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89-1873 �i � l R E S 0 L U T I 0 N V � U SAINT PAUL BOARD OF HEALTH WHEREAS, the City of Saint Paul thro gh its Division of Public Health is required by Statute to prepare a bie ial Community Health Services Plan to receive a Community Health Services ubsidy; and, WHEREAS, this plan was presented for ublic review and comment and there were no changes recommended by the public; and WHEREAS, this plan must be approved b the City Council as the Board of Health; THEREFORE, BE IT RESOLVED, that the C ty Council. sitting as the Board of Health does accept this plan for subm ssion to the Ramsey County Board for their inclusion of this plan in the R msey County Community Health Services Plan for Saint Paul and Suburban Rama y County to be transmitted to the Minnesota Commissioner of Health. Saint Paul Board of Health Members Yeas Nays � Dimond �f Long Goswitz Rettman Scheibel Sonnen �i�FiiASa� ADOPTED October 12, 1989 SAINT PAUL BOAP.D OF HE LTH � ,�'.�1�' By � Ci Council President . , AGENDA OF THE BOARD 0 HEALTH CIT1( CQINCIL CHAMBERS - IRD F100R THURSDAY, OCTOBER 1 , 1989 9:00 A.M. 1. Resolution - 89-1873 - Aooroving the St. aul Component of Community Health Services Plan Update. (Judy Barr) 2. Community Health Services Subsidy for 1990 nd 1991. (Judy Barr) 3. Report from the St. Paul-Ramsey County ommunity Nealth Services Advisory Committee. (Ch�air of the CHS Advisory mmittee) . � � � � r l� � � J i� � � � �� , --z--� �y, _ . ..___.____ � , ., 22. Resolution - 89-1370 - Authorizing the Public Works Director to request a variance from MSA rules for the design speed of the horizontal curve on Victoria from W. 7th to Tuscarora. (Public Works Com mittee recommends dQDI"OVd�� 23. Resolution - 89-1496 - Adooting the study of the street lighting in St. Paul, directing its transmittal to the neighborhood contact list, Long Range CIB Committee, Planning Commission and aoorooriate City staff and allowing District Councils to create street lighting plans which identify exceptions, and requesting the Planning Commission to establish criteria as stated. (Public Works Committee recommends aoproval with amendment) 24. Resolution - 89-1551 - Acceoting Harriet Island and Watergate Marina 1989 Market Studies. (Community & �Human Services Committee recommends aoornval of a substitute resolution) � PUBLIC HEARINGS 25. Third Reading - 89-1809 - An ordinance amending Chaoter 56 of the Administrative Code pertaining to the City's budget calendar. 26. Hearing to consider the oetition for a Lot Solit with variance by Mike Maggi for orooerty located at 850 Forest and 849 Duchess between the railroad tracks and� Sims. (Laid over from October 5th) 27. Resolution - 89-1866 - Aaoroving/denying apolication for>the renewal of State Class A Gambling License aoolied for by Rice Street Athletic Club located at 1079 Rice. 28. Resolution - 89-1867 - Auoroving/denying annlication for State Class B Gambling Li cense a nol i ed for by the St. Paul Fi re Fi ghters Local 21 at Joses' 1 ocated at 825 Jefferson. 29. Resolution - 89-1868 - Aoproving/denying aoolication for Gambling Manager's License anolied for by Richard Leitner dba St. Paul Fire Fighters Local 21 at Joses' located at 825 Jefferson. 30. e lution = 89-1869 - Aooroving aoolication for the transfer of Gambling nager's License currently held by Thomas Law dba Hayden Heights Booster Cl at the Kickoff located at 1347 Burns to Lester Hansen at the same address. 31. Resolution - 89-1870 - Aooroving aoplication for General Reoair Garage License aoolied for by Cas-Dahl Auto Service located at 62 W. Winifred. 32. Resolution - 89-1871 - Anoroving aoolication by Habib Enterarises, Inc, dba Khyber Pass Cafe located at 1399 St. Clair for Strong Malt Beverage License in conjunction with the On Sale Wine and Restaurant Licenses. 33. Resolution - 89-1872 - A�nrnving anolication for Parking Lot License aoolied for by L & L Parking, Inc.� located at 270 E. 4th Street. - SEE OTHER SIDE FOR BOARD OF HEALTH A�GENDA - r i . ,, . i � �' ..,�� I � �� • o mun� . ea erv�ces a :::::::::::�::::::..:::::::::o:::::::::::::::::.::::::::::::.::.:::::::.:::::::::::.:::::::::::::�:::::::::::��:::�::::::::::::,::::::�:�:::��:�::::::��:�:::::::. ::::: �� : :::�::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::. :::::::::::::::::::::::::;,:::o:..:..o....::::::::::::::.::...::::::,::::.::::::::��:�:��::::::�::::::::::::::::::::::::::::��:::::::::::::::::::::::::::��: :: ��:::�� . �� ......::::::::::::::::::::::::::::::. ::::::t:::::_::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::;::::::::::::.:::::::::::::::::::::::.:::::::::::::::::::::::::::::::�� City of aint Paul Septemb 1989 I � ' s - OUTLINE � R THE ST. PAUL CHS LAN UPDATE 990-91 i. Cover forms ii. Board of Health approval� esolution iii. Assurances and Agreements iv. Immunization Agreement v. CHS staffing changes vi. List of new contracts I . Planning Process descript' n A. Current planning und' taken B. Activities expected i 1990-1991 II. CHS Plan Update and Update Index of Methods A. List of inethods used o identify and select health priority problems not in 88-89 Plan B. List of new Communit� Health problems C. List of goals/objecti es for the following programs 1. Families in Cris s 2 . Chronic Disease 3 . Hepatitis B 4 . Maternal and Chi d Health Initiatives III. Special Project Grants A. Native American grant ' roposal B. Special project grants applied for in 1990-91 IV. Requested Administrative an Program Support A. MDH Workshop evaluatio B. Desired technical assi tance for 1990-91 V. Annual Budget A. 1990 B. 1991 _ VI. Appendices A. Updated Organization Ch rt B. Board of Health member� C. Updated CHS Advisory Cd ittee members D. Updated list of service office locations ' s , " CAS PLAN DATE COVER FOItM NAME OF CONiMiJNTTY HEALTH BOARD Saint Paul Division of Public Health SPONSORING UNTTS OF GOVERNMENT FUNDING PERIOD C'ity/Couaty DatC Approved - ��90 �0 1��91 City of St. Paul SUBSIDY REQLTF.Sr Name of Counties 1990 Budget 1990 CHS Subsidy Budget Cit� of Saint Paul $7,009 , 85 $956,370 TOTAL 1991 SUBSIDY REQUFST S 987 180 - - Applicadon is made for a subsidy nnder the pr ' � ns of the Local Public Health Ad in the amonnt aad for the purposes stated herein. The person who sigos this orm agrees to comply with conditions and reporting requirements, consistent with applicable M'innesota Statute and R . T6e person also assures that this GHS plaa update documents changes to the CHS plaa as inswded by tbe Co ' ioner of Health. Further, thepe rson assures tbat those portions of the enclosed forms that are left blank and an y entation not included ia this CHS plan u p d ate are ua c h a n ged hom the 1988-89 plan. ' Sipature Tltle Public Health Services Manager D�� 9/19/89 ' This form must be signed by the C6airpe ' n or vcx-CLairperson of the Community Health Board, or an appointed agenG i. • t THE 1990 - 1991 CITY OF SAINT PAUL CHS PLAN UPDATE WILL BE PRESENTED TO THE SAINT PAUL BOAR OF HEALTH ON OCTOBER 19, 1989 . DOCUMENTATION OF THE OFFICIAL AC ON OF APPROVAL OF THE COMMUNITY HEALTH SERVICES PLAN UPDATE AND UTHORIZATION TO SIGN AND SUBMIT IT FOR SUBSIDY AWARD WILL BE FORW DED TO THE MINNESOTA DEPARTMENT OF HEALTH FOLLOWING FINAL BOARD A TION. ii.. ' t ASSURANCES AND AGREEMENTS BY SIGNATURE, TI� AUTHORIZED OFFICIAL GREED AND ASSURFS TAAT: L Scrvices w�l be provided ia accordancx ' State and Federal laws, rules and polides. 2 The Community Health Board w�l oomply ' state and federal requirements for equal opportuniry employmen� 3. The Board aill comply with state and f rcquirements relating to data privary or confidentiality of informatioa collected on ' dividuals. 4. The Board will provide the Minnesota De ent of,FIealth with information referenced in the CHS plan where applicabla S. Staadards for programs or adivities w�l used in carrying out affected programs or adivities �vhere those standards eais� 6. The requirements for full community p " patioq as de6ned in M'�nnGwta Rules 4700.1800, Lave been met . 7. The Health Advisory Committee or Health Task Force of aay Human Services Board Advisory Committee in the county where applicable ' StaG 4Q2.03), shall mect the com�cuitioa and re�orting requirements of the Commt�nity ealth Services Adv�sory Committee reqtured by Minnesota Statute. & The Board will comply with all standards lating to fiscal accauntab�ity that appty to the M'innesota Departmeat of Health, specifi , a The local match identified in the b submission com lies with the definitioa • �e�ea � �nn. sc�r. iasa� sc�r. (� ias.�ii). b. The Boazd will submit plan and b rcvisions to the Commissioner for prior approval ia accordancx with appli e statute, nile, and 1�IDH poliry. c. Reports will be filed with the Com ' 'oner of Health in accordance with applicable statute, rule, and MDH poliry. d The Board will maintain a Finan ' Management System tbat provides: 1) Accurate, curre.nt, aad ' plete discloaare of the fiaancial results of each activity. ' 2) Records that identify a.l uate1y the somce and appliration of fuads for subsidy supported a These records s6a11 contam iaformation perttining to subsid a ds and author'riations, obligations, naobl'�gated balaaces, liab�ities � brancea), outlays and iacoma 3) Demonstration that the has effective control aver the acconatab�ity for all fuadg, property aad � asset4. 4) Comparison of actual with bndget amouats for each adivity. S� Acconating records tbat snpported by sonrcx docum�ntadon. . " , � Andits tbat can be ma or at the direction of the Board or the " D�epartment of Health. 5aancial records w�l be retaiaed umdl audited, with the following q ti . � i i. t � aa) The records ar�l be retained boyond this period if andit 5adings have not beea resolved. bb) Reoords fo� non-eapeadabk property wluch waa ac�uired with subsidy fuads w�l be retained for t6ree years after its 5as1 d'ispo '�h'on. 'SIGNATURE � . T1'IT.E _ ublic Health Services ManaQer � DATE September 19, 1989 • Tbia fa:m mmt be � by the Chairperaon or V'xx CLairperaoa of the Commnnity Health Board, ac an appoiated agen� _ " : . . . . ., ; , ,, . .; - _ . ... - ,_ . �� /�;� MDH-CHS AGENCY IMMUNIZATION P OGRAM AGREEMENT INSTRUCTIONS: � Saint Paul Division of Publ'c Health � pgeacy agrees to: 1) Administer Department-supplied va ' ia accordanx with I�IDH policy to use federally supported vaccines for ch�dren and indivi who lack financial resources to pay for these vaccmes. 2) Provide the a�propriate 'Important Inf 'on" forms to all vacdnees (pareats.or gnardians) receiving vaccinations m public� . .c settings and to private physicians �f th�y eled to nse the forms ia accordance with the nditions specified,in the 'Private Physician Certification" form. CHS agencies may in ude appropriate identifica6on on the forms. Any other addition to the forms, or variadons om the must have the prior written approval of the Diredor, Centers for ' Control C�. Any re qu�est for change mnst be submitted to the M'innesota Departme of Health I� wluch will forward the reqnest to the Centers. The a pro e Impo Information forms at the time of this a�reement are datcd: Polio - 3/i�f3; � - 1/1/88 D1?/Td - 1/1/88. If�npdated forma become ava�7able, the 1bIDH agrees to provide th to the CHS agency at the earliest possible date. 3) Obtain documentation of the recei�t by vaccinees (parents or guardians) of the Important Information form relating to the vaccine ' ' tered. The documentation shall consist of��fhe signed lower rtion of the Important Info ation form or a sepazate signature card which � conta�ns the ollowin& 'I have read or have had explain to me the information contained ia the Important Information statement(s) about the disease(s) and the vaccine(s)�. I have had a chancx to ask questioas wbich were ed to my satisfaction. I beliov�e I understand the benefits aad risks of the vaccine(s�) and request that the vacciae(s) mdicated below be - -- given to me or to the person nam below for whom I am author�u,d to make this reqnest.' This statement must appear at the top of I signature card or log sheet and the form mnst include at a minimum the followu�g entries: Name, address, date of birth, age at the time of immunizatioq type of vacciae(s), clinic iden ' catioq date of vaccinatioq manufacturer and lot number, signature of person to receive va or person authoriud to make the request, date of sigaatnre, and date printed oa the apprd riate Important Information form. 4�Obtain a signed copy of the "Private P 'cian Certification" form at least annually from ail P 3+�� to whom the CHS agency ' vacdae which is to be nsed ia p,��ractice. � Certification must be obtained aver�,► two y�ears, corresponding to each C -Biennial � Fstablish �rocedures for the retention o# the signed portion of the Importaat Information form and Prnate Phys�ciaa Certificatioa fo and other t�+pes of approv�ed documentation for at least ten yaars foll�win� the �nd of the , endar year m which the forms are aad, npon written request, furn�sh �pies of the rms to the MDH or the CDG Ia �q if a notioe of a claim or a lav�uit has beea m e, the Important Information Statement, Private Physician Cerrtification form, and otherty� of approved documentation to t�e - matter should be reatined nnt� after a final dispos�t�on of the claim or hU�'gat�'on�mcluding appeals). � Assur� tbat public clinics, schools and er agencies to w}uch the CHS agenry redistnbntes vacciae agee to the use sad ntendon of portant Informatioa forms as speci6ed ia 2, 3, and S. � Assnre that, ia the case of a school Program or other programs where the ' , mformation form is to be read aad signed ' advance of the immuanatioa by a pareat, �nardian � other authoriud person who not be present at the immuaizadon ciinie whea the vaccinadon is geveq procedures sball be lished and ma�e knawn for ansvreriag �:::�__ quations by telephone or otherwise. • � Assure tbat person(s) are ava�able at immimi7a6on clinic to �nsure that proapedive ' vacdnees (parenta or guardians) can read iaformation provided, aad to ansa�er queations � iv. r � about tbe vaccine, its e�ected benefits, its normal risks, its contraiadications (special. to vacanees with low resistance to infections), alternatives to vaccinatioq and to pravide�advi�ct regardiag medical assistance in the �vent of suspeded vaccine readions. Clinia serving large aumbers of persons for whom Eaglish is not a 5rst language must provide Importaat Information statements in their native language. Translations of Important Informahon forms are ava�able &om the Minnesota Departmeat of Health. 9) Assure tbat the person administering the Important Information form(s) rontiaety asks vacdaees (parents or guardians) if th¢y understand the informadon pravided to tlum and if they havo aay questions. 10) Desi�ate a Biolog�cs Control O�cxrr who w71 have overallresponsb�itq for the implementation of I�IDH vaccine polities and procedures which shall iaclude a� ordering.. ncemng� storiag,.and handliag vaccmes from the 1bIDH, b) redistributing vacane to physidans and other clinics �f the agency so chooses and assuring implementatioa of such �c�es anth these other providers, c) returning va�cinas to t6e I�IDH, aad � monitoring aad :eporting vaccine nsa�e to the MbH. The Biologics Control Of6cer(s) is/at� Laura Wingate 11) Designate a vaccine reaciion coordinator and�place the telephone number on each Important Information form as the aumber to call regarding vacane readions. The readioa coordiaator(s) for the agency is/are: Laura Wingate • 12) Report to the I�H all illnesses in vaccinees which a) began within 30 daya of receipt of vacane and which are severe eno� to require hos�italizadon or a visit to a physician or other medical carepe rsonnel, or b meet the reportmg aiteria established under the National Ch�dhood Vaarne Injury Ad. Use the CDC Report form 'Report of Adverse Event Following Immunizadon.' 13) Provide the vaccine, whether administered ia public clinics or by private �hysicians, without cbarging the recipient for the cost of the vaccines. If aa admin.istration fee �s charged, . inEormation must be �rominently dispiayed wbich indicates that no one reoeivimg an immunization in pubhc clinia may be denied this vaccine for failure to pay the administratioa fee or fa7ure to make a doaation to the pro�vider. 14) Submit a quarterly vaccineusagc and imr�ntory report by the lOth of the month following the reportpe nod. A report must b�e filed even if no vacanes were administered or distribnted. Use the MDH form 'Quarterly Report of Vacdaes Administered and Distn'buted.' By sigpah�re, the Authorized OfScial agrees and has the authority to agree to comply with these eonditions and rePo�8 n9uirements eonsistent with applicable I�H Rules and the CHS Ad. Ia additioq bY s�gnature belaw, the Authoriud Official assures full compl'iance with aU iteaas stated hereia d� 2 �9-�-�-`-. �'r21� Saint Paul Division of Public Health igaature mmtmity - Medical Director September 19, 1989 - ate - . ( • This form must be signed by the Cbairperson or V'ux-Cbairperson of the Commuaity Health Board, oc sppointed agen� . i ADMINISTRATIVE COMPLlANCE' INFORMATION Community Heaith Board's Organlzati n and Composition L How is your Community Health Board ' d? �_ Single dty Single county Joint powers Boazd composed ' • (number o� cuies (number o� counties 2 Is your Board organized uader the Humas► Services Ad? � YES Q NO 3. Are there any other Boards of Health wi your CommuniCy Health Board's jurisdic.tion? � YFS a NO If yes, please i ' f B authoriud for each statutory urce of authority. Joint Powers Agreement (Minn: tat. 145A.03, subd. Z, and 145A.10, subd. 2 (a)). Delegation Agreement (Minn. S, � 145A07, subd. 2) - � �aig,b�icy for cxs subs�dy scac. iasaio, subd. 2 (b)) - F�csting CHS program in a co of 300,000 or more persons (M'inn. Sta� 145A.10, subd. 2 (c)) 4. Iadicate the composidon of your Board and the number of inembers who serve on i� a C'ity conaa7(s); �_ members b. Connty Board(s); mcmbers� � Admmistrative Board; mem � (descn'be t� Admiaistrawe'�oard's ' 'on; ie., "One third couaty aommissionera, one third general publi� oae tbird � d. Other; m�mbers (Descnbe� - . - PERSONNEL - � L Pravide nam the e, address, aad telephone num for the CHS admmutrator. If a naw CHS adminiatrata� has been appoiated smce the ' 'on of the 1988-89 CHS plan, iadnde hia/her res�wa Nam� Judith Barr Public Health S rvices Mana er Addresx St. Paul Division of Public alth C. .. 555 Cedar Street, St. Paui, . 55101 pb� (612) 292-7712 ' , � S � o � � o� � � � H � � N .a �► � x ,�n '� � a °�u' _ � a A � - _ �w o � z � 0 H � H O� � A � � .� s � � a• D, x _ � d � _ � . � ti � _ �. ai o � � � � Za � � 00 i � c.i j � - _ � s � e E � s � � �, o � � � � 3 � � � � � � � � � ' �e a C "� '$ .°o rn °o ° ° �°n o � O I � N c'n .-� , •--i � 00 � �t N o n s � �. 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N � � i-1 � � N U m ul � b► b� V 'd0 � d .C � bf�-I bG�4' � r-I +� � +� U W tA ri C1 � +� +� 'O C� � O N O NH � H � O mw x .e x � aa aw - � � � o � � � � M � - G� G� � d _ U U o C� � � x � � � .-�i �-�i o � b � . ro �� a� w a� N x xa xa � a a ° b °+�' b � bv+ � o� � °+�' �ro m °.�' n � ns°� � s°a � °�' . � a x a a� a a� a . +� E +� G +� F Q � O ' O � U Na � H � N •� U "d "� "� N N , � . , I. Planning Process Description The Personal and Community Healt Subcommittee of the Communitq Health Services (CHS) Advisory Committe has completed a process of assessing public health problems in childr and families. Likewise, the Environmental Health Subcommitte' has also completed a similar process of identifying priority environment 1 health problems. Problems were identified through several steps of analqsis: . consensus of major problems i entified by the CHS Advisory Committee (October-December, 1988) ; _ . a key respondent surveq of lo al agencies that serve families and youth (Januarq-March, 1989) ; . an analysis of demographic an health statistic data related to families and qouth (January-A gust, 1989) ; . presentations from representa ives of agencies serving families and youth (April-July, 1989) ; . survey of health care system se, satisfaction and needs of current clients (January-March, 1989) . identification of residence o current public health clients in comparison to targeted servic areas (1988 and 1989) ; . outcome evaluation of specifi public health services (1988 and 1989) . solicitation of public health concerns from individual Board of Health members (1989) and . review of state and national riorities for public health service (i.e. Model Public Health Sta dards, Institute of Medicine Report, CDC recommendations, Minnesota De artment of Health initiatives and recommendations) . Analysis of these problem areas as been translated into a restructuring or elimination of less effective programs and targeting/creation of new program areas to meet the identi ied needs in St. Paul. In the 1990-91 planning cycle, t e St. Paul Division of Public Health intends to undertake the follow� g activities, some of which will be done • in conjunction with the Ramsey C untq Public Health Department. . continued analysis of demogr� hic, health environmental, human service and educational data; . outcome, process output and C st evaluation of eaisting services with a comparison to other commun� y providers of similar services; . analysis of targeted educatid and service delivery on changes in priority public health object'ves; . preparation of St. Paul heal objectives for the year 2000 with documentation of the progres� towards these objectives . client and non-client surveys to determine unmet health needs, use of health care resources in the ommunity and satisfaction with current health care service provider . outreach efforts to increase articipation in state and federal health programs, specificallq those' aimed at children and pregnant women � . analysis of available census data and update on personal health and environmental health indices' in St. Paul's Health Planning Areas (HPAs) � ' �� i�� Progress and outcomes of these pl nning activities will be incorporated into the next CHS Plan. II. CHS Plan Update and Updated Index of Methods Primary methods used by the St. P ul Division of Public Health and the St. Paul Board of Health to ident fy health priority problems not in the 1988-89 Plan include the followi.rt : . documentation of need based on program data, community concerns and needs identified bq elected of icials; _ . emerging issues/priority probl ms identified by the CHS Advisory Committee; . legislative changes; . local ordinance changes and _ . recommendations from the state and national health agencies with public health oversite. Comtnunity health problems which h ve been identified as "new issues/problems" are listed below . abuse or injurq to child/absen e of a parent; . lack of parenting skills for c ild care/parenting; . family planning client outreac and education (vs. service provision) ; . alcohol/drug abuse and addicti n . inadequate housing or concerns regarding housing; . insufficient income ror daily ' ecessities; . solid waste management; . food handler training; . reduction of plastics in the w ste stream; . upkeep of neighborhood housing stock and enforcement of City Housing codes; . environmental monitoring of pr vate water supplies and noise; . teen-age pregnancy; . reducing rates of chronic dise se, specifically heart disease and cancer; . better public health intervent ons for communicable diseases, specifically Hepatitis B, and . city wide goals for improving aternal and child health. Goals and Objectives for new prog ams in 1990-1991 which have resulted from the CHS planning update arel ttached. An updated index of inethods is at ached. " UPDATE OF METHODS ST. PAUL CHS PLAN UPDATE, 1990-91 Pro ram Goal Area Method F�NVIRONMENTAL HBALTH Food 8egulation Investigation Inspection Abatement Environmental Sanitation Investigation Inspection Abatement Housing Code Enforcement Investigation Survey and Correction Animal/Pest Control Investigation Equipment Loan Abatement Hodent Census FAMILY HEALTH Dental Health Assessment 8eferral �ionitoring Family Planning , Education � liedical Service , Counseling QIC Screening Assessment Intervention Counseling Childhood Lead Screening Testing Education honitoring Follov-up 8eferral Families in Crisis Screening Assessment Education - 8eferral Follov-up �iaternal and Child Health Initiatives Screening " ssessment ducation eferral ollow-up edical Service Pro ram Goal Area Method HEALTH PHOHOTION Health Services for the Elderly Assessment Screening Education Follow-up Community Health Education Education Programs Technical Assistance Nutrition Screening Assessment Referral Counseling Communitq Education Training DISEASE PBEVENTION AND CONTROL AIDS Screening Screening Counseling Referral Community Education Training STD Control Screening Treatment Community Education Immunization Program/Hepatitis B Dispense Vaccine Immunize Case Finding Medical Service Community Education Training Case Finding & Follow-up Treatment Refugee Health Screening Referral Day Care and Rooming/ Boarding Inspection Inspection - _ Abatement Consultation Education and Training Chronic Disease Screening Assessment Counseling Referral Community Education ' � � III. Special Project Grants The Native American Special Pr ject grant is attached. Other special project grants w ich the Saint Paul Division of Public Health has applied for in the 990-91 funding cycle include: . Refugee Health -- for track ng health screening status of newlq arrived refugees in Ramsey ounty; . Family Planning -- for sub$ dized sterilization services and for culture/language-specific o treach and method services to Southeast Asians; � . Lead -- for education mater al development and case-specific services to families with children h ving undue lead absorption; . Smoking -- for appropriate ealth educational message targeting of minoritq, inner-city youthi . Maternal and Child Health - for a City MCH plan and specific target objectives relative to MCH ervices. , \ ` ��` / � � � IV. Requested Administrative and Progr� Support Minnesota De artment of Health MP Worksho Evaluation Staff from the St. Paul Division of Public Health attended three MDH- sponsored workshops over the past y ar. The workshops over the past year. The workshops, Chronic Disea e� Data Practices and the CHS/Boards of Health Conferences were excellen . Staff also attended the two-part series on AIDS/HIV planning and edu ation over the past two years and found the conferences to be useful. Desi ed technical assistance fo 19 0-91 Technical assistance requested from the St. Paul Division of Public Health and St. Paul Board of Health for 1990-91 includes but is not limited to the following topic area : . health care rei.mbursement strate 'es for increasing M.A. reimbursement and decreasing payment turn-aro time; . strategies for effective outreac to underserved populations and minorities; . access to area-specific (by censu tract) health statistics; . MCH, CHS and special project cons ltation; . use of the APEX health planning m del in conjunction with the Centers - for Disease Control and the City f Minneapolis; and . environmental monitoring and envi onmental statistics related to St. Paul concerns. . �11NNfSOTA DEPARTMENT OF HEALTH O�cial Use Only PR()JECT INFORMAT'ION F'iscal (1) INDIAN HEALTH GRANT Coetrol r1o.: � ame o rant Datc Rcccivcd: (2) PROJECT II�IF'ORMATION Time Received• aPPLICANT AGENCY SAINT PAUL DIVISION OF PUBLIC HEA� TH BEGINNING DATE END D' TE PROJECT FUNDS REQUESTED JANUARY 1 , 1990 DECEMBER ' 1 , 1991 SERV[CE ARFA (City, County, or Counaes) LOCAL MA'TCH PROVIDED , RAMSEY COUNTY SOC. SEC. OR MN TAX I.D. �" :� FED. I.D. � (if applicable) (3) NON-PROFI'T S'i'�a►Tt tt; - SOi.C3 copy attached: Yes Not Appl cable X (a) vI w � Attached: Yes X No (5) AFFIRMATIVE ACT[ON: The ageary has a certificate ot compliance [ro the Commissioaer of Human Rights, pursuant to Mianatota Stuutts, Section .O?3: Yes X No Not-ApTcabie because: a. Cootrut is ,000 or less b. Agenry has or Icss full-time employees . HE-01275-02 (3/8� � . � � O � � d "� � INDIAN TH GRANT SAINT PAIIL DIVISIO OF PIIBLIC HEALTH 1990— 991 PROBLEM STATEMENT An examination of population dat using the 1980 census date reveals significant American Ind an population in five Health Planning Areas (HPAs) in Ramsey ounty including: - Thomas-Dale with 351 Ame ican Indians - Riverview with 345 Ameri an Indians - Rice Street with 318 Ame ican Indians - - Dayton' s Bluff with 267 erican Indians and - Phalen Park with 240 Ame ican Indians. Statisticians, both nationally a d locally, have long believed that the 1980 census represented an under-reporting of metropolitan minorities, includi g American Indians. Thus, it is safe to conclude that the total f 1521 American Indians identified in Ramsey County fro� the 1980 census represents a minimum number rather than an ac ual count. Census data for 1980 also documented that there were 51 out of 681 total American Indian households in Saint Paul hat were receiving public assistance. This indicates that a significant percent (36 . 9�) of American Indian households live 'n poverty. Specific health problems which ave been identified in American Indians in Ramsey County includ the following: - 2 .9$ of pregnant Americ n Indian teens begin prenatal care in the first trime ter; - 45. 8� of all pregnant erican Indian women begin prenatal care in first rimester (State goal is 91$) ; - 4.7� of American Indian births are low birth weight; - 20$ of 1986 births were teenage American Indian women (<20 years) ; - - over 60$ of all deaths 'n Saint Paul adults are due to chronic diseases; - over 20$ of Ramsey Cou y adults are at risk for at least one chronic disease ri factor (hypertension, obesity, smoking, acute drinkin ) ; - American Indian childr n and adults have received inadequate dental care primarily due to cost and access problems in Ramsey Cou ty. 1 , � � ` ��- �� To address these specific healt problems a series of public health goals and objectives hav been identified by the Saint Paul Division of Public Health. GOAL 1: To reduce the rate of iqh risk births among Ramsey County American Indian omen. Objective lA: To increase the percent of � regnant American Indian women initiating prenatal care in the irst trimester from 45� to 60� by December 31, 1991. Objective 1B: To increase the number of p egnant American Indian women receiving prenatal nutrition cou seling and supplemental nutritious food through the W.I. . Program from 23 to 28* by December 31, 1991. Objective 1C: To reduce the prevalence of chemical and substance abuse (alcohol, drugs, smoking) among regnant American Indian women in Ramsey County during the prenata care period through 1991. Methods: - Outreach worker will assi in identifying pregnant American Indian women in d ensure prenatal services are initiated. An estimated 4 pregnant women annually will be reached. - Free or low cost pregnancy tests will be provided to American Indian women in R sey County. - Transportation and child C re services may be provided/arranged to enabl, pregnant American Indian women in Ramsey County to attend prenatal care appointments. - Outreach efforts/referral ystem will be further developed to target Ramsey -County rican Indian pregnant women for W. I .C. Program participati' n. - Substance abuse status, de ermination, counseling and - intervention will be condu ted with all Ramsey County American Indian clients re eiving prenatal services . *These numbers are probably under stimated because W.I .C. determines ethnicity by visual id tification only. 2 - Support groups for pregnan American Indian women may be established to assist in r ducing substance abuse before, during and after pregnancy - Family planning services p ovided to American Indian women will address the need for , mproved health, decreased/eliminated subst nce abuse, improved nutrition and early prenatal care pr or to conception. - To secure appropriate rei� ursement from Medical Assistance and the Prenata Care Initiative when applicable. Evaluation: Subgrantee(s) of the St. Paul Division of Public Health who provide components of servic to American Indians in Ramsey County will be required to h ve an annual contract which specifies specific performan e expectations, service delivery goals, reporting re irements, reimbursement per client served and quality as rance requirements . Quarterly reimbursement will be tied t the number of clients served and the completion of design ed reports . For the project goal, the fol owing indicators will be evaluated: - rate of Ramsey County ' regnant American Indian women initiating prenatal c� e in the first trimester for the years 1988 and 19$ . - percent of pregnant Atd rican Indian women within the funded project who ini iate prenatal care in the first trimester for th years 1990 and 1991. - number of pregnant Am� ican Indian women from Ramsey County served by the p oject. - number of pregnant Ame ican Indian women from Ramsey County enrolled in the W.I .C. Program. - number of pregnant Ame ican Indian women from Ramsey County participating i substance abuse counseling/support se , ices sponsored by project. - number of American Ind an women ages 15 to 44 from � Ramsey County particip, ting in substance abuse counseling/support se ices sponsored by the project. 3 � i ' , Budget: This component of the pr ject will be contracted out by the Saint Paul Division of Public Health. A total of $25,000 per year is requested to undertak this component. The subcontractor' s expenses are ', xpected to be primarily personnel, transportation and outreach s pplies/materials . GOAL 2: To pronide early ide tification and treatment of chronic diseases commonly fo d in American Indians. Objective 2A: To identify the most curr nt rates of diabetes, hypertension, elevated serum c olesterol, smoking and alcohol abuse among American Indian yo th and adults (ages 15 to 64) in Ramsey County by December 31, 991. Objective 2B: To conduct health screeni g for diabetes, cholesterol, hypertension, smoking and alco ol abuse and referral for treatment for 800 American Ind an youth and adults (ages 15 to 64) in Ramsey County by Decemb r 31, 1991. Methods: - Epidemiological trackin tool will be used to document the number of persons scree ed for the specified chronic diseases and the rates f each specific chronic disease within the population g up. - Division of Public Heal will seek summary data from the Minnesbta Department of ealth and Department of Human Services on the morbidit and mortality rates for specific chronic diseases among sey County American Indians . - Community-based health s reening targeted at Ramsey County American Indians will be conducted with testing/assessment for diabetes, cholestero , hypertension, smoking and alcohol use. - Referral of individuals ' esting at risk for the specific conditions will be made ' o their health care provider and will be documented in wr ting for follow-up and quality assurance purposes. � . 4 . � ' � ��-- �� Evaluation: Subgrantee(s) of the 3 . Paul Division of Public FIealth who provide components of service to American Indians in --- Ramsey County will be equired to have an annual contract which specifies specif c performance expectations, service delivery goals, report ng requirements, reimbursement per client served and qual'ty assurance requirements . Quarterly reimbursemer� will be tied to the number of clients served and the completion of designated reports . For this project qoal, the fo lowing indicators will be evaluated: . - identified prevalence ate of diabetes, elevated serum cholesterol, hyperten� 'on, smoking and alcohol abuse among Ramsey County America Indians . - number of Ramsey Coun American Indians screened at community-based healt screenings for specified chronic disease indicators. - number of persons ref rred for each specific condition and the percent of indivi uals attending at least one treatment appointment with their primary health care provider (for diabete , cholesterol, hypertension) or support group ( for sm king, alcohol abuse) . Budget: This component of the p oject will be contracted out by the Saint Paul Division of Publi Health. A total of $10,000 per year is requested to undert e this component. The subcontractor' s expenses are expected to be primarily testing supplies (at $15.00 per pers n) and staffing. GOAL�: To improve the dent 1 health of Ramsey County's American Indian children and adults. Objective 3A: To conduct dental healt education to at least 300 Ramsey County American Indian child en (ages 3 to 17) anrivally through 1991 . - � Objective 3B: To provide preventive a d restorative dental care to 250 Ramsey County American Indi� s in 750 visits annually though 1991. 5 � , ` ` \ Objective 3C: To provide topical dental se lants to at least 50 Ramsey County American Indian children t ough 1991. Methods: - Culturally appropriate den 1 care, education and outreach services will be targeted t American Indians in Ramsey County. - A dental health educator wi 1 provide group education on dental topics in child car� centers, family day care homes, schools, religious i stitutions and at community gatherings . - Services provided will be d cumented in client records and extracted for quarterly rep rts and quality assurance audits . - Reimbursement will be sough from Medical Assistance when appropriate. - On-site training will be pr vided for American Indian dental students enrolled in professional and paraprofessional dental edu ation programs . Evaluation: Subgrantee(s) of the St. Pa 1 Division of Public Health who provide components of s rvice to American Indians in Ramsey County will be requi ed to have an annual contract which specifies specific pe formance expectations, service delivery goals, reporting r quirements, reimbursement per client served and quality a surance requirements . Quarterly reimbursement wil be tied to the number of clients served and the comp etion of designated reports. For this project goal, the followi g indicators will be evaluated: - identified rate of dental c ries among American Indians in Ramsey County served by thi project. - number of Ramsey County Ame ican -Indians receiving dental education, dental services nd topical sealants. - rate of dental caries ident' fied in continuing clients of this dental project. 6 ` j , , . 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D. r Saint Paul Division o Public Health Service/Offia Locations Division of Public Health 555 Cedar Street Saint Paul, MN 55101 Suburban Clinics East Suburban Health Center West Suburban Health Center 3575 White Bear Ave. 5700 No. Edgewood White Bear Lake, MN 55110 Mounds View, MN 551 WIC Clinics Division of Public Health East Side 555 Cedar Street 3575 White Bear Avenue Saint Paul, MN 55101 Saint Paul, MN 55110 Face to Face Edgewood 642 E. 7th Street County Road H & Edgewood Dr. Saint Paul, MN 55106 Moundsview, MN 55112 Dayton Avenue Presbyterian Church ' Ramsey , 217 Mackubin 640 Jackson Street Saint Paul, MN 55104 Saint Paul, MN 55110 LaClinica 153 Condord Street Saint Paul, MN 55107 M Donou h c g 1544 Timberlake Road Saint Paul, MN 55117 CJ f� .�.�/� � . T'1.r-a rv.�.�7:�"i� t:._.�i..-/.�..v . _...., ocT o 5��a� � .^9.f �r �i a.� SAINT PAUL BOA D OF HEALTH AGEN A OCTOBER 1 , 1989 1. Approval of Saint Paul Compone t of Community Health Services Plan Update - ACZ'ION Judy Barr 2 . Community Health Services Subs 'dy for 1990 and 1991 Judy Barr 3 . Report from the Saint Paul-Ra ey County Community Health Services Advisory Commi tee Chair, CHS Advisory Committee. CITY OF 5 INT PAUL INTERDEPARTMENT L MEMORANDUM ��`.'��°`�'�'�:� a"a;�3,. ocT o 5��a� �, , �� October 4, 1989 v°• � `�-�W"�' T0: Al Olson, City Clerk 1 . FROM: Judith Barr, Public Health' �t��`; ' ;� SUB: Agenda items � � U� Attached are the agenda items for he October Board of Health meeting. It would be very helpful if we had a specific time for the meeting so that we can ensure ' report from the Community Health Services Advisory Committe� meeting. Please let me know if you require nd additional information. I can be reached at 292-7712 . Thank : JB:lm Attachments I. Planning Process Description The Personal and Community Heal h Subcommittee of the Community Health Services (CHS) Advisdry Committ e has completed a process of assessing public health problems in chil en and families. Likewise, the Environmental Health Subcommitk e has also completed a similar process of identifying priority environme al health problems. Problems were identified through several ste of analysis: . consensus of major problems dentified bq the CHS Advisory Committee (October-December, 1988) ; _ . a key respondent surveq of cal agencies that serve families and qouth (January-March, 1989) ; . an analqsis of demographic d health statistic data related to families and youth (January ugust. 1989) ; . presentations from represen atives of agencies serving families and qouth (April-July, 1989) ; . survey of health care syste use, satisfaction and needs of current clients (January-March. 198 ) ; . identification of residence of current public health clients in comparison to targeted serd, ce areas (1988 and 1989) ; . outcome evaluation of speci ic public health services (1988 and 1989) . solicitation of public heal h conce ms from individual Board of Health members (1989) and . review of state and nationa priorities for public health service (i.e. Model Public Health S andards, Institute of Medicine Report, CDC recommendations, Minnesota epartment of Health initiatives and recom�endations) . Analysis of these problem area has been translated into a restructuring or elimination of less effect� e programs and targeting/creation of new program areas to meet the iden ified needs in St. Paul. In the 1990-91 planni.ng cycle�' the St. Paul Division of Public Health intends to undertake the follo ing activities. some of which will be done • in conjunctioa with the Ramse� County Public Health Department. . continued analysis of demog aphic, health environmental, human service and educatioaal data; . outcome. process output and cost evaluation of existing services with a comparison to other comm ity providers of similar services; . analysis of targeted educa� on and service delivery on changes in priority public health obje tives; . preparation of St. Paul he$ th objectives for the year 2000 �ith documentation of the progre s towards these objectines . c�lient and non-client surve s to determine unmet health needs, use of health care resources in tla community and-satisfaction vith current health care service provide s . outreach efforts to increa� participation in state and federal health programs, specifically tho$ aimed at children and pregnant vomen � . analqsis of available cens� data and update on personal health and environmental health indice in St. Paul's Health Planning Areas (HPAs) Progress and outcomes of these pla 'ng activities will be incorporated into the next CHS Plan. II. CHS Plan Update and �pdated Index o Methods Primary methods used by the St. Pau Division of Public Health and the St. Paul Board of Health to identif health prioritq problems not in the 1988-89 Plan include the following:i . documentation of need based on piogram data, community concerns and needs identified by elected offi ials; _ . emerging issues/priority problem identified by the CHS Advisory Committee; . legislative changes; . local ordinance changes and . recommendations from the state a d national health agencies with public health oversite. Community health problems which ha�t been identified as "new issues/problems" are listed belov: . abuse or injury to child/absence of a parent; . lack of parenting skills for ch; d care/parenting; . familq planning client outreach nd education (vs. service provision) ; . alcohol/drug abuse and addiction . inadequate housing or conce ms �t garding housing; . insufficient income ior dailq ne essities; . solid waste management; . food handler training; reduction of plastics in the wa$ e stream; . upkeep of neighborhood housing s ock and enforcement of City Housing codes; . environmental monitoring of pri te water supplies and noise; . teen-age pregnancy; . reducing rates of chronic disea� , specifically heart disease and cancer; . better public health interventi s foz commuaicable diseases, specifically Hepatitis B, and . city wide gosls for improving m ernal and child health. Goals and Objectives for new progr� s in 1990-1991 which have resulted from the CHS planniag update are a tached. Aa updated index of inethods is att ched. �l- /�� " UPDA� E OF METHODS ST•. .PAUL CHS PLAN UPDATE, 1990-91 . ' � ro ram Goal A ea Method EI�IVIROl�il�iTaL HEALYH Food Begulation � Investigation Inspectiaa - Abatement _ Environmental Sanitation Investigation Iaspection Abatement Housing Code Bnforcement Investigation .Survey aad Correction Animal/Pest Control Investigation Equipment Loan Abatement 8odent Census FAMILY HEALTH Dental Health Assessmeat 8eferral Monitoring Family Planning - Education Nedical Service Counseling QIC Screeaing Assessment Interventioa Counseling Childhood Lead Screeniag Yesting Educatioa �onitoring Follov-up Seferral Families in Crisis Screening Assessment Education - . 8eferral Follov-up Materaal and Child Health Initiat ves Screeaing " Assessmeat Educatiaa 8eferral � Follov-np �edical Service Pro ram 6oa1 A ea Method HEALTH P80HOTION � Health Services for the Eiderly Assessment Screening Education � Follo�-up Community Health Education Education Programs TechrLical Assistance Nutrition Screening Assessment Referral Counseling .Community Education Training DISEASE PBEVENTION AND CONTROL AIDS Screening Screening Counseling � Referral Community Education _ Training STD Control Screening Treatment Community Education Immunization Program/Hepatitis B Dispense Vaccine ' Immunize Case Finding Medical Service Communitq Education Training Case Finding & Follow-up Treatment Refugee Health Screening Referral Day Care and Rooming/ Boardiag Inspection Iaspection �_ _ Abatement Consultation Education and Training Chroaic Disease Screening � Assessment . Counseling � Referral Community Education ' III. Special Project Grants The Native American' S�ecial.Px ject grant is attached. , Other special project grants w ich the Saint Paul Dinision of Public Health has applied for in the ' 990-9,1 funding cycle include: . Refugee Health -- for track g health screeaing status of newly arrived refugees in Ramsey ounty; . Family Plaaning -- for subs dized sterilization services and for culture/language-specific o treach and method services to Southeast Asians; �. . Lead -- for education mater al development and case-specific services to families vith children ving undue lead absorption; . Smoking -- for appropriate ealth educational message targeting of minority, inner-city youth; • . Maternal and Child Health - for a City MCH plaa aad specific target objectives relative to MCH ervices. � . _ - _ - ,�'' �- /'� i � RAMSEY COUNTY ;` � BOARD OF HEALTH PUBLIC HEALTH DEPART ENT � f Hal Norgard, Chairman .._.3 Diane Ahrens 150 E. Kellogg Blvd., Suite 61 John T. Finley St. Paul, Minnesota 55101 Ruby Hunt Duane McCarty 298-5971 Donald E. Salverda Warren W. Schaber Rob Fulton,Director RAMSEY C�UMY MEMORA DUM TO: Judy Barr St Paul Health Department FROM: Dennis Ohlund �� DATE: October 2 , 1989 SUBJECT: Revised CHS subsidy all cations In an August 23 memo to Kathi Cai ns I indicated the preliminary State CHS subsidy allocations for calendar years 1990 and 1991 . The preliminary amounts were base upon estimates provided by the Minnesota Department of Health. We have now received notification of the actual award amounts from the State. The actual amoun s are slightly less than the estimated amounts. Attached is a revised schedule which indicates the amounts St Paul and Ramsey County will receive for 199�p and 1991 . As before, the increase in State HS subsidy for geographic Ramsey County is split between S Paul and Ramsey County based upon population. Please call if you should have a y questions. cc: Linda Nelson 1990 APID 1991 CHS S[JBSIDY ALTACATI�i REVISED 10/2/89 �89 $ '90 INCRF�SE '90 TO►!'AL $� '91 Il�TCREASE '91 Z+OrI'AL $ S°T P 802,323 152,652 954,97 30,559 985,534 R C 637,331 121,494 758,82� 24,321 783,146 'IbTAL 1,439,654 274,146 1,713,801� 54,880 1,768,680 1990 $ 1,713,800 1991 $ 1,768,680 LFaSS '89 1,439,654 I,F,SS '90 1,713,840 90 Il+iCCR 274,146 90 INCR 54,880 1988 POP 476,089 ST PAUL 265,100 55.68� R. C. 210,989 44.32�s minnesota department of h Ith 717 s.e.delaware st. p.o.box 9441 minneapol s 55440 O (612)623•5000 September 20, 1989 Rob Fulton CHS Administrator Ramsey County 150 East Kellogg St. Paul, Minnesota 55101 Dear Rob: We have completed our calculati ' s of funds available for distribution through the Commun' y Health Services subsidy based on the 1988 population estimate . These calculations are based on the statuatory formula estab ished by the 1985 Legislature (Minn. Stat. 1986, section 145. 21) . This formula allocates to each Community Health Board the amount of subsidy available in calendar year 1985 plus a per c pita share of appropriations above the 1985 funding level. The total subsidy award (based n the 1988 population estimates) available for Ramsey County for calendar year 1990 is $1,713 , 800. 00. The exact amount of the availab e CHS subsidy for calendar year 1991 cannot be calculated until the State Demographer issues ' official estimates of populatio for 1989. The preliminary amount of 1991 subsidy for Rams y County (based on the 1988 population) is $1,768, 680.00. s soon as I receive the 1989 population estimates, I will in orm you of the exact amount of subsidy available for your CHS rea for 1991. If you have any questions abou your subsidy allocation, or if you would like assistance as y finish preparations on your CHS plan and meeting the eligibili requirements, please let me know. Sincerely, Chery E. Smoot District Representative cES/jw cc Judith Barr � an equal opportunity employer M�� p � r ♦ minnesota department of h alth 717 s.e.delaware st. p.o.box 9441 minneapo is 55440 O (612)623•5000 August 25, 1989 Katherine Cairns Health Administration Manager Division of Public Health Department of Community Service City of Saint Paul 555 Cedar Street Saint Paul, Minnesota 55101 Dear Ms. Cairns: Cheryl Smoot has aiscussed your request that subsidy funding for the Saint Paul Community Health Board be paid directly to the city, rather than to the county as has been our policy since the inception of the subsidy progra . As I believe she has communicated to you orally, we o not consider it appropriate to depart from this policy. The L gislature clearly intends that a city Board within the CHS area f a county Board participate in the preparation of a countywide Community Health Plan and that, for the purposes of the subsidy, the Commissioner consider the county as the funded area, rath r than dividing it into specific political subdivisions. This me principle applies to counties that are part of joint powers mmunity Health Boards. In both cases, the Commissioner makes single payment for the entire area. Further distribution is hen made by the fiscal agent receiving the check. With res ect, then, I must indicate that we would consider it disruptiv to the development of integrated public health programs to modi y the policy that has been in place since 1977. We do understand that the Ci y of Saint Paul has some problems with a quarterly payment sched le and with delays in payment. It would seem in the city's and c unty' s interests to resolve this problem without the direct adm nistrative intervention of our s�ate agency. We ca�uld be hap y to meet with you to discuss a way to solve your problems, sh rt of departing from a policy that we consider to be entirely con istent with the basic purpose of the CHS subsidy. Please let M . Smoot know your wishes. Sincerely, Q�-�``�``'"�---�._____ J' arker � ir tor, Community Health Ser ices cc: Cheryl Smoot Dave Hovet Rob Fulton Tom Maloy Kathy Stack Judith Barr � an equal opportunity employer M�Nx p i�o ��_/�'�� COMMUNITY HEAL H SERVICES � ��Tt o. ADVISORY COM ITTEE �+� :� OF THE ST PAUL CITY OUNCIL AND o a � 111111111 � THE RAMSEY COUNTY BOAR OF COMMISSIONERS � �� o • � RAMSEY COUIVIY ,••• 898-5971 � 292-7712 / September 7, 1989 James Scheibel , Chair Saint Paul Board of Health Roam 716 City Hall & Courthouse 15 W. Kellagg Boulevard Saint Paul , Minnesota 55102 Dear Mr. Scheibel : : On Wednesday, September 6, 1989, the St. Paul-Ramsey County Com�[►unity Health Services Advisory Co�nittee discussed th, level of funding proposed by the Mayor " ' in the 1990 budqet. The issue was whet r the City's propased increase should � be matched to the County's proposed lev l af funding. . During the discussion, it became clear hat while the impressian has been that the City and County funding have been inC easing at the same rate each year, this has not been the fact. The last year whi h the rate of increase between the City and County was the same, was 1982. Based an this infarmatian, the Adv sory Comanittee passed a resolution recommending that the rate af increase far community clinic funding by either governmental unit not be tied to the rate of any other governmental unit. Therefore, the St. Paul-Ramsey Coun y Community Health Services Advisory Committee continues to support the thr e percent (3$) increase recommended in the Mayor's proposed 1990 budget far c mmunity clinics. � Sincerely, ,�.��, � Elaine Saline Chair JB/am c: Community Clinic Directors Mayor Latimer Greq Bless