Board of Health

Skokie Board of Health February 9th, 2017 Present Dr. Sood Excused Absent Mr. Abbasi Ms. Jones Thorne Dr. Dave Mr. Nidetz Dr. Drachler Dr. Topouzian Dr. Werner Dr. Polin Dr. Gaynes Ms. Urbanus Ms. Nickisch Duggan Dr. Usman Mr. Pandya Ms. Varma Dr. Prince Dr. Vernon Dr. Shim Dr. Williams Dr. Catherine A. Counard, Director of Health Bruce A. Jones, Staff Guest, Dr. Edward McCarron – Family Services Commission Guest, Megan Hoffman – Student 1. Call to Order: The meeting was called to order at 7:01 p.m. by Dr. Drachler, Chairman. 2. Approval of Minutes: The minutes of the previous meeting were approved. 3. Presentations (a copy of the presentation is attached) Stan Sonu, MD Internal Medicine and Pediatrics Preventive Medicine / Public Health Program; Cook County Health and Hospitals System: Adverse Childhood Experiences and Trauma-Informed Care. Dr. Sonu gave a very comprehensive and detailed presentation on The Adverse Childhood Experiences Study or “THE ACEs STUDY” Below are some of the highlights from these reports Dr. Vincent Felitti • 1985 - Kaiser Permanente in San Diego • Obesity Clinic • 50% dropout rate over 5 years - why? • 286 “dropouts” interviewed – most were sexually abused during childhood and overeating in response CDC/Kaiser Permanente ACEs Study – Began in 1995 Over 17,000 adults Asked about ACEs and unhealthy behaviors + chronic dz Prevalence and Odds Ratio MOSTLY CAUCASIAN MIDDLE CLASS EDUCATED #510919  ACE’s = Poor health outcomes I think this man is suffering from memories: Sigmund Freud” Understand the link between Adverse Childhood Experiences (ACEs) and poor health outcomes Resilience, trauma-informed care Introduce ways to address ACEs from a primary care perspective; opportunities for engagement Most people had ≥1 adverse childhood experiences Dose-response relationship: More ACEs Higher risk of medical, mental, Social problems as an adult 3 ACEs associated with early mortality Adverse Childhood Experiences and Adverse Community Experiences • Maternal depression • Homelessness • Abuse - emotional, sexual • Poverty Racism • Substance abuse • Violence • Domestic violence • Poor housing: affordability, quality • Neglect - physical, emotional • Lack of social/economic opportunity • Parental separation • Discrimination • Mental illness • Incarceration #510919  There’s good news. “Resilience” The ability (capacity) to adapt (and succeed) in the face of significant adversity Resilience transforms potential toxic stress into tolerable stress POSITIVE FACTORS Strong, stable relationship with caregiver Self-regulation skills Connection with community, faith NEGATIVE FACTORS Poverty Exposure to violence Bullying Absence of ≥1 caring adult Maltreatment 4 KEY factors that predispose children to positive outcomes in the face of adversity The presence of at least one stable, caring, supportive adult Developing strong executive function and self-regulation skills Helping to build a sense of mastery over life circumstances (capacity) Supportive context of faith and cultural traditions #510919 Discussion: Dr. Sonu mentioned doing “Trauma Informed Health Fairs” as a means of connecting with the public. Counard asked if the Cook County team had ever held this type of event and how was it received? Dr. Sonu said they had not, but he has heard it’s been done and there would be better ways to market the event. Dr. Drachler asked about the questionnaire used at Cook County, what is the answer sheet and how is that interpreted? Dr. Sonu responded most questions if answered no it’s abnormal. But some yes can be a concern; there is no specific key to the questionnaire. Dr. Williams’s added that you need to have internal validity and ask double sided questions, as seems to have been done with the questionnaire. Dr. Williams commented that he used to head up a team in the U.S. Navy using a similar approach to respond to post-traumatic stress disorder. He would like to collaborate with Dr. Sonu and the Cook County team, now that he is a civilian. Dr. Counard asked if NorthShore is doing anything similar to this. Dr. Drachler said he had not heard of the ACEs approach being used a NorthShore. He would take this concept to the pediatrics department, and see about having a presentation. Dr. Sonu said he would like to speak to this group about the ACEs Study. Ms. Jones Thorne asked about those cases where parents are neglectful or in denial - can you ask other questions to shed some light on any issues? Dr. Sonu said that is great question and concern and has been discussed at length. The counter argument is that they are still screening. Ms. Jones Thorne mentioned other screening pathways through other means such as daycares, schools etc. Dr. Sonu said that it could be done but the main focus is to identify the family’s need for help. Dr. Topouzian asked about the brain size issue and if the Cook County team is monitoring this concern. Dr. Sonu explained that they are not specifically doing this but the literature shows the effects and that with proper treatment for the ACE’s the brain can return to the normal percentile. Dr. Drachler asked about funding. Dr. Sonu said there needs to be an intersection of primary care and other central sources that could offer funding. Dr. Williams thought a great resource for screening is the public school system that could identify potential problems seeing the symptoms and then getting resources to help. Dr. Drachler thanked Dr. Sonu for coming and it will be interesting to see how these types of social issues are incorporated into the 2017 Skokie Community Health Plan, and this is a really novel start. 4. Chair’s Report: Dr. Drachler reminded the Board that on March 13th the Village is holding the Boards & Commissions dinner and that everyone should be receiving an invitation in the mail for the event. Dr. Drachler commented on how the 2017 IPLAN process is moving forward and progressing very well and that Dr. Counard will be updating the group. 5. Director’s Report: January Monthly Report highlights – a copy is attached: Marching with Skokie Board of Health members against racism – Jan. 29 Interfaith rally and march at the Morton Grove Mosque. Both Dr. Usman and Mr. Abbasi mentioned that the march was very well received. They had a great turn out and thanked Dr. Counard for attending. #510919  Dr. Usman, Mr. Abbasi and Dr. Counard mentioned on February 19th there is another march taking place in Chicago and everyone is welcome to attend. “Skokie Welcomes Everyone” campaign Health Director Dr. Counard joined Board of Health members, friends and colleagues to kick-off the “Skokie Welcomes Everyone” campaign, celebrating Skokie’s remarkable diversity and our ability to work together “for the betterment of the entire community” (quoting Village Manager John Lockerby). Buttons and signs are available for display through www.skokiecares.org Supporting the Affordable Care Act – Letters to Gov. Rauner, Illinois members of Congress With the approval of Mayor George Van Dusen and Village Manager John Lockerby, Health Director Dr. Counard called and sent follow-up letters to Gov. Bruce Rauner and Illinois members of Congress highlighting how the Affordable Care Act (ACA) has benefitted Skokie residents. In the letters Dr. Counard asked that Congressional leaders perform due diligence and develop a replacement plan prior to repealing ACA. Of note, two weeks later Gov. Rauner's administration sent a letter to House leaders urging thoughtful reform of ACA with time for Illinois to adapt. Numerous Board members had a lengthy and passionate discussion and dialogue about the ACA and various facets of this issue. 6. Old/New Business Dr. Counard gave a quick update on the Environmental Plan and how the Environmental Sustainability Commission has been working on a variety of topics. She added that Jenny Grossman, Chair of this commission, will give a one year update to the Board at the September meeting. Dr. Williams brought up Tobacco 21 and asked if he could write to Mayor Van Dusen about the topic. Dr. Counard said that certainly he could write to Mayor Van Dusen. Dr. Drachler spoke again about promoting commercial recycling. Dr. Drachler said that he asked the staff at Kaufman’s Deli why they do not recycle and was told that the Village does not pick up recycling for businesses. Mr. Jones explained that businesses can request one 95 gallon recycling cart once per week free of charge; a larger cart or more frequent recycling services would have a cost, but that could result in the business’ garbage collection cost being reduced if recyclables are ending up in the trash. Dr. Counard said that she and Bruce would follow up with Max Slankard the Director of Public Works about business recycling and how this can be improved. Adjournment: The meeting adjourned at 8:32 p.m. #510919