5 Questions with…

by | Jun 11, 2019 | News

Penny Caudill
Monroe County Health Administrator
Monroe County Health Department

The Monroe County Health Department completed a community health needs assessment in 2016. What are the major findings of that assessment and where can interested community members access that information?
The Monroe County Health Department, IU Health Bloomington Hospital, Indiana University, and members of ACHIEVE joined forces in 2015 to conduct a community health assessment (CHA). It was a long process that involved many community members and many meetings yet was worth the effort. A survey was conducted with the help of Indiana University, focus groups were held, and secondary data was collected. We gathered community partners to review the data. Their job was to prioritize the top three community needs and forge a path for improvement in a few short years. The selected areas of focus were 1) Basic Needs (shelter, food, transportation, safety, & social inclusion); 2) substance use and mental health needs; and 3) chronic disease including obesity. These are not easy challenges to meet. They are complex issues and each is multifaceted vs single concern. This complicates how the challenges are addressed and how impact is demonstrated. Each priority area of focus formed a work group or taskforce to create a community health improvement plan (CHIP) and to monitor progress in selected activities. The CHA/CHIP may be found here https://www.co.monroe.in.us/topic/subtopic.php?topicid=152&structureid=12.

In 2018, we again joined the hospital in the process of conducting a CHA and we will be developing the next CHIP in 2019. The health assessments and improvement plans must be renewed every 3-5 years.

Substance Use Disorder is an ongoing issue in our community and the Health Department has been partnering with the Indiana Recovery Alliance to combat this issue. What accomplishments are you most proud of as a result of this collaboration and what are plans for future outreach?
Many positive steps have been taken in the past few years related to substance use disorder. Make no mistake, the road is long and we have far to go.

    • In late 2015, the Monroe County Health Department was able to obtain local and state approval for a syringe services program (SSP) in the county. The health department partners with the Indiana Recovery Alliance (IRA) to operate the program on the health department’s behalf. Services began in February of 2016. Having a local organization manage the day-to-day operations has increased our capacity and allowed the program to serve more people. The health department maintains oversight and manages several grants which support the syringe program operated by IRA. The grants and the local health department funds may account for a small portion of IRA’s overall budget but the funding is important to sustain the local program. The Monroe County SSP has served many people by meeting people where they are, by offering education on harm reduction, by providing new syringes to reduce the risks from needle sharing, and by providing referrals to other services as needed, including but not limited to treatment. Naloxone distribution and training has saved many lives and after all, that is the point. IRA and the health department have naloxone available for those who need it. The goal of the syringe services program is to reduce the spread of disease, to reduce complications, and to save lives.
    • The substance use & mental health task force that I mentioned earlier has been working on activities that include educational events with the purpose of increasing knowledge. Topics included Medically Assisted Therapy or MAT, building resilience, and decreasing stigma of substance use. The taskforce also focused on increasing access to care. The Monroe County Health Department received a small grant to pilot a program helping people connect to treatment.
    • There are activities occurring to build resilience and reduce trauma since childhood traumas play a crucial role in our development, the development of coping skills, and our health outcomes.
    • The Opioid Summits have been successful in building community connections, and the County Commissioners established an Opioid Commission in 2017.
    • Most recently a Substance Use Disorder Coalition has been formed bringing service providers, government, and businesses together to find solutions.

I am proud of all of these steps and how this community can come together to work toward a common goal even when individual objectives may vary. I am proud that we have community partners willing and able to step up, to collaborate, and to enhance public health practice. I want each person to know they have value and they deserve a good quality of life.

You spoke with WFHB about rising rates of hepatitis A last year and recently we have experienced a couple of specific incidents at local establishments. Have hepatitis A rates continued to increase and what can we do as a community to address this issue?
Hepatitis A cases began increasing nationally in 2017.  Monitoring hepatitis A movement across the country was important and we expected a likely increase at some point. We started assessing ways we might be able to increase local vaccination rates in 2017. Retail food establishments were given information about the increase in cases, how to clean and sanitize should they need to do so. However, this outbreak is a little different compared to a more “traditional” HAV outbreak since no food has been linked to this outbreak. Our public health nurses, department staff and some volunteers have held over 20 clinics and vaccinated over 1600 people for hepatitis A since June 2018. The health department encourages everyone to consider being vaccinated. It has been part of childhood vaccination schedule since 2014. I can’t stress the importance of vaccinations enough! This is a vaccine-preventable disease.

The Monroe County Health Department offers health services in addition to providing oversight for other services that many are familiar with – such as restaurant inspections. Are there a few underutilized health services that your team offers that you would like people to be aware of? How can we take advantage of those opportunities?
The MCHD does offer a variety of services. Some you might expect and some might surprise you. The more expected services include birth and death certificates, permitting and inspections of septic systems, swimming pools and restaurants. Among those that might surprise someone are family planning services, tobacco cessation, harm reduction, and public health preparedness.

    • Futures Clinic is a grant funded clinic that provides family planning services through reproductive health care, birth control, sexually transmitted infection testing and treatment. The clinic accepts private and state insurance and any fees are based on a sliding scale. Services are NOT denied based on a person’s ability to pay. We have a certified insurance navigator one day per week who can assist client with accessing healthcare coverage. While the ACA enrollment period is short, HIP 2.0 is open throughout the year.
    • The tobacco educator offers tobacco cessation classes and facilitates the Baby and Me Tobacco Free program. This program helps pregnant women and their families stop tobacco use and improve birth outcomes. It is a national, evidence-based program.
    • Harm reduction includes the syringe services program and related services in our department. Harm reduction educators offer Naloxone education, training and distribution.
    • Public health preparedness relates to public health emergencies which can range from outbreak response to recovery after a natural disaster.
    • We have Disease Intervention Specialists who assist with partner referrals for sexually transmitted infections. Their purpose is to reduce the spread of infections through education, referrals, testing and adequate treatment.
    • The environmental staff offer free radon testing. January is radon awareness month so we highlight testing early in the year. Requests for testing have been increasing over the past few years.
    • Have you obtained your “secure ID” yet? We have seen an increase in birth certificate requests with the new requirement for secure ids.

Other than attend to our own physical and mental health, what can we do as individuals to positively impact health in our community?
Social connections are an important part of quality of life. Tending to our personal care needs both physical and mental along with making social connections helps keep us feeling good and improves our outlook on life. I believe that giving to your community has great value and gives us purpose. A person might give in the form of volunteerism, they might give financially to a cause, or it could be as simple as picking up some trash on the street when you walk past instead of passing it by. We can have a positive impact by fighting against stigma and by breaking down barriers to inequity.

Too often we beat ourselves up for our shortcomings instead of acknowledging them, working to be better, and admitting that despite our faults, we have strengths and value to our community. Together, we are better. Together, our community is better.

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Penelope (Penny) Caudill began her tenure with the Monroe County Health Department (MCHD) in 1992. She interfaces with local, state and federal government in her work to address public health issues. Prior to joining MCHD Penny worked in training and management with Planned Parenthood. She graduated in 1981 from Indiana State University with a B.S. in Health & Safety/School Health Education. In 1990, she became a Certified Health Education Specialist. Penny was the Disease Intervention Specialist at MCHD for 12 years, then moved into the Health Educator/Sanitarian position before becoming the Deputy Administrator and then Health Department Administrator in 2008.  Penny believes in collaboration, which is evidenced, through her work on coalitions and committees in the community.