The Newsletter of Contra Costa Public Health 
In This Issue
Program Links
Service Excellence
You're a Gem for Going the Extra Mile

Roylen Stack
Clarissa Domen
Wedad Shammas
Kim Dao
Accountant III
Durae Sheppard
Account Clerk-Experienced Level
Tina Kingsley-Paulson
Account Clerk-Experienced Level
Fred Rivera
Retiree Temp
Laura Lejano
Student Worker
For stepping up to work as a team and get the work done after our department went through a difficult period. For keeping positive and cheering me up when I needed it.
-Nominated by Sherry Martija
Nancy Benavides
Administrative Services Assistant III
Laura Volante
Administrative Analyst
For their hard work in getting billings done, demands reviewed and requests from Finance completed. For working patiently with subcontractors.
-Nominated by Sherry Martija
Tashionna Goodwin
Clerk-Senior Level
For quickly completing important tasks while maintaining her smile, and for being encouraging and hopeful during the HFA accreditation process.
-Nominated by Claudia Sanchez
Alma Arias
Community Health Worker Specialist
For bringing love, gratitude, fairness, humor and hope to our program. For being an excellent home visitor, quick to implement changes and committed to the fidelity of our HFA model.
-Nominated by Claudia Sanchez
Silvia Maldonado
Community Health Worker Specialist
For bringing honesty, kindness, perseverance, prudence, and social intelligence to our program. For your positive attitude and for always reminding the team of what is important in our work.
-Nominated by Claudia Sanchez
Patricia Creel
Community Health Worker Specialist
For bringing leadership, perseverance, prudence, spirituality and gratitude to our program. For being courageous by asking the necessary questions.
-Nominated by Claudia Sanchez
Eliza Virata, RN
For taking on new responsibilities in the newborn/lactation clinic at the West County Health Center with compassion, skill and efficiency. For insuring our newborn babies and families are treated with excellent care and timely follow up.
-Nominated by Leigh Pierson Brown
Marta Rincon
Clerk-Specialist Level
For going above and beyond by taking the time to assist me with a software issue. For the efficiency and patience she demonstrated and for teaching me how to operate the software myself.
-Nominated by Jami Daviner
GiGi Bolanos
Community Health Worker II-Project
For going the extra mile to help one of our Homeless Hospice patients.  For always offering suggestions and support in helping our patients. For her compassion and endless energy.
-Nominated by the Health Care for the Homeless Team
Socorro Padilla
For going the extra mile to assist patients with completing various applications, scheduling appointments and getting their medications.
-Nominated by Fadua Galdamez
Natalie Koch, RN
Bertha De La Paz
Joellen Gomez
Community Health Workers
For going the extra mile as a team to assist a family with urgent transportation needs for their child. For being kind, supportive and compassionate to this family as they dealt with their child's illness.
-Nominated by Leigha Brown
Jeremy Horan
Emergency Planning Coordinator
For going above and beyond by supporting two Bay Area Public Health Coalitions for six months until permanent staff was hired. For helping these coalitions thrive under his leadership.
-Nominated by Kim Cox

These recognitions originally appeared in the August and October 2016 issues of the Director's Report.
October 2016
Director's Message
Dan Peddycord, Public Health Director
Social Determinants of Health Take Center Stage
For years, the national dialogue around health has focused on healthcare insurance and access to clinical care. But recently a new idea has taken center stage as an essential strategy to improve the health of our communities and contain healthcare costs. The idea is that social attributes, such as income, education, access to nutritious food and affordable housing, matter a lot in shaping health. So do language barriers, ethnicity and race.
We in Public Health have long championed the premise that health is strongly influenced by a myriad of interwoven social and economic issues. More so, if we truly want to improve the health of the nation, we must address the social needs and inequities that surround our clients, patients and their respective communities.
Contra Costa Health Services has long understood this. Our department has a rich tradition of helping our clients and patients with their social needs, in addition to providing excellent clinical care. Our colleagues at Contra Costa Regional Medical Center have leveraged Health Leads as a pilot project at the West County Health Center to advance social needs screening and resource connection.
Of course, for those of us in Public Health, that idea is woven into our DNA, and very much woven into our programming. From WIC to the Senior Nutrition Program to our Ryan White HIV Program to our Nurse Home Visiting, Black Infant Health and Lift Every Voice programs, we are designed to help address not just health issues, but also acknowledge the importance of a complex web of social, family and community dynamics that influence health and health behaviors. Now we are poised to advance the importance of social determinants and health equity to an even higher level.

Health Care for the Homeless (HCH)
Pictured: Dr. Joesph Mega, MD, MPH (HCH Medical Director) & Christina Ramirez (HCH RN)
HCH Medical Outreach Team Hits the Streets to Help the Homeless
In August 2016, our Health Care for the Homeless (HCH) Program created an integrated and multidisciplinary street outreach team in an effort to help so-called "rough sleepers," who tend to avoid shelters and other points of care. This subset of the homeless population suffers higher mortality rates and higher rates of co-occurring medical, mental health and substance abuse problems.
The team provides weekly medical and behavioral health services to homeless encampments in partnership with Anka Behavioral Health's Project HOPE outreach team. Together, Anka and the HCH team locate homeless residents with health problems and provide assessment, treatment, counseling services, follow-up appointments with county health centers and transportation vouchers. Additionally, the team has provided wound care, steroid injections, ultrasounds, psychotherapy and on-the-spot follow-ups, sparing clients a trip to the clinic or ER. During one 16-hour period, the outreach team saw a total of nearly 30 patients.
"We've seen everything from patients who lost their medications and need refills to people who have been homeless since 1989," said Dr. Joseph Mega, HCH's medical director. "There was a woman who recently left the hospital after a stroke and never picked up her meds. We were able to get them for her and check in on a weekly basis."
The medical outreach team will eventually increase the hours of the program, ensuring that patients receive timely follow-up care and that encampments throughout the county are visited and offered services.
For more information, visit the Health Care for the Homeless program's website or call 925-313-6166.
Family, Maternal & Child Health (FMCH)
Back row: Lorena Martinez Ochoa (FMCH Director), Monica Wilcox (CHWS), Silvia Maldonado (CHWS), Alma Arias (CHWS) Front Row: Tashionna Goodwin (Senior Clerk), Lili Sardinas (Peer Reviewer), Cassie Sweet (Peer Reviewer), Patricia Creel (CHWS), Claudia Ivette Sanchez (Program Manager)
Home Visiting Program Impresses Site Visitors
Contra Costa Public Health on its way to becoming the first agency in the County to receive accreditation for a home visiting program utilizing community health worker specialists.    

On August 30th, the Contra Costa Healthy Families America (HFA) program concluded a successful three-day site visit with two peer reviewers from Prevent Child Abuse America, Inc.
Our site was evaluated on 12 research-based critical elements.  Contra Costa HFA was found to meet model expectations in all 12 areas, while exceeding expectations in 9 areas. Through an evaluation of 150 HFA best practice standards, the peer review team found that our program met or exceeded model expectations in 148 out of 150. This is a huge success for FMCH Programs and for Contra Costa County Public Health!

Our local efforts to implement the nationally-recognized and evidence-based HFA home visiting model began in November 2013 when our FMCH Programs applied for affiliation with Healthy Families America and Prevent Child Abuse America, Inc. Since then, our HFA staff has completed intensive training and served over 80 families.
Contra Costa HIV/AIDS Surveillance Brief Published
The HIV/AIDS & STD Program recently published a surveillance brief on HIV/AIDS in Contra Costa County. The report presents data on new HIV diagnoses between 2010 and 2014 and the prevalence of HIV through 2014 in Contra Costa.
While new HIV diagnoses have remained stable during this time period, averaging 92 new infections per year, specific populations are disproportionally affected by HIV. West County residents and African Americans experience higher rates of new HIV infections. Sixty-nine percent of new cases between 2010 and 2014 were among men who have sex with men (MSM), another population that continues to be disproportionally impacted by the epidemic.
Starting this fall, the HIV/AIDS Program will begin using STD data to conduct targeted outreach to the highest risk populations in order to more quickly identify new positives and encourage those who are negative to consider Pre-Exposure Prophylaxis (PrEP).
Contra Costa is doing well linking newly diagnosed individuals to care quickly. From 2010 to 2014, 70% of newly diagnosed HIV-positive clients were linked to care within 30 days. Additionally, in 2014, 70% of people living with HIV/AIDS had a suppressed HIV viral load as of the last lab test. These results compare favorably to the national average where it is estimated that only 30% of people living with HIV/AIDS are virally suppressed.
Community Wellness
Concord Adopts Bike Plan
In September, the Concord City Council voted unanimously to approve the Concord Bicycle, Pedestrian, and Safe Routes to Transit Plan, a culmination of two and a half years of work. Our Community Wellness & Prevention Program (CWPP) played a key role in the process by working with the city to identify funding opportunities and co-wrote a grant to support development of the plan. CWPP also facilitated community workshops and provided data and analysis.
Concord's new plan focuses on changing streets to accommodate all users, including pedestrians, bicyclists, and mobility challenged residents, as well as motorists. The city will use the plan to write grants and guide the build-out of a pedestrian and bicycle network for the next 20 years. Next year, the city will appoint a Bicycle and Pedestrian Advisory Committee to promote pedestrian and cyclist safety.
Please contact Coire Reilly of CWPP at 925-313-6252 or  for more information.
Contra Costa Moving to Adopt Rapid Antiretroviral Therapy for HIV
Our HIV/AIDS program has plans to implement a new protocol being used in San Francisco to reduce HIV
The new approach would immediately link patients to care and get them started on medications the same day they test positive for HIV. Currently, many clinicians do not start clients on treatment at the first visit. They typically wait for lab results and give the patient time to think about starting treatment. This gap between testing and treatment causes some patients to disengage from the process and fail to link to care quickly.
To address this challenge, San Francisco has implemented an approach called "RAPID" where patients are immediately placed on antiretroviral therapy for HIV as soon as they test positive. The findings from San Francisco demonstrate that in the majority of cases there is no medical reason to wait to start HIV medication and that, in fact, starting immediately leads to faster suppression of the virus.
The HIV/AIDS & STD Program recently hosted a grand rounds lecture from Dr. Oliver Bacon, an infectious disease specialist who detailed how San Francisco is reducing the time between testing positive for HIV and starting medication to treat the virus. Efforts to develop a protocol for Contra Costa will move ahead in the coming months.
Injury Prevention
Brochure Offers Safety Tips When Using Popular App
In response to the incredible popularity of the mobile app Pokemon Go, our Injury Prevention Program produced a 4-page brochure with helpful tips on how to stay safe when playing the game. While the augmented-reality game encourages exercise and outdoor activity, it also distracts users from their surroundings, resulting in players tripping, falling and bumping into things. Our brochure shows how players can put safety first while still having fun. Check it out!

Employee Appreciation
The DIT team (from back to front:)
Mark Condit
Maxine Larry, Jennifer Bosch, Toni Philbrick, Ana Jimenez
Roberto Montes, Vaya Wilde
 Nicole Lapointe, Sara Sowko
Not pictured: Gilbert Soberal, Sergio Martin, Tracey Walker, Denise Root
Click to enlarge.
National Disease Intervention Specialist Recognition Day
There is no typical, routine day for a disease intervention technician(DIT). Many of our DITs spend their work day in the community providing a wide range of services for Contra Costa residents.
DITs in the HIV/AIDS & STD Program provide follow-up with community members who have been diagnosed with syphilis to ensure treatment. They also assist patients in notifying their sexual partners. DITs provide targeted mobile HIV and HCV antibody testing as well as risk reduction services to high-risk community members.
DITs in the Communicable Disease Programs deliver medications to patients with tuberculosis and observe them for compliance. They inform public health nurses if a patient should develop side effects. They also assist recent immigrants with latent and active tuberculosis infections to be evaluated by a doctor and appropriately treated. An immunization program DIT supplies public health clinics with vaccines and also assists pregnant women with chronic hepatitis B to ensure that their baby is protected from infection.  
For many of our community members, DITs are the face of public health. Their colleagues in public health and the community they serve greatly appreciate their hard work and enthusiasm!

October 7, 2016 was National Disease Intervention Specialist Recognition Day.
Director's Message (continued)message
Our Health Care for the Homeless Program is a model for addressing the highly complex social needs of its clientele. The launch of the integrated and multidisciplinary street outreach team is an example of how we meet people where they are. The recent creation of the Health, Housing and Homeless Division, the newest CCHS Division, is yet another example of how we have designed and structured our programs and services to better address the social determinants of health. And yet, we do even more.
Our Healthy Family America program was recently surveyed for national certification. They did very well and the program serves as another example of one that emphasizes the social determinants of health. In recent months, we convened a multi-disciplinary team to take a closer look at the needs of youth in foster care, recognizing that traumatic experiences also play a factor in shaping and determining health. Life-course theory is taking root as a key component to shape our strategies for addressing social determinants. And yet, we do even more.
Our Community Wellness & Prevention Program (CWPP) continues to emphasize how public policy and the built environment shape health. Just last month, our CWPP team played an instrumental role in shaping Concord's bicycle, pedestrian and safe routes to transit plan, which was adopted by unanimous vote of the city council. CWPP is also at the center of one of the most important determinants of health, educational attainment. The Public Health Solutions program is working with the CCHS Office of the Director to consider strategies for building more and stronger bridges with local schools and colleges to more fully develop career pipelines in health and internships . And there is more yet.
We are poised to embrace Whole Person Care. This is one of the most significant projects ever funded out of the Centers for Medicare & Medicaid Services, aimed at addressing the complex social needs of clients and patients who are high utilizers of healthcare services and those who are at risk of becoming high utilizers. We should know soon if this this five-year pilot program is approved. If it is, we will have a rare opportunity to further align our systemwide efforts aimed at improving the health of some of our most at-risk clients and patients by addressing social needs, and creating entry points to the health system that afford a more appropriate utilization of health-related services. The Public Health Division will play a critical role in implementing this program, in large part due to the wealth of insight and experience we have in addressing health via the lens of social determinants and health equity.
This is an exciting time for all of us in Public Health as we are on the verge of new horizons.

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