is an unfunded mandate. The complaints are made by residents or visitors of Mohave County, therefore, the entire population of the County is affected by how well the Environmental Health Division administers the public health nuisance complaint and response program.
Public health nuisances can have detrimental effects to those in the vicinity of the condition, ranging from vectorborne diseases to infestation of rodents and insects to raw sewage exposure.
In order to gain funding, the goals and objectives included timely, efficient and legally sound response to nuisances in order to prevent public health effects on the neighborhoods in which they exist; Collaboration with other County Departments including Zoning, Building, County Attorney, Finance and the Office of Management and Budget, which is vital in making jurisdictional determinations, fostering teamwork between Departments and ensuring proper legal procedures are followed at all times; and finally, provision of funding to administer this program which is an unfunded mandate.
In 2004, after a leadership change, the EHD began reviewing the public health nuisance program. Outdated procedures existed that were not legally sound. With the assistance of the County Attorney’s Office, new procedures and legal forms were created and staff was trained. Response and compliance timeframes were set for the complaints in order to move the response along at a reasonable pace. Within a year, the program was running smoothly with all unabated violations followed through to court. The open cases that were on the books went from hundreds to an average of 35-40 at a time as complaints were closed after abatement or when the court case was complete.
The final objective was to find funding for this unfunded mandate. The challenge how was the EHD to pay for the abatement of the property if the owner did not comply? In the spring of 2007, while budgets were prepared for FY08, the EHD requested and was
Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. given $20,000 by the Mohave County Board of Supervisors (BOS) to start a clean-up fund. This fund was set up as an enterprise fund. As properties were abated, property lines were placed (including civil penalties. When the liens were paid off, the funds were deposited into the clean-up fund (today this fund is approximately $170,000). While this provided funding for abatements, the problem still existed of how to pay for staff time. In 2009, the Office of Management and Budget conducted a study which resulted in a recommendation to add a 50 cent surcharge per ton to the landfill fees. The Public Works Director supported this increase and the Board of Supervisors approved it. In FY10, the public health nuisance complaint program was fully funded for the first time in the history of the County. That same year, the Director of Development Services formed an Abatement Action Committee which combined staff from Zoning, Building, Environmental Health, Sheriff’s Office, ERACE (Wildcat Dumping officers), and Community Development. The goal of the committee is to look at the worst property cases in the County and decide how best to move forward. Community Development was added after a couple of meetings to provide assistance to those property owners that needed financial help to bring their property into compliance. The cooperation, teamwork and creative thinking exhibited by members of the aforementioned Departments was crucial in meeting the objectives of this program. The benefits are increased communication across Departmental lines and jurisdictions, improved public health in the areas where abatements have been completed, and increased morale of the EHD staff as they are now able to follow cases through to the very end and see results that benefit public health in the County. Many lessons were learned throughout this process, including the incorporation of other Departments in public health programs rather than thinking as if the Health Department is an island; learning to ask questions and use other (non-health department) perspectives for brainstorming creative ideas; allowing an unsuccessful program to be exposed to criticism, and addressing the issues head-on; and that even the smallest change in a program can have such a huge payback, both by increasing employee morale and creating a positive change in the public’s view of the Department. Describe the public health issue that this practice addresses. (350 word limit)
Arizona Revised Statutes require the local health departments to respond to public nuisance complaints. These complaints range from stagnant water to surfacing sewage to accumulation of refuse on a property. Response to these complaints is vital in that these types of conditions, when they exist on a property, can have an effect on the public health to the people living in the vicinity. If response time is delayed and/or funding does not exist for the program, the public health effects can be devastating. What process was used to determine the relevancy of the public health issue to the community? (350 word limit) Because this is a mandated function, the Environmental Health Division needed to find funding for the program. Public health nuisances are outlined in State Statute and can have severe effects on the community's health when they are not dealt with in a timely manner. We knew our job was not being fully accomplished as we did not have the resources to follow the cases through to abatement of the nuisance and therefore, inherent risk to public health was present. How does the practice address the issue? Because we were able to set up legally sound procedures, find funding that will carry us forward, and work closely with other Departments on larger cases, we are able to confidently address public health nuisances that couldn't have been effectively addressed before. Is the practice new to the field of public health? If so, answer the following questions. Yes What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. We believe the creative funding approach is definitely new to the field of public health nuisance programs. Most public health nuisance programs are funded via general fund monies and/or offset by other program fees. This program is paid by landfill use fees and lien payoffs without a burden to the taxpayers and without pulling funding from other fee-supported programs. We have searched for information on funding sources for public heath nuisance programs and have yet to see this approach.
In general, the idea of asking other departments for support of a public health program is not often done. For example, working with the Office of Management and Budget and the Public Works Department on approval of the landfill funding for staff time or asking the Board of Supervisors to approve seed money for cases where abatement is accomplished by the Health Dept. and turning that fund into an Enterprise Fund with the support of the Finance Department is an accomplishment. It is often difficult to get other Departments to see the value of a program and support it. The key was starting with sound procedures and showing what could be accomplished. Once the program was running efficiently it wasn't difficult to garner support for its continuation, even if that included some funding to get started. How does this practice differ from other approaches used to address the public health issue? We believe that the basics of the program are very similar to other approaches. Response to public health nuisance complaints is a common responsibility among Environmental Health Divisions. The way this practice differs is that we have found different funding sources (as stated above) in order to run this program without it being a burden to other programs or the general fund.
As noted in the previous question, the work leading to the creative funding included development of sound procedures that the County Attorney's office could buy into. This was very important in that we take many cases to court each year and needed to know that we would have success at the hearings and be able to fund the abatements once the judgments were signed. We also created close relationships with other Departments including Public Works, Zoning, Building, Planning, Community Development and the Office of Management and Budget. Not only was this helpful in ensuring that we were not stepping across jurisdictional boundaries, but we were also able to familiarize the other Departments with our program so they knew what we did. This led to more support for our program, including funding ideas. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?
What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. How does this practice differ from other approaches used to address the public health issue? Who were the primary stakeholders in the practice? LHD, County Attorney's Office, OMB, Public Works, Development Services What is the LHD's role in this practice? The LHD responds to public health nuisance complaints and makes the determination whether the complaint is valid or invalid (based on Statute). LHD will send out legal notices, conduct follow up inspections, work closely with County Attorney's Office(CAO) when abatement is not completed, testify in court and oversee any abatement when needed. LHD also oversees the funds transferred and deposited that pay for the program as well as the placement of liens and lien payoffs. What is the role of stakeholders/partners in the planning and implementation of the practice? LHD: Completed procedures regarding complaint response, requested seed money from the Board of Supervisors(BOS) and oversees the funds which are used for the program.
CAO: Reviewed and approved procedures, developed legal templates for court cases, takes the cases to court.
Public Works: Supported the landfill surcharge which now funds LHD staff time in the program.
OMB: conducted the study which led to the proposal of the landfill surcharge to the BOS. Made the determination of how much funding would be needed for the program and what the surcharge should be to cover LHD staff time in the program.
Development Services: Provides program support through referrals of complaints, Abatement Action Committee, joint inspections, communication/discussion of complaints and was also a support for the landfill surcharge (they receive a portion of the surcharge for building and zoning abatements). What does the LHD do to foster collaboration with community shareholders? Describe the relationship(s) and how it furthers the practice's goals. In order to gain support for the program, and ultimately, funding, the LHD has spoken to community groups about the public nuisance complaint program, attempting to educate the public as to what we do and what we can do for them. Included in these presentations is information on how the program is funded.
Understanding that receiving a legal notice from the LHD can be daunting, we have designed a brochure to be mailed with the legal notices to the property owners that explains the process in layman's terms. This brochure is also available for general distribution.
We have attempted to work with Community Development to provide information to property owners on grant programs that could possibly help them. We include flyers with the legal notices when they are mailed out. In addition, we have (with BOS approval) waived permit fees for septic systems that are installed under one of these grant programs and conduct inspections of the properties with Community Development to help them ascertain what all on the property is in violation.
By doing the few things outlined above, the practice's goals can be furthered in that it gains more support for the program, indicating to the community that it isn't ALL just about enforcement, but we are also willing to help you as well with clear explanations of what needs to happen and access to possible grant funding.
Describe lessons learned and barriers to developing collaborations Many lessons were learned throughout this process, including the incorporation of other Departments in public health programs rather than thinking as if the Health Department is an island; learning to ask questions and use other (non-health department) perspectives for brainstorming creative ideas; allowing an unsuccessful program to be exposed to criticism, and addressing the issues head-on; and that even the smallest change in a program can have such a huge payback, both by increasing employee morale and creating a positive change in the public’s view of the Department.
One barrier to the process was the procedures the Department had in the beginning. We had to work through those procedures and come up with a completely different program than had been running. Once the program was off the ground, proven, and management recognized the change, other doors opened. It took approximately 3 years for the first funding source to be approved. During that time procedures were developed, staff trained and the program ran well enough for us to be able to pursue the seed money for clean-ups. A few years after that we were able to take the next step to get funding approved for staff time. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
1. Timely, efficient and legally sound response to nuisances in order to prevent public health effects on the neighborhoods in which they exist.
2. Collaboration with other County Departments including Zoning, Building, County Attorney, Finance and the Office of Management and Budget, which is vital in making jurisdictional determinations, fostering teamwork between Departments and ensuring proper legal procedures are followed at all times.
3. Provision of funding to administer this program which is an unfunded mandate. • Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Timely, efficient and legally sound response to nuisances in order to prevent public health effects on the neighborhoods in which they exist:
Performance Measures:
Procedure/policy change; Number of abatements completed by the Department; Number of open cases at one time before/after; Interaction with various Departments before/after
Data:
Procedure/policy change: found in policy and procedure manual
Number of abatements completed by the Department after procedure change: found in department spreadsheet (collected by Department Manager by review of judgments and liens)
Number of cases open at one time: Data found in Department permitting/complaint program (current open case data can be collected in a report by any user at any given time)
Interaction with various Departments: found in email correspondence, meetings held, etc.
Evaluation results: We believe this objective was met fully. Response time has decreased, legally sound procedures are in place, proven by the fact that the very few of our cases are not fully supported by the judges and the number of abatements has increased indicating that proper funding exists for abatements. In addition, we have a high level of compliance, most likely due to the fact that all cases are followed through to a resolution.
Feedback:
The results of the performance measures have been directly observed by the Department Manager and the Health Director and shared with numerous other people within the County, including politicians, Board of Health members, and Department heads. Modifications to procedures are made as needed. For example, a revision to the lien ordinance was needed to clarify legal language on when a lien could be placed and under what process. One lesson learned during this process was that sometimes we have to cut our losses. When the new procedures were implemented we had hundreds of old, historical, open complaints that had no follow-through. We reviewed them and changed their status to historical if no action had been taken in at least one year. This gave us a place to start from. We now have an average of 35-40 open complaints at one time that are all followed up on within designated timeframes. A report is run each Monday and given to the inspectors. This was a modification to deal with timeframe issues. Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Collaboration with other County Departments including Zoning, Building, County Attorney, Finance and the Office of Management and Budget, which is vital in making jurisdictional determinations, fostering teamwork between Departments and ensuring proper legal procedures are followed at all times.
Performance Measures: procedural changes, meetings held, change in support
Data: Correspondence between the Departments is excellent. An Abatement Action Committee was formed by the Development Services Director in the past two years. The Committee is comprised of most of the stakeholders mentioned above. We look at the worst cases in the county and decide the best avenue to abatement and work as a team toward that end. Procedures changed which included several of these Departments in the loop (County Attorney's Office, Development Services, Community Development) and support was garnered for the reason for these changes: funding. Supported by the BOS, Public Works, OMB and Finance.
Evaluation results: evident in the fact that the committee mentioned above was formed and is successful, able to work successfully with several of the stakeholders for funding support which was received, and while there is always room for improvement we believe this objective was fully met.
Feedback: results have been evident to the Department Manager - can be seen through increased communication with several of the stakeholder Departments. I would consider the Abatement Action Committee a modification to the process as this is a relatively new addition to our program. This was a result of difficulty in communication on projects that more than one Department had jurisdiction in. The committee modified this so that we are able to talk about these projects rather than respond on our own, including discussion on how the abatements will be funded (e.g.most appropriate agency to pay for abatement/take lead). This has increased the amount of joint inspections and information sharing across jurisdictional lines. Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: 3. Provision of funding to administer this program which is an unfunded mandate. Performance Measures: Number of abetments completed since receiving funding and establishment of clean-up fund in 2007, Percentage increase in fund due to lien payoffs (including civil penalties, interest, inspection time, etc.), approval of funding, approval of landfill surcharge to cover staff time. Data: Since 2007, the Environmental Health Division has conducted 46 abatements at a cost of $82,474. Previously, we know of 4 that were conducted. The clean-up fund was approved/started with $20,000 and is now at approximately $170,000. The landfill surcharge was approved in order to cover staff time in the field. At this point we break even each year in this funding category. Evaluation Results: We learned that once proper procedures and lines of communication are in place as outlined in the first two objectives, that the funding followed as a result of the support we received. Brainstorming ideas with other Departments is invaluable. At this point we believe our funding objective was fully met. Feedback: The data above is available by the Environmental Health Division and has been outlined in community presentations. Lessons learned are outlined under the Evaluation Results section above. No modifications have been made to the funding sources as they seem to be working well and should continue to do so. Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? 1. Timely, efficient and legally sound response to nuisances in order to prevent public health effects on the neighborhoods in which they exist. Tasks: a. Make contact with the County Attorney's office (CAO), meet and discuss strategies for implementing a legally sound program b. Write policies and procedures, get sign-off from CAO and Health Director, c. Implement response and compliance timeframes in order to make the program consistent and efficient d. Publish policies and procedures to staff and oversee training of staff 2. Collaboration with other County Departments including Zoning, Building, County Attorney, Finance and the Office of Management and Budget, which is vital in making jurisdictional determinations, fostering teamwork between Departments and ensuring proper legal procedures are followed at all times. Tasks: a. Begin building relationships with Development Services (building, zoning, planning) by inviting comment on cases that could cross jurisdictional lines b. Build relationship with the Office of Management and Budget. Make them welcome in the Department to experience what Environmental Health does first-hand c. Work with other Departments as opportunity allows, and support them in their endeavors (e.g. Abatement Action Committee, presentations to Board of Health, etc.) 3. Provision of funding to administer this program which is an unfunded mandate. Tasks: a. Once the above two objectives are met, work with the same Departments to brainstorm ideas for funding both for clean-ups and for staff time b. Ask for seed money during the budget process c. Work with CAO on lien procedure/ordinance for BOS approval. This will be the tool to recover funding
What was the timeframe for carrying out these tasks? When this process started there really wasn't a timeframe set for completion of these tasks or objectives. Once we were able to cover the clean-ups with the funding of the BOS to start, then from lien payoffs, we began to brainstorm as to a funding source for staff time so that it wasn't offset by other program fees and/or general fund monies. This is where the close relationship with the other Departments came into play. The OMB conducted a study and Public Works went to the BOS for approval of the landfill surcharge. From start to finish, the three objectives took about 5 years to complete. Of course, the procedures were in place very quickly, the funding took longer. Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. Yes. We believe there is sufficient stakeholder commitment to sustain this practice. Because this is a mandated program and is unfunded, the funding has to come from somewhere. Both of these funding sources have no affect on the taxpayers' general fund so the disadvantage of dissolving these funding sources would be that the general taxpayer would pay for the program. The clean-up fund is designed so that it is funded by those who violate the law having no burden on the County taxpayers and the landfill surcharge only affects those who use the landfill and is a program that is beneficial to public health and the environment so it is a perfect way to obtain funding.
Describe plans to sustain the practice over time and leverage resources. The practice is very well proven and the funding is solid. The clean-up fund is set up as an enterprise fund for the use of the program abatements. As the liens continue to be paid off, the funding will continue. We have enough of a cushion within the fund to sustain the program for a long time to come. The funding source for staff time is a public health surcharge to the landfill fees and charged per ton. This was approved specifically for the use of Environmental Health to pay for staff time in the public health nuisance program. We don't expect any changes or recession to take place. In addition, if a recession were ever proposed, there is enough evidence of the positive impact on public health to back up the use of these funds aside from the fact that if we don't use that funding source, the funding will have to come from the taxpayers. The procedures that support this program are modified as needed. Practice Category Choice 1: Environmental Health Practice Category Choice 1, Part 2: Public Health Infrastructure Practice Category Choice 2: Environmental Health Practice Category Choice 2, Part 2: Quality Improvement Practice Category Choice 3: Environmental Health Practice Category Choice 3, Part 2 Other Check all that apply. NACCHO Public Health Dispatch |
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