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HomeMy Public PortalAboutBOH 5.1.24 packetE w $�/i//moi 0,0" �`°E� @9F 9 Town of Brewster Board of Health 2198 Main St., Brewster, MA 02631 0rl4 brhealth@brewster-ma.gov == (508)896-3701 PEI' t 9. 1 so \\ `///�ftfllllllllllltll�l\����\\\\ BOARD OF HEALTH MEETING AGENDA 2198 Main Street May 1, 2024 at 6:30PM Board of Health This meeting will be conducted in person at the date, time and location identified above. This means that at least a quorum of the members of the public body will attend the meeting in person and members of the public are welcome to attend in person as well. As Penny Holeman a courtesy only, access to the meeting is also being provided via remote means in accordance with applicable law. Please note that while an option for remote attendance and/or participation is being provided as a courtesy to the public, the meeting/hearing will not be suspended or terminated if technological problems interrupt the virtual broadcast or affect remote attendance or participation, Kimberley Crocker unless otherwise required by law. Members of the public with particular interest in any specific item on this agenda, which includes Pearson an applicant and its representatives, should make plans for in-person vs. virtual attendance accordingly. David Bennett Members of the public who wish to access the meeting may do so in the following manner: Phone: Call (301)715-8592 or (312)626-6799. Webinar ID: 820 4394 4509 Passcode: 979174 John Keith To request to speak: Press *9 and wait to be recognized. Zoom Webinae hftps: us02Web zi i.ua&82043944509?owd=MytoM2kyUExKbU1RS hhmM01Zb3siCZZO9 Abigail Archer Passcode: 979174 To request to speak: Tap Zoom "Raise Hand", then wait to be recognized. When required by law or allowed by the Chair, persons wishing to provide public comment or otherwise participate in the meeting, may do so by accessing the meeting remotely, as noted above. Additionally, the meeting will be broadcast live, in real time, via Live broadcast (Brewster Government TV Channel 18), Livestream (livestream.brewster-ma.gov) or Video recording (tv.brewster- ma.gov) Health Director 1. Call to Order Amy von Hone 2. Declaration of a Quorum Assistant Health 3. Recording Statement Director 4. Chairman's announcements 5. Citizen's forum: Members of the public may address the Board of Health on matters not on the meeting agenda for a Sherrie McCullough maximum 3-5 minutes at the Chair's discretion. Under Open Meeting Law, the Board of Health is unable to reply but may add items presented to a future agenda Senior Department 6. Tobacco Violation - Brewster Farms Assistant 7. Delinquent Animal Permit Hearing -1286 Long Pond Road Tammi Mason 8, Discuss June 5th BOH meeting agenda- proposed focus group discussion for PHE Lower Cape Health Needs Assessment 9. Review & Approve 4/17/24 minutes 10. Liaison Reports 11. Matters not reasonably anticipated by the Chair 12. Items for next agenda 13. Next meeting: May 15, 2024 14. Informational items: a. Monthly report for Serenity b. Dispatch newsletter C. Letter from Laraja Kanaga re: abutter notification 15. Adjournment Date Posted: Date Revised: Received by Town Clerk: 4/25/24 'iil ff Fv, \\fileserverl6\rdocuments$\tmason\Desktop\BOH 4.17.24 agenda.docx April 23, 2024 By Hand Delivery Mr. Saumil Patel 2771 Main Street Brewster, MA 02631 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 0263 1-1 898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth.r&.brewster-majzov W W W.BREWSTER-MA.GOV RE: Notice of Violation — Retail Sale of Tobacco Products Brewster Farms Quick Pic, 2771 Main Street, Brewster, MA Dear Mr. Patel: Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant The Brewster Health Department has been informed by the Cape Cod Regional Tobacco Control Program that a compliance check of your establishment by same was conducted on April 11, 2024 and a violation of the state and town tobacco regulations was observed. The following flavored tobacco product was observed for retail purchase. (See enclosed Tobacco Compliance Check Form). - Garcia y Vega Game Green Cigarillos. Per Regulation of the Brewster Board of Health Restricting the Sale and Use of Tobacco Products & Nicotine Delivery Products: - Section S (1): It shall be the responsibility of the establishment, permit holder and/or his or her business agent, not their employees, to ensure compliance with all sections of this regulation. - (b) In the case of a second violation within thirty-six (36) months of the date of the current violation, a fine of two thousand dollars ($2000.00) shall be issued and the Tobacco Product Sales Permit shall be suspended for seven (7) consecutive business days. Per our records, this current violation qualifies as a second violation of local regulations within thirty-six months (36) of the last violation that occurred on August 24, 2022. Per MA 105 CMR 665.000 Minimum Standards for Retail Sale of Tobacco and Electronic Nicotine Delivery Systems: - 665.045 (A): It shall be the responsibility of any person to ensure compliance with 105 CMR 665.000. If an inspection pursuant to 105 CMR 665.000 reveals a retail establishment, and/or his or her business agent does not comply with the violated provision of 105 CMR 665.000, the retail establishment shall be ordered to comply with the violated provision of 105 CMR 665.000. In addition to the correction order, the following fines and actions apply against any person who violates 105 CMR 665.000: (1) In the case of a first violation, a fine of $1,000.00 shall be imposed. N:\Health\Violation Notices\Tobacco\Brewster Farms\Brewster Farms 20241BrewsterFarmsQuickPicTobaccoViolation04.11.2024.doc Per our records, this current violation qualifies as a first violation of State regulations due to the thirty-six month (36) period that began on November 6, 2020 and ended on November 6, 2023. Please be advised that the Board of Health will discuss these violations at their meeting scheduled for May 1, 2024 at 6:30 pm to determine whether you have violated the terms of the local and state tobacco regulations listed above, and to impose sanctions and/or fines as deemed appropriate. The Hearing will be held in person at Brewster Town Hall, 2198 Main Street, Brewster, MA 02631. Please confirm via phone or email (brhealth(aftrewster-ma. ov ) your receipt of this letter and your attendance at the Board of Health meeting by either you or your representative. Please do not hesitate to contact this office with any questions at 508-896-3701 X1120. Sincerely, Amy L. von Hone, R.S., C.H.O. Health Director Enclosure cc: Cape Cod Regional Tobacco Control Program file Regular Mail Certified Mail #9589 0710 5270 1227 9992 04 NAHealftViolation Notices\Tobacco\Brewster Farms\Brewster Farms 20241BrewsterFarmsQuickPicTobaccoViolation04.11.2024.doc P 0 S T t*+MOLS COUNTER POINT OF SALE TOOLKIT Visit #1159567 summary: Retailer info: • Retailer name: Brewster Farms • License Number: - • Corporation/Owner: - • Address line 1: 2771 Main St • Address line 2: • City, State: Brewster, MA • Zip: 02631-1948 Submission info: • Survey Submitted Date: Apr 11. 2024 • Survey Submitted Time: 09:20:00 AM • Visit Completed By: Bob Collett (# 821) Visit info: • If violations were found, check all that apply: Flavored products or flavor enhancers (including mint/menthol flavors) sold • Specify other violation: - • What action was taken? Check all that apply: $2,000 fine • Specify other fine: - • Employee/merchant name: - • Employee/merchant title: Owner • Enter field notes: Game Green Cigarillos for sale- FLAVORED PRODUCT • Which of the following topics were discussed with the employee/merchant? Check all that apply: • Checked local BOH and DOR permits • Reviewed regulations/tobacco sales laws • Retailers' responsibilities Survey Submitted Date: Apr 11, 2024 Page 1 of 1 Survey Submitted Time: 09:20:00 AM Visit link: hfti):Hmass.countertools.org/education/l 159567 2 om 99c 2019 2020 2021 2022 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealthtcr_ brewster-masiov W W W.BREW STER-MA. GOV Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Hunter Twombly Health Inspector Tammi Mason Senior Department Assistant Brewster Farms Tobacco Violations Timeline (Febragy 13 2019 to Aril 11 2024 2771 Main Street, Brewster February 13- Inspection by County revealed the following violations: 1) Juul pods on counter for self-service. 2) Cigars on top of humidor for self-service. 3) Humidor unlocked. 4) Cheyenne 20 -pack cigars $2.79. March 7- BOH voted to fine them $100 as it was their first violation. State Tobacco Law went into effect June 1, 2020 1St Violation: November 6- Inspection by County revealed the following violations: 1) No signage present. 2) Humidor was unlocked. 3) Fronto King Blunt wraps for sale. December 2- BOH did not fine Brewster Farms. They agreed that the legality of Fronto King Blunt Wraps was not clear with regards to flavored tobacco prohibitions (the BOH agreed to let them remove the blunt wraps and notify their supplier). The humidor was to be relocated behind the self-service counter where it was inaccessible to the public or must always remain locked. If another violation occurred prior to February 13, 2021, Brewster Farms would be subject to a fine and the Tobacco permit would be suspended for 7 days. The current Brewster BOH Tobacco Regulations went into effect on September 15, 2021 August 24- Inspection by County revealed the following violations: 1) Missing signage. 2) Flavored products, or flavor enhancers (including mint/menthol flavors) were being sold (delta -8 product). 3) Humidor was unlocked. October 5- BOH agreed to continue the hearing to confirm: N:\Health\1lunter\Brewster Farms Violation Timeline rev.avH 4.24.24.doc 2023 2024 1) Flavored Delta 8 product (no nicotine, but CBD- confirm requirement for CBD product). 2) Determine level of violation for unlocked humidor (1St vs 2nd, amount of local fines, amount of state fines if Delta 8 is regulated). September 19- DOR seized untaxed electronic nicotine delivery systems from premises and suspended Brewster Farms Tobacco license for 30 days. November 2- BOH voted to enforce a $2200 fine, 1) $2000 for a second violation of State Tobacco Regulations 2) $200 for a second violation of local Tobacco Regulations, also a loss of Tobacco license for (7) consecutive business days beginning Sunday, January 1, 2023 and ending Saturday, January 7, 2023. 3) Verbal warning was issued for missing signage. Second Violation within (36) month period which began with the first violation on November 6, 2020. No violations. April 11- Inspection by County revealed the following violations: 1) Flavored products or flavor enhancers (including mint/menthol) being sold. - Garcia y Vega Game Green Cigarillos. According to State Tobacco Regulations, (105 CMR 665.045 Violations), section (A), subsection (2), "In the case of a second violation within a period of (36) months from the first violation, a fine of $2000 shall imposed." The first violation since the State Tobacco Law went into effect was November 6, 2020. The (3 6) month period would have ended November 6, 2023 making the violation on April 11, 2024, the first violation of the State Tobacco Regulations which would incur a $1000 fine. According to the local Brewster BOH regulations on tobacco, under section (S) Enforcement, sub section (2b), "In the case of a second violation within (36) months of the date of the current violation, a fine of $2000 shall be issued..." The current violation of April 11, 2024, is a second violation within a (36) month period, the first violation occurring on August 24, 2022. This would make the April 11, 2024 violation a second violation of local regulations, which would incur a $2000 fine and up to a (7) day tobacco license loss. According to the Brewster BOH Tobacco regulations, "In the event of a conflict between this regulation and any other applicable law, the more stringent requirement will apply." Compiled by: Hunter Twombly NAfIealth\Hunter\Brewster Farms Violation Timeline rev.avH 4.24.24.doc &C -i r UR P. Prohibition of the Sale of Tobacco Products by Health Care Institutions: No health care institution located in Brewster shall sell or cause to be sold tobacco products, as defined herein. No retail establishment that operates or has a health care institution within it, such as a pharmacy, optician/optometrist or drug store, shall sell or cause to be sold tobacco products, as defined herein. Q. ,Prohibition of the Sale of Tobacco .Products by Educational .Institutions: No educational institution located in Brewster shall sell or cause to be sold tobacco products, as defined herein. This includes all educational institutions as well as any retail establishments that operate on the property of an educational institution. R. Incorporation of Other Laws and State Regulations: The possession, sale and distribution of tobacco products as defined and regulated herein, shall comply with all applicable federal, state and local laws, including but not limited to the following: The sale or distribution of tobacco products, as defined herein, must comply with those provisions found at M.G.L. Ch. 270, §§6,6A, 7, 28, 29 and M.G.L. Ch. 112, §61A. 2. The sale or distribution of tobacco products, as defined defined herein, must comply with those provisions found at 940 CMR 21.00 ("Sale and Distribution of Cigarettes, Smokeless Tobacco Products, and Electronic Smoking Devices in Massachusetts") and 940 CMR 22.00 ("Sale and Distribution of Cigars in. Massachusetts"), and 1.05 CMR 665.00 ("Minimum Standards for Retail Sale of Tobacco and Electronic Nicotine Delivery Systems"). In the event of a conflict between this regulation and any other applicable law, the more stringent requirement %i ill apply. S. Enforcement It shall be the responsibility of the establishment, permit holder and/or his or her business agent, and not their employees, to ensure compliance with all. sections of this regulation. 2. Whoever violates any provision of this Regulation maybe penalized by indictment or on complaint brought in a court of competent jurisdiction. Except as may be otherwise provided by law and as the court may see fit to impose, for violations of the sections of this regulation that incorporate state laws and state regulations, the following penalties apply: a. In the case of a first violation, a line of one thousand dollars ($1000.00). b. In the case of a second x-iolation within thirty-six (36) months of the date of the current violation, a fine of mo thousand dollars ($2000.00) shall be issued and the -tobacco Proiiuct Sales Permit shall be suspended for seven (7) consecutive business days. 11 C:\Users\klambert\AppDa&J-ocal\Microsoft\Windows\INetCache"Content.Outlook\OCTJ112L\Final Adopted Tobacco Regulation July 2021.doc c. In the case of three or more violations within a thirty-six (36) -month period, a fine of five thousand dollars ($5000.00) shall be issued and the Tobacco Product Sales Permit shall be suspended .for thirty (30) consecutive business days. 3. For violations of all other sections specific to the Town of Brewster, the violator shall receive: a. In the case of a first violation, a fine of one hundred dollars ($100.00). b. In the case of a second violation within tbi.rty-six (36) months of the date of the current violation, a fine of two hundred dollars ($200.00) and the Tobacco Product Sales Permit shall be suspended for seven. (7) consecutive business days. c. In the case of three or more violations within a thirty-six (36) -month period; a fine of three hundred dollars ($300.00) and the Tobacco Product Sales Pennit shall be suspended for thirty (30) consecutive business days. d. The sections specific to the Town of Brewster include: 1. The maximum number of tobacco sales permits :allowed in .Brewster (§E.9); 2. No new retailers near schools (§E.9); 3. The prohibition of smoking bars (§F); 4. Minimum pricing on the sale of cigars (§G); 5. The prohibition of the sale of flavored blunt wraps (§J); 6. The prohibition of self-service displays (§M); 7. The prohibition of vending machines (.§N); 8. The prohibition of non-residential roll -your -own machines (§O); 9. The prohibition of the sale of tobacco products in health care institutions (§P); and 10. The prohibition of the sale of tobacco products in educational institutions (§Q) e. Each day or portion thereof shall constitute a separate offense. If more than one, each condition violated shall constitute a separate offense. 4. The Board of Health may refuse to renew, modify, suspend or revoke any permit issued pursuant to this Regulation for any violation of this Regulation, or any other applicable General Law, regulation or by-law relative to the control of tobacco. The Board shall follow the following guidelines when .considering disciplinary action: • First Offense: Written Warning • Second Offense: Permit Suspension of up to seven (7) days • Third Offense: Permit Suspension for. up to thirty (30) days • Fourth or subsequent Offense: Permit revocation • Failure to Cooperate with Inspection: Permit Suspension for up to thirty (30) days • Distribution of Tobacco Products During Suspension: Additional Suspension of up to thirty (3.0) days 1.2 C:\Users\klambert\AppData\Local\Microsoft\Windows\lNetCache\Content.Outlook\OCTJ112L\Final Adopted Tobacco Regulation July 2021.doc Only offenses which Have occurred within the thirty-six (36) months preceding the date of violation sliall be used in calculating the number of offenses for purposes of the penalty guidelines. 5. The Board of Health may enforce these Regulations or enjoin violations thereof through any lawful process, and the election of one remedy by the Board of Health shall not preclude enforcement through any other lawful means. The Brewster .Board of Health shall provide notice of the intent to suspend or .revoke a Tobacco Product Sales Permit, which notice shall contain the reasons therefor and establish a time and date for a hearing which date shall be no earlier than seven (7) days after the date of said notice. The permit holder or its business agent shall have an opportunity to be heard at such hearing and shall be notified of the Board of Health's decision and the reasons therefor in writing. After a hearing, the Brewster Board of Health shall suspend or revoke the Tobacco Product Sales Permit if the Board of Health finds that a violation of this regulation occurred. All tobacco products, as defined herein, shall be removed from the retail establishment upon suspension or revocation of the Tobacco Product Sales Permit. Failure to remove all tobacco products, as defined herein, shall constitute a separate violation of this regulation. T. Non -Criminal! Disposition: Whoever violates any provision of this regulation may be penalized by the non -criminal method of disposition as provided in Massachusetts General Laws, Chapter 40, Section 21D. If noncriminal disposition is elected, then the non -criminal fine for each such violation shall be: First Offense: one hundred dollars ($100); Second Offense: two hundred dollars ($200); Third and Subsequent Offense: three hundred dollars ($300). U. urate Violations: Each day any violation exists shall. be deemed to be a separate offense. V..Enforcement: Enforcement of this regulation shall be by the Brewster Board of Health or its designated agent(s). Any resident who desires to register a complaint pursuant to the regulation may do so by contacting the Brewster Board of Health or its designated agent(s) and the Board shall investigate. W. Severabili If any provision of this regulation is declared invalid or unenforceable, the other provisions shall not be affected thereby but shall continue in full force and effect. X. Effective Date: This regulation shall take effect on September 15 2021. Board of Health 13 C:\Users\klambert\AppData\Local\Microsoft\Windows\INctCache\Content.Outlook\OCTJ112L\Final Adopted Tobacco Regulation July 202Ldoe S �a e_ 665.035:_ Liquid Nicotine Container Packaging No person shall knowingly sell or provide: (A) A liquid or gel substance containing nicotine, unless the substance is contained in child - resistant packaging; or (B) A liquid nicotine container, unless the container includes child -resistant packaging as part of its design. 665.040: Requirements for Retail Establishments A retail establishment operating on or after December 11, 2019 must meet the following requirements: (A) Only establishments with a permanent, non-mobile location are eligible to operate. (B) Operation of a retail establishment shall be conditioned on the retailer's or retail establishment owner's consent to unannounced, periodic inspections of his or her retail establishment and tobacco products to ensure compliance with 105 CMR 665.000 and any applicable local regulations, orders, or ordinances. (C) A retail establishment shall be prohibited from selling tobacco products if the retailer or owner of the retail establishment has failed to pay all fines issued and the time period to appeal the fines has expired and/or the retail establishment has not satisfied any outstanding orders issued pursuant to 105 CMR 665.000. (D) Sale of a tobacco product by a retail establishment to a person younger than 21 years old shall result in the retail establishment being prohibited from selling tobacco products for up to 30 consecutive business days, or for a longer term as enacted, adopted, or promulgated in a rule, regulation or other measure by the appropriate and legally designated health authority of the city, town, or other legally constituted governmental unit within the Commonwealth. 665.045: Violations Unless otherwise specified or provided for in 105 CMR 665.000, violations of 105 CMR 665.000 shall be assessed as follows: (A) It shall be the responsibility of any person to ensure compliance with 105 CMR 665.000. If an inspection pursuant to 105 CMR 665.000 reveals a retail establishment, retailer, and/or his or her business agent does not comply with the provisions of 105 CMR 665.000, the retail establishment shall be ordered to comply with the violated provision of 105 CMR 665.000. In addition to the correction order, the following fines and actions apply against any person who violates 105 CMR 665.000, provided, however, that such fines and actions related to any violation within a retail establishment shall apply against the retailer and/or his or her business agent and not an employee thereof. (1) In the case of a first violation, a fine of $1,000 shall be imposed. (2) In the case of a second violation within a period of 36 months from the first violation, a fine of $2,000 shall be imposed; and a prohibition on the sale of tobacco products may be imposed for at least one day and up to seven consecutive business days, or for a longer term as enacted, adopted, or promulgated in a rule, regulation or other measure by the appropriate and legally designated health authority of the city, town, or other legally constituted governmental unit within the Commonwealth. (3) In the case of a third violation within a period of 36 months from the first violation or additional violations during that time period, a fine of $5,000 shall be imposed; and a prohibition on the sale of tobacco products may be imposed for at least seven consecutive business days and up to 30 consecutive business days, or for a longer term as enacted, adopted, or promulgated in a rule, regulation or other measure by the appropriate and legally designated health authority of the city, town, or other legally constituted governmental unit within the Commonwealth. April 19, 2024 Inger & Daniel Montgomery 1286 Long Pond Road Brewster, MA 02631 Re: 2024 Barn Permit Dear Mr. & Mrs. Montgomery: Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth a)brewster-ma. ov WWW.BREWSTER-MA.GOV Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Annual renewal permits were due on January 1, 2024. After several attempts to contact you through email and regular mail, we still have not received the renewal. Therefore, the Board of Health has requested that you attend their next regularly scheduled meeting on Wednesday, May 1, 2024 at 6:30PM to discuss the matter. If you no longer have animals, please let me know immediately so that I can take you off the agenda and the barn list. Please do not hesitate to contact the office with any questions. Sincerely, I a*Y Ti' HGF Tammi Mason Senior Department Assistant Brewster Health Department Enclosure: Barn Permit Application Of7 r O 00 March 11, 2024 Inger & Daniel Montgomery 1286 Long Pond Road Brewster, MA 02631 Re: 2024 Barn Permit Dear Mr. & Mrs. Montgomery: Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealthna Brewster -ma.& WWW.BREWSTER-MA.GOV Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Annual renewal permits were due on January 1, 2024. As of today's date, we still have not received your renewal. Several emails were sent out with the link to our online portal for you to renew. Because it is overdue by 2 months now, late fees will be attached. If you do not have animals anymore, please let me know so that I can take you off our barn list. Please do not hesitate to contact the office with any questions. Sincerely, eI aNI'I.m Hao6'1 Tammi Mason Senior Department Assistant Brewster Health Department Enclosure: Barn Permit application Inger & Daniel Montgomery 1286 Long Pond Road Brewster, MA 02631 Town of Brewster 2198 Main Street Brewster, Massachusetts 02631- 1898 (508) 896-3701 X1120 FAX ( 08) 896-4538 brhealth@brewster-ma.gov 2024 Barn Permit Renewal FEE: $36.00(includes late fee) If all information is correct and the blanks filled in, please sign and return to the Health Department with the Fee and the state required WORKER'S COMPENSATION INSURANCE AFFIDAVIT FORM (no permit will be issued if this form is not returned). Should corrections be needed, please make them. Owner/Operator: In er &Daniel Mon ome Mailing Address: (if different from above) Property location:_ 1286 Long Pond Road rc�u�rc � Phone #: __Email Address: Type of flooring: Type of bedding:— Feed Storage: Manure Disposal — Numbers and kinds of Animals/Poultry to be kept: 2Horses, 19 Chickens Please note that the Health Department Animal Inspector for the barns is Sherrie McCullough. She will be doing the annual inspections for this Department. **Enclose application fee and Worker's Compensation Insurance Affidavit Form** **This permit application will expire on December 31, 2024 Signature; Inspector: Date: www.brewster-ma. ov Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealthfu_ L—ewster-margo W W W.BREW STER-MA.GOV Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tarnmi Mason Senior Department Assistant Barnstable County Public Health Excellence Grant (PHE) Lower Cape Community Needs Assessment May 1, 2024 BOH Meeting The Brewster Health Department, with Board of Health approval, is part of the Barnstable County Public Health Excellence Grant Shared Services Program funded through the MA Department of Public Health. In 2023, the Board of Health and Select Board officially approved the participation of the Brewster Health Department in this County Program to enhance County services for purposes of supporting the individual Cape town members for the advancement of community public health. The Lower Cape Towns, consisting of Brewster, Chatham, Dennis, Harwich, and Orleans, through PHE funding, are currently participating in a contracted Lower Cape Community Needs Assessment to help identify strengths and weaknesses in our local health systems, access to care, overall health of our individual populations, and to establish strategies to address our system gaps and identify county and town opportunities. Crescendo Consulting Group was awarded the contract and is conducting the assessment which includes but is not limited to data collection through stakeholder input via one-on-one interviews and focus group discussions. A Crescendo team member will be visiting our Lower Cape communities to conduct the focus group discussions during the time period of June 3 — 5, 2024. Board of Health Discussion — Brewster Focus Group Opportunity - Conduct a Focus Group Session at our BOH meeting on June 5th (only agenda item) that will be open to the public to actively participate in the discussion with the BOH members. Crescendo consultants will facilitate the session. N:\Health\BOH Meeting Notes\BOH Hearing Notes\BOH Hearing Notes Lower Cape Community Needs Assessment 05.01.24.docx Proposal to Conduct a Lower Cape Community Needs Assessment 0 r J000.00 - Presented to Barnstable County, Regional Government of Cape Cod by Crescendo Consulting Group March 4, 2024 Updated March 12, 2024 Katie O'Neill Public Health Shared Services Program Manager Barnstable County Department of Health and Environment Barnstable County 3195 Main St / PO Box 427 Barnstable, MA 02630 March 4, 2024 Ms. O'Neill, Crescendo Consulting Group is pleased to submit the following proposal to complete a Community Needs Assessment of the Lower Cape for the Barnstable County Department of Health and Environment (BCDHE). Crescendo believes that the proposed approach represents a technically effective and fiscally prudent methodology to achieve the objectives discussed in our call on February 29, 2024. In this proposal, you will find details about why we believe the Crescendo team is uniquely qualified to assist Barnstable County Department of Health and Environment. Ilial ucallom • Expertise gleaned facilitating in-depth needs assessments across the U.S. for 25 years. • In-depth experience conducting needs assessments for municipalities, hospitals (including multi -site, regional hospital systems), health departments, Federally Qualified Health Centers, behavioral health service providers, and others. • Project team diversity, as well as strategies to engage the breadth of BIPOC1, gender- based, cultural, disability, mentally challenged, and other unique communities. • A strong local knowledge, as well as an objective, national perspective on health issues, community engagement, diversity, and access to services. • A proven history of establishing mutually beneficial, long-term relationships with clients. Crescendo will serve as the prime contractor and is a woman -owned Maine Limited Liability Company. Its Tax Identification Number is 20-0160042. The primary place of business and project office is in Portland, Maine. Katelyn Michaud (contact information below) will serve as the main point of contact for the project. Thank you in advance for your consideration. Best regards, Katelyn Michaud, MPH, Managing Principal 1 (207) 409-9093 1 katelynm@crescendoch.com 1 Black, Indigenous and People Of Color Crescendo's Experience and Qualifica�.`L(anz Crescendo's mission is "to positively change the lives of the people, organizations, and communities we serve." With extensive community health knowledge, Social Determinants of Health (SDoH) experience, community engagement strengths, and comprehensive communications capabilities, Crescendo's capacities align well with the needs and mission of the BCDHE. The Crescendo team includes experts in consumer engagement, statistical analysis/marketing research, quantitative and qualitative research, communications, project management, and other fields. Crescendo engages local members of diverse groups at every stage of the assessment, including the needs analysis, prioritization, and strategy development phases. Crescendo is uniquely qualified to assist the BCDHE for the following reasons: • Community health needs assessment and operational best practice expertise Crescendo has over 25 years of experience conducting Community Health Needs Assessments, Behavioral Health Needs Assessments, Implementation Plans, and Strategic Plans for some of the most challenged and diverse areas across the U.S., such as rural New England; Tennessee; Dayton, Ohio; southwestern Missouri; the San Francisco Bay Area; Baltimore; New York City; and others. Crescendo has worked with (or is currently working with) regional collaboratives or multi -site health systems, FQHCs, county governments, service providers, consumer groups, and many others. • History of regional experience Crescendo has established strong relationships across New England, as well as with leaders across the U.S. In Massachusetts, Crescendo conducted a Demographic and Options Analysis for HealthQ (formerly Health Quarters), an operator of several sexual health clinics North of Boston. Crescendo also has an ongoing working relationship with McLean Hospital as part of the Harbor Performance Initiative — a national benchmarking and learning collaborative featuring more than 20 participating behavioral health hospitals. • Unique, validated needs prioritization process Crescendo has a unique and highly validated needs prioritization process. The results from primary and secondary research typically include a long list of needs — needs that must be prioritized in a way that builds consensus, is practicable, and creates the greatest impact on the community. Crescendo's modified "Delphi Technique" adopts a three -stage process to embrace quantitative, qualitative, and operational/practical aspects to generate a prioritized needs list that meets these requirements. The company has deployed the modified Delphi Technique to successfully prioritize cancer Fa research funding needs, COVID-based emergency service needs, community support needs for diverse and underserved communities, community health needs, and others. Select Current and Past Work Experience The following examples of the Crescendo team's work experience reflect in-depth knowledge of chronic disease research, hospital operations, and care, community/FQHC healthcare, and behavioral health (including substance use disorder issues). The following also reflect Crescendo's ability to engage diverse sets of community partners and provide communication skills that lead to excellent results. Please note the following: The Springfield and Greene County Health Department (Missouri) worked with Crescendo to evaluate community-based mental health and substance abuse needs and system gaps. The project engaged over 100 community and direct care service organizations. Crescendo's methodology included extensive data analysis, experience - based best practice development, qualitative research (e.g., focus groups, one-on-one interviews, large group meetings, and others), digital and social media analysis, development of a "learning collaborative" to provide ongoing support and analysis, extensive community engagement activities, and others. • Public Health - Dayton & Montgomery County (Ohio) engaged Crescendo to conduct a Community Needs Assessment to assess needs, gaps, and systems barriers for community health services in Montgomery County, Ohio, an area of just over 533,000 people with a diverse racial and ethnic composition and a substantial number of people living below the federal poverty level. Crescendo conducted focus groups, secondary data analysis, individual interviews, a quantitative survey, and a cost -comparison study of three comparable counties in Ohio. Due in part to Crescendo's work, the progress made by Dayton in improving public health and lowering the opioid death, hospitalization, and addiction rates was noted in New York Time articles (e.g., NYT, "This City's Overdose Deaths Have Plunged. Can Others Learn From !t? " 11/25/18). • Children's Trust of South Carolina contracted with Crescendo on a Statewide Adolescent Needs Assessment in which Crescendo employed a regional approach to assess needs among young people across the state's four geographic regions. In addition to its state -level assessment of pressing issues, challenges, and strengths of the state's population of young people, Crescendo created county -specific demographic profiles detailing the adolescent population of each of the state's 46 counties. • Critical Access Hospitals. Crescendo has conducted BHNAs/CHNAs for rural health systems and/or Critical Access Hospitals (CAHs) and others in highly diverse communities like Peterborough and Woodsville, New Hampshire; Turlock, California; Laramie, Wyoming, and Greene County, Missouri. Many of these programs envisioned 3 needs assessment and implementation plans that take a "root -cause" approach to meeting community health needs. "Root -cause" strategies are designed to address core issues — primary care, behavioral health/medical health integration, poverty, family integrity, employment, and education that drive long-term health status. • Crescendo has worked with Federally Qualified Health Centers (most with multiple service locations) to provide strategic service area assessments (i.e., Community Needs Assessments, Strategic Plans, communications strategies, and others). Projects vary tremendously (as do the character of each FQHC), yet all projects successfully engaged marginalized community groups, as well as highly diverse sets of stakeholders. Assessment Goals & Crescendo's Approach Consideration of racial, ethnic, cultural, and other factors will be foundational to assuring an equity -centered assessment while identifying the needs of each town within the Lower Cape to provide a data -driven vision of the community. Crescendo has a unique, innovative approach that engages hard -to -reach communities and deploys validated, inclusive, data -founded techniques that do more than identify prioritized needs. Crescendo's approach will guide the BCDHE strategies to address high priority needs efficiently and effectively. Crescendo is committed to, and experienced in, capturing human stories and voices to ensure that secondary data do not overshadow the personal, qualitative voices that are often hard to hear. Those voices include those of young people, gender minorities, BIPOC households, households where English is rarely spoken, and working single -parent households. The BCDHE project goals and Crescendo's Assessment as Action° model, shown above — which integrates research, assessment, implementation, process improvement, and community Assessment as Action Cycle© engagement — are very compatible. The approach simultaneously op engages stakeholders and uses data Pew and service to help create a positive cycle of WWM"109 change in health status through an understanding of community determinants of health across the Lower Cape. al lect `valuate and revise ndprocess ._ ia of n.eded) omess E, programs and data strategies implement ^mss pregrarns and gaps, nssda6 strategies and b■rrlsrs engagement — are very compatible. The approach simultaneously op engages stakeholders and uses data Pew and service to help create a positive cycle of WWM"109 change in health status through an understanding of community determinants of health across the Lower Cape. al Scope of Services Crescendo's approach will simultaneously engage community partners, use data analytics, and join discovery to help create a positive cycle of change. Assessment activities do the following: • Identify local health system resources (i.e., VNA, local municipal/private wellness programs, etc.), strengths, barriers, and continuity of care processes in the Lower Cape, its towns, and regionally. • Develop a deeper understanding of community residents' access to care challenges and needs, including those faced by marginalized communities and substance use services. • Enable partners to coalesce around, and act upon, the opportunities for population health improvement. • Establish strategies to address system gaps and identify county and town opportunities. Stage 1: Environmental Analysis Purpose: Profile of the Lower Cape by Town Methods: Secondary Research, Access Audit, Resource Mapping / Spatial Analysis Stage 2: Needs Assessment and Stakeholder Input Purpose: Comprehensive, Equity - Focused, Community-based Research and Needs Prioritization Methods: Key Stakeholder Interviews; Focus Groups; Community Survey; and Needs Prioritization Stage 3: Reporting Purpose: Provide a Comprehensive, Easy to Read Set of Reports - Useful to BCDHE, municipal leaders, and the General Public Methods: Reporting: An Aggregate, Lower Cape -level report featuring town Analysis; Presentation -Friendly Materials as needed Major elements of the proposed approach include (but are not limited to) the following: PROJECT MANAGEMENT AND COMMUNICATIONS: Clear communications between Lower Cape/Barnstable County and Crescendo will help ensure that the project is conducted successfully and within established timelines. To assure that communications are well managed, Crescendo suggests the following: 5 • Early in the project, Crescendo will hold a virtual "kick off" meeting with the Lower Cape team. During the meeting, Crescendo will confirm the workplan / timeline, discuss and collect names of prospective stakeholder groups that will be integral in the proposed approach, and review data or existing reports that may be helpful. • Identify the primary BCDHE point of contact (POC) who can serve as a communications liaison to the larger Lower Cape/Barnstable County team and be available to respond to operational issues. • Convene biweekly project update calls between the POC and the Crescendo PM. • Hold regular communications with BCDHE (frequency TBD based on need) to align assessment work with county activities, as needed. • Develop monthly project progress reports —written and submitted to the POC— and meet in-person to discuss progress and next steps. • Convene public forums and other presentations as described in the staged approach below, in order to review initial findings with BCDHE and others, as desired. • Provide a full final report including complete appendices and data citations. Communications platforms can be customized to meet client needs, but Crescendo typically uses platforms such as Zoom or Microsoft Teams for video conferencing, Google Docs for collaborative document development, the Microsoft Suite for analytical work and report development, and R and custom built engines for statistical work. R STAGE 1: ENVIRONMENTAL ANALYSIS Secondary data research yielding a profile of public health needs in the service area, including key CDC Social Vulnerability Index (SVI) indicators sourced from the most recent U.S. Census Bureau American Community Survey Five -Year Estimates for 2017-2021, in addition to data focused specifically on behavioral health and more broadly on Social Determinants of Health. Other data sources may include the Massachusetts DPH, CDC, and recent Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Survey (YRBS) data as available, among others. Crescendo will also request de -identified (i.e., HIPAA safe) service use data from Lower Cape/Barnstable County and partner organizations. Crescendo has developed a proprietary method using service use data to empirically validate the impact on access to care based on factors such as transportation / distance of service sites, income levels, poverty status, and other factors. Spatial analysis and resource mapping of current services, programs, and public transportation options accessible to specified populations of interest, such as children and older adults, relative to their locations across the Lower Cape. Data visualization and mapping provide easy-to-use tool sets that graphically illustrate demographics, service use, prevalence, other key data, and trends. The Crescendo team will create sets of interactive maps and other easy-to-use tools. As an example, the Crescendo team created a county -level map showing where the use of antidepressants is higher than projected (i.e., a model using validated data and Crescendo's proprietary forecasting model). Mapping on a county level shows that, for example, the Bennett County use of antidepressants is 23% higher than predicted based on Crescendo's model.' In the map above, darker colored areas represent counties in 2 Crescendo developed a tool to estimate the use of antidepressants (i.e., the "percent of adults using antidepressants") based on variables such as population, poverty levels, education, and other proprietary, validated measures. The model is highly predictive. [For statisticians, the F -score = 298.57. The F -score is the weighted harmonic mean of the test's precision and recall.] Crescendo has generated projections and variances for every U.S. county. More details about the model and related mapping can be shared upon request. 7 which variation to the predicted antidepressant use is above expected rates. An interactive, more clearly legible version of the map below is available at: https:Harcg.is/Of5irn. STAGE 2: NEEDS ASSESSMENT AND STAKEHOLDER INPUT The needs assessment provides the core of the assessment and involves combination of onsite presence, local knowledge and expertise, and community engagement. Crescendo's proven approach is geographically comprehensive in that it gathers insight and information from the target service areas while uniquely engaging typically difficult -to -reach audiences (in addition to the general population). Crescendo will deploy a mixed -mode primary assessment approach that will engage policy leaders, key stakeholders throughout the area, non-profit organization representatives, healthcare consumers, the criminal justice system, diversity representatives, people experiencing homelessness, and others. This stage of the assessment includes four activities: • Stakeholder interviews • Focus group discussions • Access Audit • Community survey (online and paper options available) • Needs prioritization using a "Modified Delphi" approach Stakeholder Interviews Directly engaging key stakeholders, healthcare consumers, policy leaders, system -level experts, and others is key to getting in-depth information about the community health landscape. Crescendo has extensive expertise in working with special populations and difficult -to -reach audiences. We will work alongside those willing to identify their respective needs and solutions. Crescendo will conduct telephone, video, or in-person discussions with community members knowledgeable about health care and social services in the Lower Cape. A comprehensive understanding of the strengths, capabilities, resources, and operational challenges will largely define service gaps. Crescendo will conduct between 15 to 20 interviews throughout the region with individuals such as the following: o Consumers (e.g., community members, high-risk populations, representatives from equitable and racially comprehensive community groups). o Direct service providers (e.g., public health nurses and division staff, community service providers, outpatient service providers, specialized medical or behavioral healthcare providers). o Sectoral representatives (e.g., public health leaders, schools, non -profits). o Policy experts (e.g., state legislators, local/ regional regulatory agencies, Health Department leaders, regional health advocates, health-related non-profit organizations and councils, and others). • When evaluating the system gaps and needs within any jurisdiction, public policy and the regulatory environment help mold the creation and degree of impact of any public health initiative. Individual or group discussions will be held to collect insight and craft strategies to improve community health in the Lower Cape and its towns. Focus Group Discussions Crescendo proposes to conduct four to six focus group discussions in Barnstable County, including one in each of its four towns. Groups will be designed to discuss community health, behavioral health, SDoH, access to care, and other issues that define the service environment and help direct future public health activities. Groups will provide the opportunity to conduct interactive discussions regarding key issues, and in doing so, wrestle with root causes and possible solutions to challenges. Participants will include groups such as the following: • Consumers (e.g., community members, high-risk populations, representatives from equitable and racially comprehensive community groups). • Direct service providers (e.g., public health staff, community service providers, outpatient service providers, specialized medical or behavioral healthcare providers). • Sectoral representatives (e.g., public health leaders, schools, non -profits). To support the development of focus groups, Crescendo will work closely with Barnstable County and identified community partners to develop discussion guides, recruit participants, and manage other logistics. Access Audit of Customer Service The Crescendo team will conduct an "Access Audit" to understand practical access to care issues perceived by health service consumers. Access audits, or "mystery shopper" calls, are a highly effective way to evaluate customer service data and consumer -level access to care issues in health. The Crescendo team proposes to evaluate approximately 12 to 15 sites across the Lower Cape. Access to care issues assessed include (but are not limited to) the following: • Ability of the site to accept new patients or clients. • Expected wait time to have an initial appointment for new patient and other appointments. • Ability of the facility to refer the caller elsewhere when the desired services are not provided. D • Staff members' ability to ask questions to define prospective client needs and other information prior to making an appointment (e.g., insurance coverage, appropriate levels of service, other access to care issues). The results identify service access gaps, focus improvement strategies, and identify any service variations based on geography, insurance status, or other issues. Community Survey In order to increase the amount of feedback directly from public health nursing service consumers, Crescendo will administer a large -sample, online community survey through the Lower Cape and identified community partners. Crescendo will create the survey in a platform such as Survey Monkey so that it can be disseminated via hyperlink through websites, direct email, and other channels. Crescendo and project leaders will jointly establish the preferred operational details. The survey will include or provide the following: • Equitable and racially comprehensive responses from higher -need populations. • Insight regarding access to care, perception of services, and current and anticipated health needs. • Ideas and strategies to better meet needs and address service gaps. • Surveys will be available in English, Spanish, and other languages, as needed. • Estimated number of responses is over 400. The final report will also identify gaps in current data available and recommend means for collecting and analyzing future data, including data relating to timely access to services such as that in the Access Audit. Needs Prioritization Using a Modified Delphi Approach Initial assessment will yield a strong list of sector- and geographic -specific policy issues, service needs, and other important topics. The significant, common challenge faced by communities at this point is that the prioritization is often based on positional. authority, non -representative quantitative ranking, or some other process that does not fully incorporate disparate insights and build consensus among the stakeholders. To address this challenge, Crescendo will work with project leaders to implement Crescendo's validated needs prioritization process. STAGE 3: REPORTING The purpose of the report writing phase is to create a set of materials that provide information appropriate for the readers' situation — executive summaries for consolidated project findings, a comprehensive report for those seeking detailed information, online resources for exploration and digital use, etc. Crescendo's report writing deliverables include the following: 10 • A comprehensive, fully documented report showing the project background, assessment results, citations, supporting materials, and other information. The aggregated report will also include a regional summary of research activities and results. Results will be stratified by town and population group, as appropriate. Report will include potential strategies and solutions to address system gaps and County and town opportunities that meet the PHE Grant funding criteria. A Summary Report. The summary report will be extracted from the aggregated report but will highlight prioritized needs and other research results for specific communities. • Community-based, culturally modified (as helpful) "on the road" PowerPoint presentations, to be used by Crescendo for end -of -project presentations. The purpose of the presentations is to provide information about local needs and strategies that can be easily shared with interested stakeholders and community groups. All reports will be ADA -friendly and easy to use. All electronic versions of reports will contain embedded hyperlinks to interactive maps, internal portions of the report(s), and easy access to data sources and supporting information outside of the report(s). oil Timeline Crescendo will commence project work immediately upon notification of award. The general timeline for the project includes the expected key dates below, all of which are negotiable. Project kickoff _ Stage 1— Environmental Analysis Crescendo meets with BCDHE staff to confirm project scope and gather and assess secondary data. Stage 2 — Needs Assessment and Stakeholder Input Stakeholder Interviews (up to 20) - Focus Group Discussions (up to six) Access Audit Community Survey - Needs Prioritization Implementation Plan Development Stage 3 — Reporting - Draft final report due - Final report due - Final presentation due March 18, 2024 March 18 —April 30, 2024 April 15 — July 15, 2025 f June 15 —July 30, 2024 July 15, 2024 July 30, 2024 By July 30, 2024 12 Budget Total not -to -exceed cost of the project: $32,700 (including the aggregated report, all other deliverables, all travel and other direct costs). Please note that, when required, travel is estimated at coach airfare and other expenses assume reasonable lodging, rental car or public transportation, meals and incidental expenses consistent with federal per diem rates. The budget does not include any focus group honorarium or room rentals. The Environmental Analysis (Phase 1) is priced as an optional add-on below and is not included in the project budget above. The following budget shows a detailed layout of tasks and associated fees. Direct costs are enumerated on the same table. Exhibit 1. Detailed Project Budget Project initiation and planning Secondary data analysis Stakeholder interviews Focus group discussions 1Community survey Access Audit Needs prioritization Deliverables: Reports, presentations, others Project management and travel Administrative costs and overhead (15% of professional fees) Net Fe $1,50_0 _ $7,200 $2,500 $4,250 $3,500 _ $750 $2,000 $5,000 _ $2,500 $3,500 Total Other Costs 532.70n Please note that Crescendo is willing to collaboratively work with Barnstable County to modify research activities (including the budget) in order to best meet project objectives, capitalize on emerging opportunities, and/or address other changes impacting the project. 13 Crescendo Team Crescendo's depth of expertise enables us to allocate staff members who have extensive experience conducting indicator identification, data collection and analysis, report development, and similar work, and who have practical experience conducting projects regionally in New England as well as nationally with many of the nation's leading community -focused organizations. Katelyn Michaud, MPH, Managing Principal Ms. Michaud brings a diverse set of skills and experiences including quantitative and qualitative research, project management, marketing, and grant writing. Before joining Crescendo, Ms. Michaud worked on health information technology projects on the Maine State Innovation Model (SIM) grant. Her work supported behavioral health organizations access to electronic health record systems and connection to the Health Information Exchange. Ms. Michaud completed her master's thesis on HIV/AIDS in Latin America and helped the National Alliance of State and Territorial AIDS Directors (NASTAD) complete a 10 -year Epidemiology profile of HIV/AIDS in Haiti. Well versed in CSBG and CDBG funding, she has served as the project manager on several CNAs for CAP agencies, municipal, and health systems. Ms. Michaud graduated summa cum laude with a Master of Public Health degree from the University of New England and a BA in Biology/Chemistry from the University of Maine at Farmington. Additionally, she holds a Project Management Certificate from Husson University. She is an active member of the Junior League of Portland, Maine and is a commissioner for the Bangor Housing Authority. Kevin Koegel, MPH, Research Manager Based in Tucson, Mr. Koegel brings a diverse technical skill set to Crescendo, with more than 12 years of experience conducting data I �� collection and analysis, program evaluation, and policy analysis �•�. across topic areas as diverse as behavioral health, food insecurity, HIV/AIDS, and juvenile justice. Kevin's demonstrated ability to distill and visualize quantitative and qualitative data has been critical in assisting government and community leaders to understand and address complex issues. Mr. Koegel has extensive experience in local government, including ten years analyzing data and evaluating programming in Pima County, Arizona. He coordinated and provided analytical 14 support to several of Pima County's collaborative stakeholder groups, including initiatives to address disparities in contact with the local juvenile justice system and to coordinate crisis services across the regional behavioral health system. During the COVID-19 pandemic, Kevin co - led performance measurement and evaluation planning associated with federally funded response and recovery efforts, from public health mitigation to eviction prevention and job training investments. Kevin has a Bachelor of Arts degree in Humanities from Providence College, with minors in Business Studies and Italian, and a Master of Public Health from the University of Arizona. He currently resides in Tucson. Following graduation Ms. Edwards relocated to Charlotte, North Carolina to work for Mallinckrodt Pharmaceuticals. Inspired by the COVID-19 pandemic, she began coursework remotely in pursuit of a master's degree in public health data science from Columbia's Mailman School of Public Health. During her studies she worked in epidemiology for Mecklenburg County's Public Health Department as a part of the COVID-19 Response Team, where she coordinated outreach and education of COVID-19 health & safety procedures and vaccine efficacy in local communities, monitoring compliance of public safety directives, and promoting vaccination in zip codes with high transmission rates. Nicole Hallas, Research Manager Nicole Hallas brings over 12 years of versatile expertise spanning research analytics, social work, content creation, and marketing communications. Grounded in robust qualitative and quantitative research methodologies, Nicole excels in distilling intricate information into accessible formats for diverse audiences. Beginning her career in a Boston hospital, Nicole navigated various roles, including as a community resource social worker, where she compassionately facilitated connections between patients and essential community supports, gaining invaluable insights into community health dynamics. Nicole's dedication propelled her into progressively advanced positions, culminating in her role as Manager of Research Analytics at a leading financial services and regulatory research firm. Here, she refined her skills in data interpretation and communication, spearheading the production of insightful analyses and research reports while managing a team of researchers. Nicole's academic journey includes a Bachelor of Science in Psychology with a minor in Law and Public Policy from Northeastern University, followed by a Master of Arts degree in Psychology from Boston University. Her academic achievements, coupled with her diverse professional experiences, have molded her into a dynamic individual deeply committed to advocacy and community support. With a multifaceted skill set and a profound understanding of the intersection between research, social work, and community engagement, Nicole continues to make meaningful contributions, driven by her passion for effecting positive change and fostering resilient communities. Aidan Ottoni-Belval, Research Analyst Prior to joining Crescendo, Ms. Ottoni-Belval gained extensive experience both on the ground working for communities and analyzing data on behalf of the communities she has served. After receiving a B.A. in Psychology with a focus on trauma studies, Ms. Ottoni-Belval worked as a community-based Health Coach for people experiencing severe mental illness and as a jail -based Recovery Coach for incarcerated men and women at the Wayne County Jail (Richmond, IN). The experiences and people Ms. Ottoni- Belval met during this time inspired her to pursue a Master of Public Health degree at George Washington University. While completing her MPH degree, Ms. Ottoni-Belval was non -clinical COVID-19 support for Baltimore's Field Hospital and for the University of Maryland Medical System's mobile vaccine and testing units in West Baltimore. This involved community-based patient care and using EMR software/databases. Ms. Ottoni- Belval's passion for working with the people of Baltimore led her to a role as the Data Analyst and Interim Program Manager for the University of Maryland Medical System's portion of the Baltimore Metropolitan Diabetes Regional Partnership health equity grant. Isabella Perea Caicedo, Research Analyst Ms. Caicedo graduated from the Johns Hopkins University Bloomberg School of Public Health, earning a Master of Health Science degree with a concentration in Mental Health. She was born in Colombia and immigrated at a young age to Miami, where she completed her bachelor's degree in Biological Science and a double minor in Chemistry and French language and culture. Her passion for minority community health led her to join Centro SOL, Hopkin's Latino health equity center. She worked diligently with an interdisciplinary team to bring to life the mission of the center in promoting equity in health and opportunity for Latinos by advancing clinical care, research, and education in active partnership with the community. Her research included the development and facilitation of an NIH grant -funded program to address maternal mental health among 16 Latina immigrant mothers. Her work has further included Redcap survey development, translation of educational material, literature reviews, and facilitation of focus groups as well as qualitative interviews. Ms. Caicedo's lived experiences and graduate work have led her to embody the core principle of conducting research with the community and not on the community through using evidence -based research to yield actionable change. Carly Wittman, MS Ed, Research Analyst Prior to joining Crescendo, Carly spent over 15 years in the education sector, mentoring; tutoring; working with ESL students; teaching cultural awareness; adult education; substituting; teaching in Hebrew schools; and working in public and special education. Carly's passion for education was solidified during her time as a volunteer English teacher in Argentina. During her time abroad, Carly developed an after-school tutoring program for the indigent student population that she worked with and traveled throughout South America during her free time. Upon returning to the United States, Carly enrolled in the Extended Teacher Education Program (ETEP) at the University of Southern Maine. Carly graduated summa cum laude with her Master of Science in Education and continued to teach in the public school system during which she was known for her rigorous proficiency -based curriculum, trauma -informed classroom management skills, and development of a strong rapport with the most challenging students. After leaving the public education sector, Carly spent some time in the healthcare industry. She also helped facilitate the closing of the iconic Maine plant, B&M Baked Beans, where she developed an original deployment process that drastically reduced shipping issues. Carly has volunteered with Planned Parenthood, animal shelters, and Sexual Assault Response Services of Southern Maine. Carly is passionate about women's rights and reproductive health, animal rights, environmentalism, and education. Carly also has a Bachelor of Art in English and a minor in psychology from the University of Maine. FIVl DocuSign Envelope ID: EOA648BB-1657-44AC-A246-29FA1D3661EC Barnstable County 3195 Main Street Barnstable, MA 02630 THIS AGREEMENT is made this 14 Contract for Services Terms and Conditions day of March 2024 by and between Bid# Contract# Crescendo Consulting Group: 3896, 63 Federal Street #1028, Portland, ME 04101 (Contractor's Legal Name and Address) ( hereinafter referred to as Contractor), and Barnstable County (hereinafter referred to as County and collectively as the "Parties"). The Contract for Services Terms and Conditions and any agreed upon changes thereto included in any Contract Amendments shall take precedence over any additional or conflicting terms and conditions as may be included in any other document attached hereto. NOW THEREFORE, the County and the Contractor do mutually agree as follows: 1. Employment of Contractor. The Contractor hereby agrees to perform the services hereinafter set forth in the Scope of Services. Contractor hereby agrees to hold the County harmless from any claims regarding worker's compensation benefits, unemployment compensation benefits, retirement benefits, or any other benefit normally attributable to the status of "employee" and Contractor specifically agrees to pay for all damages incurred by the County or Town, including costs, benefits, and reasonable attorney fees in the event the Contractorfiles such claim. Scope of Services. The contractor shall perform the scope of services set forth in Please see Attachment A. 3. Contract Amendments. The following amendments to the Contract have been executed by duly authorized representatives of the Parties and are attached hereto and incorporated herein: N/A 4. Time of Performance. Upon Contract Execution Start Date July 31, 2024 End Date 5. Responsible County Official: The County Official and Department exercising managerial and budgetary control for this Contract shall be: Katie O'Neill- Department of Health & Environment DocuSign Envelope ID: EOA648BB-1657-44AC-A246-29FA1 D3661 EC 6. Payment: A. The County shall compensate the Contractor for the services rendered at the rate of $ 32,700 --per Project (e.g., hour, week, quarterly, project, etc.). B. In no event shall the Contractor be reimbursed for time other than that spent providing the described service(s). C. Payment will be made upon submittal and approval of the Contractor's Invoice(s) that is (are) received Monthly x , Quarterly , Other (specify)_ _ D. Reimbursement for Travel and Other Contractor Expenses: 10 All travel and meals are part of this Contract. No reimbursement will be made. ❑Contractor will be reimbursed for pre -approved travel in an amount not to exceed $ Copies of receipts must be submitted. Any expense claimed by the Contractor for which there is no supporting documentation shall be disallowed. Contractor will be reimbursed for OTHER expenses in an amount not to exceed $ ❑OTHER Expenses shall be limited to: Copies of receipts must be submitted. Any expense claimed by the Contractor for which there is no supporting documentation shall be disallowed. The total of all payments made against this Contract shall not exceed: $ 32,700 Upon acceptance of the Contractor's invoice, payment will be made within thirty (30) days. If an invoice is not accepted by the County within fifteen (15) days, it shall be returned to the Contractor with a written explanation for the rejection. At the end of each County fiscal year Contractor must submit any outstanding invoices for services performed or delivered during the fiscal year (July 1 -June 30) to the County no later than July 315 of the year when the services were performed. Contractors shall submit invoices within sixty (60) days of completing the work. 7. Certification. Contractor certifies under the pains and penalties of perjury that pursuant to Mass .Gen. Laws ch.62C, §49A, that the Contractor has filed all state tax returns, paid all taxes and complied with all applicable laws relating to taxes; and that pursuant to Mass. Gen. Laws ch.151A, §19A(b), has complied with all laws of the Commonwealth relating to contributions and payment in lieu of contributions to the Employment Security System; and, if applicable, with all laws of the Commonwealth relating to Worker's Compensation, Mass. Gen. Laws ch.152 and payment of wages, Mass. Gen. Laws ch. 149, § 148. Pursuant to federal law, Contractor shall verify the immigration status of all workers assigned to the contract without engaging in unlawful discrimination; 8. Termination or Suspension of Contract for Cause. If through any sufficient cause, the Contractor or the County shall fail to fulfill or perform its duties and obligations under this Contract, or if either party shall violate or breach any of the provisions of this Contract, either party shall thereupon have the right to terminate or suspend this Contract, by giving written notice to the other party of such termination or suspension and specifying the effective date thereof. Such notice shall be given at least fifteen (15) calendar days before such effective date. 9. Termination for Convenience of County. The County shall have the right to discontinue the work of the Contractor and cancel this contract by written notice to the Contractor of such termination and specifying the effective date of such termination. In the event of such termination or suspension of this Contract, the Contractor shall be entitled to just and equitable compensation for satisfactory work completed, for services performed and for reimbursable expenses necessarily incurred in the performance of this Contract up to and including the date of termination or suspension. DocuSign Envelope ID: EOA648BB-1657-44AC-A246-29FA1D3661EC 10. Non -Discrimination in Employment and Affirmative Action. The Contractor shall take affirmative action to ensure that qualified applicants and employees are treated without regard to age, race, color, religion, sex, marital status, sexual orientation, national origin, disability, or Vietnam Era Veteran status. The Contractor agrees to comply with all applicable Federal and State statutes, rules and regulations prohibiting discrimination in employment including but not limited to: Title VII of the Civil Rights Act of 1964, as amended; Massachusetts General Laws Chapter 1518§(1); the Americans with Disabilities Act of 1990; and all relevant administrative orders and executive orders including Executive Order 11246. 11. Subcontracting. None of the services to be provided to the County pursuant to this Contract shall be subcontracted or delegated in whole or in part to any other organization, association, individual, corporation, partnership or other such entity without the prior written approval of the County. No subcontract or delegation shall relieve or discharge the Contractor from any obligation or liability under this Contract except as specifically set forth in the instrument of approval. If this Contract is funded in whole or in part with federal funds, Contractor further agrees to comply with the provisions of the Office of Management and Budget Circular A-110, as amended, with respect to taking affirmative steps to utilize the services of small and minority firms, women's business enterprises and labor surplus area firms. All subcontracts shall be in writing and shall contain provisions which are functionally identical to, and consistent with, the provisions of this Contract. The County shall have the right to obtain a copy of the subcontract upon request. 12. Interest of Members of County and Others. No officer, member or employee of the County, and no member Of its governing body of the locality or localities in which the Project is situated or being carried out who exercises any functions or responsibility in the review or approval of the undertakingcarrying orout of the Project, shall participate in any decision relating to this Contract which affects his personal interest or the interest of any corporation, partnership, or association in which he is directly or indirectly financially interested or has any personal or pecuniary interest, direct or indirect, in this Contract or the proceeds thereof. 13. Conflict of Interest. Contractor acknowledges that it maybe subject to the Massachusetts Conflict of Interest statute, Mass. Gen. Laws ch. 268A, and to that extent, Contractor agrees to comply with all requirements of the statute in the performance of this Contract. 14. Assignability. The Contractor shall not assign any interest in this Contract and shall not transfer any interest in the same (whether by assignment or novation), without the prior written consent of the County thereto; provided, however that claims for money due or to become due the Contractor from the County under this Contract may be assigned to a bank, trust company, or other financial institution without such approval. Notice of any such assignment or transfer shall be furnished promptly to the County. 15. Recordkeeping, Audit, and Inspection of Records. The Contractor shall maintain books, records, and other compilations of data pertaining to the requirements of the Contract to the extent and in such detail as shall properly substantiate claims for payment under the Contract. All such records shall be kept for a period of seven (7) years or for such longer period as is specified herein. All retention periods start on the first day after final payment under this Contract. If any litigation, claim, negotiation, audit or other action involving the records is commenced prior to the expiration of the applicable retention period, all records shall be retained until completion of the action and resolution of all issues resulting therefrom, or until the end of the applicable retention period, whichever is later. if this contract is funded in whole or in part with state or federal funds, the state or federal grantor agency, the County or any of its duly authorized representatives or designees, shall have the right at reasonable times and upon reasonable notice, to examine and copy, at reasonable expense, the books, records and other compilations of data of the Contractor which pertain to the provisions and requirements of this Contract. Such access shall include on-site audits, review and copying of records. 16. Findings Confidential. Any reports, information, data, etc., given to or prepared or assembled by the Contractor under this Contract which the County requests to be kept as confidential shall not be made available to any individual or organization by the Contractor without the prior written approval of the County. DocuSign Envelope ID: EOA648BB-1657-44AC-A246-29FA1D3661EC 17. Publication, Reproduction and Use of Material. No material produced in whole or in part under this Contract shall be subject to copyright in the United States or in any other country. The County shall have the unrestricted authority to publish, disclose, distribute, and otherwise use, in whole or in part, any reports, data or other materials prepared under this Contract. 18. Political Activity Prohibited. None of the services to be provided by the Contractor shall be used for any partisan political activity or to further the election or defeat of any candidate for public office. 19. Anti -Boycott Warranty. During the term of this Contract, neither the Contractor nor any "affiliated company" as hereafter defined, shall participate in or cooperate with an international boycott, as defined in Section 999 (b) (3) and (4) of the Internal Revenue Code of 1954, as amended by the Tax Reform Act of 1986, or engage in conduct declared to be unlawful by Sections 2 and 3 of Chapter 151E, Massachusetts General Laws. As used herein, an "affiliated company" shall be any business entity of which at least 51% of the ownership interested is directly or indirectly owned by the Contractor or by a person or persons or business entity or entities which directly or indirectly own at least 51% of the ownership interests of the Contractor. 20. Choice of Law. This Contract shall be construed under and governed by the laws of the Commonwealth of Massachusetts. The Contractor and the agents thereof, agree to bring any federal or state legal proceedings arising under this Contract, in which the County are a party, in a court of competent jurisdiction within the Commonwealth of Massachusetts. This paragraph shall not be construed to limit any rights a party may have to intervene in any action, wherever pending, in which the other is a party. All parties to this contract and covenant agree that any disputes be litigated in the District or Superior courts in Barnstable County. 21. Force Majeure. Neither party shall be liable to the other nor be deemed to be in breach of this Contract for failure or delay in rendering performance arising out of causes factually beyond its control and without its fault or negligence. Such causes may include but are not limited to: acts of God or the public enemy, wars, fires, floods, epidemics, strikes, or unusually severe weather. Dates or times of performance shall be extended to the extent of delays excused by this section, provided that the party whose performance is affected notifies the other promptly of the existence and nature of such delay. 22. Indemnification. To the fullest extent permitted by law, the Contractor shall indemnify, defend and hold harmless the County, its elected or duly appointed officers, and employees against liability, losses, damages or expenses (including reasonable legal expenses) resulting from any claim based upon to the extent caused by breach of this contract or negligent acts, errors or omissions or willful misconduct of the Contractor, its employees or its agents in providing its service(s) to the County pursuant to the Contract. After prompt notification of a claim by the County, the Contractor shall have an opportunity to participate in the defense of such claim and -any negotiated settlement agreement or judgment. The County shall not be liable for any costs incurred by the Contractor arising under this paragraph. Any indemnification of the Contractor shall be subject to appropriation and applicable law. Notwithstanding the foregoing, Contractor has no obligation to defend or pay indemnitee defense costs incurred prior to a final determination of liability or to pay any amount that exceeds the proportionate share of Contractor's finally determined percentage of liability as determined by a court of competent jurisdiction. 23. Compliance with Laws. The Contractor shall promptly comply with all applicable laws, rules, regulations, ordinances, orders and requirements of the Commonwealth and any state or federal governmental authority relating to the delivery of the services described in this Contract subject to section 18 above. Unless otherwise provided by law, the Contractor shall promptly pay all fines, penalties and damages that may arise out of or are imposed because of the Contractor's failure to comply with the provisions of this section and, shall indemnify the County against any liability incurred as a result of a violation of this section. If the Contractor receives federal funds pursuant to this Contract, Contractor understands and agrees to comply with all requirements outlined in the Office of Management & Budget Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (2 CFR Part 200 subpart A -F) DocuSign Envelope ID: EOA648BB-1657-44AC-A246-29FA1D3661EC 24. Tax Exempt Status. The County is exempt from federal excise, state, and local taxes; therefore, sales to the County are exempt from Massachusetts sales and use taxes. If the County should become subject to any such taxes during the term of this Contract, the County shall reimburse the Contractor for any cost or expense incurred. Any other taxes imposed on the Contractor on account of this Contract shall be borne solely by the Contractor. 25. Headings, Interpretation and Severability. The headings used herein are for reference and convenience only and shall not be a factor in the interpretation of the Contract. If any provision of this Contract is declared or found to be illegal, unenforceable, or void, then both parties shall be relieved of all obligations under that provision. The remainder of the Contract shall be enforced to the fullest extent permitted by law. 26. Waiver of Liability. The Contractor hereby covenants and agrees to waive any and all claims against Barnstable County and release Barnstable County from any liability for Contractor's negligent actions in performing of the Scope of Services. 27. Amendments. The County may, from time to time, require changes in the Scope of Services to be performed hereunder. Such changes, including any increase or decrease in the amount of the Contractor costs, which are mutually agreed upon by the County and the Contractor, shall be incorporated in written amendments to this Contract. 28. Entire Agreement. The Parties understand and agree that this Contract and its attachments or amendments (if any) constitute the entire understanding between the Parties and supersede all other verbal and written agreements and negotiations by the Parties relating to the services under this Contract. 29. Notice. Unless otherwise specified, any notice hereunder shall be in writing addressed to the persons and addresses indicated below (Name, postal address, phone, email address): To the county: Katie O'Neill, 3195 Main Street, Barnstable, MA 02630 Katie.Oneill@CapeCod.gov To the Contractor: Crescendo Consulting Group, 3896, 63 Federal Street #1028, Portland, ME 04101 katelynm@crescendocg.com Employees of Barnstable County shall not be held personally or contractually liable by or to the Contractor under any term or provision of this Contract or because of any breach thereof. This Contract is not binding until signed by an authorized County official. IN WITNESS WHEREOF, the County and Contractor have executed this Agreement this date: 03/18/2024 FOR THE COUNTY: BARNSTABLE COUNTY EDowSipned by: � 6218A2FABBE24DB... Beth Albert 3/25/2024 FOR THE CONTRACTOR: Katel n Michaud Managing Princi al 4000-4 BARNSTABLE COUNTY GAPE COD REGIONAL GOVERNMENT Lower Cape Cod Community Needs Assessment Contents Overview...................................................................................................................................................1 Initial Set of Domains and Measures...........................................................................................................2 Data Sources (Example) 5 Overview The following is an initial draft list of domains and measures to be considered for the secondary research portion of the Community Needs Assessment (CNA) in the Lower Cape Cod region for the Barnstable County Department of Health and Environment. Data measures include a broad collection of approximately 60 population based, social determinants of health (SDoH), health equity, lifestyle, and community health measures falling within five domains. o Domain 1: Core Demographics o Domain 2: Social and Economic Factors o Domain 3: Health Status o Domain 4: Mental Health Status Profile o Domain 5: Risk and Access Measures The following table shows a list of individual tables and measures within each of the five domains, data sources, and endnotes. The sources will be supplemented throughout the project as new or emerging sources of validated data become known. Community Needs Assessment 1 L- `4RNSTABLE COUNTY CAPE COD REGIONAL GOVERNMENT Lower Cape Cod Community Needs Assessment Initial Set of ' -)mains and Measures Domains Tables Measures Domain 1: Core Demographics Maps Service Area Social Vulnerability Index Measures Population Median Age Median Household Income by Race / Ethnicity and Total Population by Race/Ethnicity Percent Living in Poverty (100% FPL) by Race / Ethnicity and Tota I Percent Living in Poverty (100% FPL) by Age Group (including Children) Percent 16+ Unemployed Age 65+ Age 17 or Younger Households with Disability Don't Speak English Children Living in Single -Parent Households Multi -Unit Housing Structures Mobile Homes No Vehicle Age Categories Gender Categories Language Spoken Percent by approximately 12 age groups Median Age Male Female Non -binary or Other, as available Non-English Speaking Foreign -Born Population Community Needs Assessment C.• 2 BARNSTABLE COUNTY -- CAPE COD REGIONAL GOVERNMENT Lower Cape Cod Community Needs Assessment Domains Tables Measures Disability Language Spoken at Home Population with Disability Percent Population with Disability Disability by Age Groups Disability by Difficulty Type Disability by Race/Ethnicity Disability by Gender Domain 2: Social and Economic Factors Educational Achievement Highest Level of Educational Attainment Housing and Households Profile Transportation/Commute Domain 3: Health Status Profile Causes of Death Median Home Value Housing Wage (NLIHC) Percent Housing Cost Burdened Percent Severely Housing Cost Burdened Mean Travel Time to Work (In Minutes) Percent Without Vehicle Total and 10 Most Common Causes (Rate per 100,000) Chronic Disease Incidence Summary (Rate per 100,000) Heart Disease High Blood Pressure Asthma (Adults and Children) Diagnosed Diabetes (Adults and Children) Domain 4: Mental Health Status Profile Mental and Behavioral Health Status Percent of Frequent Mental Distress Poor Mental Health Days Community Needs Assessment 3 440k_ BARNSTABLE COUNTY CAPE COD REGIONAL GOVERNMENT Lower Cape Cod Community Needs Assessment Domains Tables Measures Poor Physical Health Days Suicide Data Section Adult and Youth Suicide Rates Domain 5: Risk and Access Measures Overview Adults who are Obese Percentage of Adults Current Smokers Mental Health Care Providers Ratio of Mental Health Providers Primary Care Maternal and Child Health Insurance Status Substance Use and Misuse Ratio of Primary Care Physicians Teen Birth Rate Low Birthweight Infant Mortality Uninsured Population Uninsured Children Uninsured Seniors Alcohol Use Illicit Drug Use Marijuana Use Environmental Public Health Percent of Land Use Climate Change —Vulnerable Populations Environmental Justice Community Needs Assessment10 4 440k_ BARNSTABLE COUNTY CAPE COD REGIONAL GOVERNMENT - Lower Cape Cod Community Needs Assessment Data Sources (Example) • Market areas and data granularity. Geographies Included Data Granularit in the CNA • Brewster, MA • Chatham, MA • Dennis, MA Note: Data will be collected at the town level, wherever possible, for all Harwich, MA demographic data that will be used to create heat maps and similar tasks. For data not available at the town level, county -level data will be used. • Orleans, MA • Barnstable County • Massachusetts • Data collection: Crescendo has developed an initial set of data domains and measures for review. Crescendo will work with the Barnstable County Department of Health and Environment in the Lower Cape Cod region to develop and confirm the initial data domains and measures to collect. o Sources: Data sources include (to the greatest granularity available), but are not limited to the following: ■ American Community Survey ■ Behavioral Risk Factor Surveillance Survey (BRFSS) ■ County Health Rankings and Roadmaps ■ Dartmouth Atlas ■ ESRI / ArcGIS / Business Analyst Online ■ Health Equity Data Analysis (HEDA) system ■ Kaiser Family Foundation ■ Kids Count ■ Massachusetts Department of Public Health ■ Massachusetts Executive Office of Energy and Environmental Affairs ■ Massachusetts Executive Office of Health and Human Services ■ Robert Wood Johnson Foundation (RWJ) ■ The Surveillance, Epidemiology, and End Results (SEER) Program database ■ U.S. Department of Housing and Urban Development, CHAS Database ■ Youth Risk Behavior Survey (YRBS) Community Needs Assessment 5 BARNSTABLE COUNTY -� CAPE COD REGIONAL GOVERNMENT Lower Cape Cod CHNA Project "i-tikeholder Interview Guide Good morning [or afternoon]. My name is [Interviewer Name] from Crescendo Consulting Group. We are working with the Barnstable County Department of Health and Environment to conduct a community health needs assessment of the towns on Lower Cape Cod. The purpose of this conversation is to learn more about the strengths and resources in the community, as well as collecting your insights re ag rdin�communit health and related service needs. Specifically, we are interested in learning about the ways people seek services, the challenges they may have, and your insights about equal access to health care across the community. While we will describe our discussion in a written report, specific quotes will not be attributed to individuals. We consider what participants say in our conversation to be confidential. Do you have any questions for me before we start? Introductory Questions 1. Please tell me a little about yourself; what you like about the community; and/or how you generally interact with the local community (i.e., what does your organization do?) 2. Overall, if you had to pick the top two or three challenges or things people struggle within your community, what comes to mind? [PROBE: behavioral health, access to health care, housing, etc.] Access to Care and Delivery of Services 3. What, if any, healthcare services are difficult to find and/or access? And why? [PROBE (As needed): Quality primary care and/or specialty care availability (Services for adults, children & adolescents), Specialty care services, Maternal and prenatal care for expectant mothers Other OB/GYN services, Senior Services (PROBE: hospice, end -of -life care, specialists, etc.)., Post-COVID-19/impacts of COVID-19 care, Dental] 4. What barriers to services exist, if any? [PROBE (As needed): Financial, insurance, transportation, cultural incompatibility, wait times, etc.] Lower Cape Cod CHNA Project Health, Vulnerable Populations and Health Equity Often in the U.S. people think of the health care system as the key driver of health and health outcomes. In this conversation we'd like to define health as a state of complete physical, mental, and social well- being, not merely the absence of disease or infirmity. Health in this view may include other factors like education, neighborhood physical environments, climate change, employment, and other factors, as well as access to health. 5. What factors do you see as important drivers of individual and community health? 6. Using'this broad definition, how would you describe the community's health overall? 7. What, if any, local populations are especially vulnerable and/or underserved in your community? 8. Would you say health care services are equally available to everyone in the community regardless of gender, race, age, or socioeconomics? [PROBE (As needed): veterans, youth, immigrants, LGBTQ+ populations, people of color, older adults, people living with disabilities] 9. How can the health of the community be improved, especially with these vulnerable populations? Social Determinants (Top non -healthcare service needs) 10. From your perspective what are the top three non -health-related needs in the community and why? [PROBE LIST (As needed): Affordable housing, Services for people experiencing homelessness, Food insecurity and access to healthy food, Childcare, Transportation, Internet and technology access, Employment and job training opportunities, Others.] Magic Wand 11. If there was one issue that you personally could change about community health in the area with the wave of a magic wand, what would it be? ank you for your time and participation! RESEARCHER FOOTNOTES Bring up each of the topics and include probes and subcategories in the dialogue as needed. Not all topics may be covered in all interviews. Discussion content will be modified to respond to the interviewees' professional background and availability of time during the interview. Lower Cape Cod CHNA Project 2 Stakeholder Contact List Recommendations • Please complete each column in the Stakeholder Contact List Excel template, to the best of your ability. • When planning who to include in the Stakeholder Contact List, keep the following in mind: o Stakeholders make up a diverse group of individuals including members of the populations served by your organizations, including low-income families, households experiencing food insecurity, households experiencing housing instability, parents of young children, single parents, minority sub -populations, older adults, and those who work directly with these sub -populations. o We recommend that Stakeholder Contact List participants include: ■ Partner agencies and non -profits ■ Funders ■ Social service agencies ■ School employees ■ Faith -based leaders ■ Childcare providers ■ Municipal and public officials ■ Public safety representatives cres ccindo, , NAME OF CLIENT *RED = CHANGE BASED ON PROJECT Stakeholder List Goal: Conduct 15 to 20 Stakeholder Interviews. Task: Please enter 30 to 40 possible interviewees. Please put an * next to individuals on your "must have" list. Vow-V Sector Representation (i.e., *Priority Stakeholder Name Stakeholder Job Title Stakeholder Organization Email Address Phone Number elected office, business, education, etc.) Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealthA rwster-ma.vov WWW.BREWSTER-MA.GOV Board of Health Meeting Wednesday, April 17, 2024 at 6:30PM Town Hall, Room A Health Department Amy L. von Hone, RS., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Board members present: David Bennett, Chair; Kimberley Crocker Pearson, MS, MD, MPH, Vice Chair, Penny Holeman, MPH, MA, MS; Abigail Archer and John Keith (virtual) Others present: Amy von Hone, R.S., C.H.O., Health Director, Sherrie McCullough, R.S., Assistant Health Director and Jason Ellis, engineer for 4053 Main Street. 1. Call to order The meeting was called to order at 6:30PM. 2. Declaration of a quorum Quorum present 3. Recording Statement Noted. 4. Chair announcements Conservation Day will be in July. The BOH will have a booth there. More information to come on this. DB and AVH met with the Barnstable representative for the RME. They announced that they will be going around to do presentations to various towns. One will take place at the Brewster Ladies Library. S. Citizen's forum None. 6. Variance request -4053 Main Street, Cape Cod Ready Mix Jason Ellis presented this to the Board. AVH-stated that a year ago, an in-house variance was reviewed in the office. The variance that was requested, which is allowed under Maximum Feasible Compliance is for less than the minimum 12" separation between pipe inverts going into the septic tank and pump chamber units and adjusted high groundwater elevations. Groundwater at the lower elevation was confirmed by a test hole. There were 2 abutters at that time with concerns about their wells. N:\Health\from Shari\MSWORK FOLDERSWEETINGS\BOM4.17.24 minutes.doc She stated that she had recently spoken with the Water Superintendent regarding these wells and town water access. He provided her with a picture of where town water is available in that area. JE- They owners are going to be upgrading to a new Title 5 system from cesspools. There will be a 1500 -gallon primary tank and a 1000 -gallon second tank, both will be H2O rated and waterproof. Rubber boots will be installed in the concrete that will seal off around the pipes so it will be a completely sealed tank that water would not be able to get into. The property to the SW (Besso property at 54 Western Eagle Cartway) was recently re -developed with a new house and new septic installed. They are on town water. There was an old well shown on Louise Paquette's property plan (62 Western Eagle Cartway) from the early 1980's, which is not functioning anymore, Town water is shown on her property plan also. KCP asked about wetland lines. JE stated that they are shown on plan. AA stated that this is an improvement from what is currently there. DB spoke about the well locations. Steven Ferguson from 62 Western Eagle Cartway asked questions about the SAS and groundwater and stated that he had concerns with how close this system is to the marsh. DB told him that was a Conservation Commission question. SF spoke about the septic system size and asked questions about that and his well on the property. There was a bit of a discussion between him and the Board. AVH spoke about having a well and town water and how it is not allowed (unless the well is used for irrigation). The Town is aware of the issues surrounding town water in that area and will be meeting about it in the next few weeks. Verena Besso, 54 Western Eagle Cartway stated that she had a well on the property that was abandoned and asked if they could possibly make it available for the owners at 62 Western Eagle Cartway. AVH stated that was a legal question that they would have to ask their attorney. Motion: Approve variance as requested. Motion: Penny Holeman Second: Kimberely Crocker Pearson Vote: 5 yes Action: Motion carried 7. Update on review of local BOH regulations and policy AVH stated that after a discussion with the Town Manager and the Town Planner, recognizing that a considerable number of the Board's wastewater local regulations under the BOH will be part of our wastewater planning moving forward with our watershed permits, it made sense to put the review on hold for the time being. Staff will go through all the regulations and the Town Planner will be reviewing them and the hope is to get them all into 1 code. JK asked how long this would take and if there was anything urgent that needed to be fixed. AVH stated that it will probably be at least a year. There are some existing conflicts in the regulations, but she doesn't want it to "piece mailed" together. 8. Consent Agenda a. The Kitchen Cafe — change of owner SM gave an update on this and stated that the new owners will not be making any changes to the restaurant. 9. Review & Approve minutes from 3/20/24 & 4/3/24 Motion: Approve 3/20/24 minutes as written WHealth\from SharWSWORK FOLDERS\MEETINGS\BOH\4.17.24 minutes.doc Motion: Kimberely Crocker Pearson Second: Abigail Archer Vote: 5-0 Action: Motion carried Motion: Approve 4/3/24 minutes as written Motion: Abigail Archer Second: Penny Holeman Vote: 5-0 Action: Motion carried 10. Liaison Reports PH — the next COA meeting is tomorrow, and they are still working on the 5 -year plan. KCP — next week is the next meeting. She attended a meeting with Care Mass (the Opioid Abatement PartnershiPO on April 11, 2024. The meeting was much more focused on the City of Boston. She believes a much more focused solution is needed for Brewster. AA -Recycling Committee met yesterday and noted that Beautify Brewster is on April 27th (with a rain date of the 28th). To get signed up for a team, residents can email Ryan Burch or Meg Morris. More information is available on the Town's website. The Swap Shop is open on weekends now. DB-WRTF-they have not met. He did speak with Dave Isso from the RME program, and they •,%, ii be postponing their presentation because of the many unanswered questions they still have. KCP- the EPA did come out with their PFAS standard this week. JK stated that the standard for PFAS is only for a few chemicals. 11. Matters not reasonably anticipated by the Chair AVH stated that the non-compliant system at 34 Captain Connolly Road has submitted a signed 2 -year maintenance contract and are in compliance now. 12. Items for next agenda None. 13. Next meeting: May 1, 2024 Noted. Informational items were noted. Meeting adjourned at 7:40PM 'Accompanying documents in packet: Agenda, variance information for 4053 Main Street, minutes, information items NAHealth\from Shari\MSWORK FOLDERSWEETINGSWER4.17.24 minutes.doc -Se� Ww\,� 202-q Massachusetts Department of Environmental Protection -1 eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: EBELAIR Transaction ID: 1706083 Document: Groundwater Discharge Monitoring Report Forms Size of File: 1075.45K Status of Transaction: Submitted Date and Time Created: 4/15/2024:10:14:12 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT 3. Sampling information: 13/21/2024 a. Date Sampled (mm/dd/yyyy) LAUREN BATALON c. Analysis Performed By (Name) B. Form Selection 599 1. Permit Number 2. Tax identification Number 2024 MAR MONTHLY 3. Sampling Month & Frequency SMA 02631 d. State e. Zip Code imakhter@elevabonfinancialgroup.com c. e-mail address RI ANALYTICAL b. Laboratory Name 1. Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2024 Mar Monthly F All forms for submittal have been completed. 2. F This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use SERENITY BREWSTER WWTF only the tab key to a. Name move your cursor - 873 HARWICH ROAD do not use the return key. b. Street Address �- BREWSTER C. City 2. Contact information: tam MAHEEN AKHTER a. Name of Facility Contact Person .6178526110 b. Telephone Number 3. Sampling information: 13/21/2024 a. Date Sampled (mm/dd/yyyy) LAUREN BATALON c. Analysis Performed By (Name) B. Form Selection 599 1. Permit Number 2. Tax identification Number 2024 MAR MONTHLY 3. Sampling Month & Frequency SMA 02631 d. State e. Zip Code imakhter@elevabonfinancialgroup.com c. e-mail address RI ANALYTICAL b. Laboratory Name 1. Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2024 Mar Monthly F All forms for submittal have been completed. 2. F This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 1599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number _ Groundwater Permit 2. lax identification Number DISCHARGE MONITORING REPORT 2024 MAR MONTHLY 3. Sampling Month & Frequency D. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled 1. Parameter/Contaminant Units BOD MG/L TSS MG/L TOTAL SOLIDS MG/L AMMONIA -N MG/L NITRATE -N MGL TOTAL NITROGEN(NO3+NO2+TKN) MG/L OIL & GREASE MG/L 2. Influent 3. Effluent 25 9.6 56 24 380 3.7 4. Effluent Method Detection limit 8.0 2.0 2.2 0.050 10.50 6.2 10.50 2.1 infeffrp-blank.doc • rev. 09/15/15 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DAILY LOG SHEET A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use SERENITY BREWSTER WWTF only the tab key to a. Name move your cursor 873 HARWICH ROAD do not use the return key. b. Street Address BREWSTER C. City 2. Contact information: MAHEEN AKHTER a. Name of Facility Contact Person 6178526110 b. Telephone Number 599 1. Permit Number 2. Tax identification Number 2024 MAR DAILY 3. Sampling Month & Frequency MA 102631 d. State e. Zip Code makhter@elevationfinancialgroup.com c. e-mail address 3. Sampling information: 3/31/2024 WHITEWATER a. Date Sampled (mm/dd/yyyy) b. Laboratory Name RICK BRULOTTE c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Daily Log Sheet - 2024 Mar Daily F All forms for submittal have been completed. 2. E This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 1599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Ll� - Groundwater Permit 2. 'fax identification Number DAILY LOG SHEET 2024 MAR DAILY 3. Sampling Month & Frequency C. Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent pH Effluent Chlorine Uv Flow GPD Flow GPD Flow GPD pH Residual Intensity (mg/1) N 1 6974 -� 2 3 7636 4 5 7689 7.2 6 8266 � � 7 7 7866 6.8 8 8162 6.8 9 J8103 10 7855 11 7270 12 7724 7 13 6663 `� � 7.1 14 7900 7.2 15 6838 16 7803 17 7920 18 8319 V7.5 [ j 19 8261 20 7723 21 7215 7.4 22 7376 7.4 23 6625 6306 6393 24 7940 25 7.5 26 6.9 27 6009 _� i 7.22 28 6895 7.2 29 9044 6.8 30 16959 31 ElJ gdpols.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number MONITORING WELL DATA REPORT 2024 MAR MONTHLY 3. Sampling Month & Frequency 3. F Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use ISERENITY BREWSTER WWTF only the tab key to a. Name move your cursor - 873 HARWICH ROAD do not use the return key. b. Street Address BREWSTER MA 02631 C. City d. State e. Zip Code 2. Contact information: MAHEEN AKHTER a. Name of Facility Contac[ Person 6178526110 makhter@elevationfinancialgroup.com b. Telephone Number c. e-mail address 3. Sampling information: 3/12/2024 WHITEWATER a. Date Sampled (mm/dd/yyyy) b. Laboratory Name RICK BRULOTTE c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Monitoring Well Data Report - 2024 Mar Monthly : All forms for submittal have been completed. r 2. This is the last selection. 3. F Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 10 Massachusetts Department of Environmental Protection 1599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number MONITORING WELL DATA REPORT 2024 MAR MONTHLY 3. Sampling Month & Frequency C. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" < • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant MW1 MW2 Units Well #: 1 Well #: 2 PH 5.9 _ 1 5.7 5.8 S.U. STATIC WATER LEVEL 59 4 58.4 59.5 FEET SPECIFIC CONDUCTANCE 514 114 122 UMHOS/C MW3 MW4 Well #: 3 Well #: 4 Well #: 5 Well #: 6 5.7 29.5 97 mwdgwp-blank.doc • rev. 09/15/15 Monitoring Well Data for Groundwater Permit • Page 1 of 1 _ — Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit Important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Any person signing a document under 314 CMR 5.14(1) or (2) shall make the following certification If you are filing electronic -ally and want to attach additional comments, select the check box. FAM Facility Information (SERENITY BREWSTER WWTF a. Name 1873 HARWICH ROAD b. Street Address BREWSTER C. City 599 ��1. Permit Number 2. Tax identification Number MA 02631 d. State e. Zip Code Certification "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that ther are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." ELIZABETH BELAIR 4/15/2024 a. Signature b. Date (mm/dd/yyyy) Re ortipg Package Comments FACILITY WAS IN FULL COMPLIANCE WITH ALL PERMIT REQUIREMENTS FOR THE MONTH gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit • Page 1 of 1 Q W 4.J W ATC H CL. Resources and InforIS Pmation about Local Public Health NACCHO NEWS Bundle Your NACCH0360 + PHI*con Registrations and $ave Big Are you looking to learn more about topics like data modernization, decision support, and data governance? Registration is open for Mk.on PHI*con (Public Health Informatics * Conference), NACCHO's conference specifically focused on iving Data Moderni7 Public Health Informatics, Surveillance, and The Public Health 1067 tatics, Information Technology (IT). PHI*con will be Surve!V,e sca, 17Ccr'i&rence held on Monday, July 22 and Tuesday, July 23, 2024 in Detroit, Michigan. This year's theme, Driving Data Modernization, addresses how to effectively serve communities in today's information -driven world and shows that public health must advance and strengthen its informatics, surveillance, and IT capability to transform data into action. Bundle NACCH0360 + PHI*con registrations together for discounted rates and big savings! Please note that registrations for PHI*con and NACCH0360 can be purchased separately or bundled together for savings at a discounted rate. Additional information about PHI*con is available here: https-//virtualcommunities.naccho.org/2024phicon/home. NACCHO Recognizes 16 Local Health Departments for Preparedness in Public Health Emergencies NACCHO is pleased to announce that 16 agencies from across the United States have been recognized by NACCHO's Project Public Health 100e _ Ready (PPHR) for their ability to plan for, respond PROJECT to, and recover from public health emergencies. PUBLIC HEALTH These 16 agencies successfully renewed their recognition for the 2023 cycle. Learn more about R E A D Y the program and agencies recognized at https:// www.naccho.org/blog/articies/naccho-recognizes- sixteen-local-health-departments-for-preparedness-in-public-health-emergencies. NACCHO Announces More Than $1.2 Million in MRC Operational Readiness Awards NACCHO announced the 2024 Medical Reserve Corps (MRC) Operational Readiness Awards. These awards, made possible through a cooperative agreement with the Administration for Strategic Preparedness and Response's Medical Reserve Corps Program Office, will build the operational readiness capabilities of MRC units to meet the emergency preparedness and response needs of local, regional, and statewide stakeholders. The awards, totaling $1.26 million, will support 153 units to build MRC response capabilities (Tier 1) or strengthen and sustain MRC response capabilities (Tier 2). https://www.naccho.org/blog/articles/naccho-annou nces-more-than-1- 2-million-in-medical-reserve-corps-operational-readiness-awards-2. PublicHeaitth Prevent. Promote. Protect. In the Spotlight... i March 2024 President's Corner During his visit to Washington, DC for the Board of Directors meeting and Local Public Health on the Hill Day, NACCHO President Dr. Pramod Dwivedi met with various elected officials to discuss some of the most pressing issues facing local public health departments. He also presented the inaugural National Champion of Local Governmental Public Health Award to Representative Jason Crow (CO -06) for his significant role in advancing legislation to establish a Public Health Workforce Loan Repayment Program into law. Read the full recap of his exciting visit in the March President's Corner article: https://www. naccho.org/about/board/presidents-corner. NACCHO Resource: Building an Equitable Workplace at Local Health Departments NACCHO and HealthTeamWorks have paired up to create a robust toolkit for our members to address the pressing topics of diversity, equity, and inclusion in local health departments: Building an Equitable Workplace at Local Health Departments. Download the toolkit here: https://www.naccho. org/uploads/downloadable-resources/Building- an-Equitable-Workplace-FINAL-V3-11-14-2023. pdf, or via the NACCHO Toolbox: https://toolbox. naccho.org/pages/tool-view.html?id=6047. Host an AmeriCorps Member at Your Local Health Department With Support From Health360 Is your local health department interested in hosting a Public 0 Amen orpS Health AmeriCorps member? Health360 is working to address local mental healthcare needs, foster inclusivity, and create a brighter, healthier future by partnering with organizations, including health departments that can host a Public Health AmeriCorps member to support their community -focused programs and services. To learn more about Health360, click here: https://www. health360.org/, or email Hanna Tomaszek, host site recruitment coordinator at tomaszek@health360.org, to learn more about hosting a Public Health AmeriCorps member! You can also view this informational webinar recording with NACCHO, CDC, Public Health AmeriCorps, and Big Cities Health Coalition that discusses the program and experiences from the field: bit.ly/47LCJHX. CDC Updates and Simplifies Respiratory Virus Recommendations The Centers for Disease Control and Prevention (CDC) released updated recommendations for how people can protect themselves and their communities from respiratory viruses. The new guidance brings a unified approach to addressing risks from a range of common respiratory viral illnesses, such as COVID-19, flu and RSV, which can circulate at the same time during the fall and winter and can cause significant health impacts and strain on hospitals and healthcare workers. As part of the guidance, CDC provides active recommendations on core prevention steps and strategies. These include staying up to date with vaccinations, practicing good hygiene and taking steps to circulate fresher air. The updated guidance also recommends that people stay away from others when ill with a respiratory virus, only returning to normal activites when there's an overall improvement of symptoms and no presence of a fever for at Public Health Dispatch • April 2024 least 24 hours without the use of medication. Visit the CDC's Updated Respiratory Guidance landing page for more information: https://www.cdc.gov/respiratory- viruses/guidance/respiratory-virus-guidance.html. NACCHO Releases Video: Community Partnerships to Prevent Suicide, Overdose, and Adverse Childhood Experiences NACCHO is pleased to share a brief video entitled Community Partnerships to Prevent Suicide, Overdose, and Adverse Childhood Experiences. It can be 4M a JW Al., viewed here: https:// www.youtube.com/watch?v=Vjg40MkPl SU. Suicide, overdose, and adverse childhood experiences (ACEs) are three urgent, preventable, and connected public health issues. Learn how NACCHO and the Education Development Center (EDC), with support from CDC, are helping local health departments and their communities adapt a community -led suicide prevention framework to focus prevention efforts on the intersection of suicide, overdose, and ACEs. Questions? Check in with NACCHO's Injury & Violence Prevention Team at ivp@naccho.org. CDC's Tips From Former Smokers® Launches Powerful New Ad Campaign CDC's successful Tips From Former Smokers® (Tips®) campaign returned with new ads encouraging people who smoke to quit. This year, the Tips® ads feature seven new people sharing their stories about how cigarette smoking and smoking-related diseases have negatively impacted their lives. Many of these new ads include messaging about the harms of menthol cigarettes, which can contribute to tobacco -related health disparities. The Tips" campaign has had significant and sustained impact over the past decade, helping millions of U.S. adults to quit smoking or try to quit. Year after year, the Tips® campaign has proven its effectiveness while promoting a range of quit services. Each year when the Tips® campaign is on air, there is an immediate and dramatic spike in calls to 1 -800 -QUIT -NOW. Visit the campaign website for more information: https:// www.cdc.gov/tobacco/campaign/tips/index.htmi. ■ Public Health Dispatch • April 2024 Position Yourself to be a Climate for Report: Surveillance for Lyme Disease After Implementation Health Ambassador in 20241 of Revised Case Definition - United States 2022 Climate for Health and NACCHO now offer targeted climate -focused resources including our popular, on -demand, ambassador training that will equip you with the knowledge, hands-on experience, and resources to speak and act confidently on climate change and solutions. With this toolkit, you will be able to engage your community, the public, and policymakers to inspire climate solutions that help protect our families and communities now, and ensure a prosperous, just, and secure future. The training qualifies for three continuing education units, so use the code NACCHOCfHAmbassador to start your climate action journey today! https:H virtualcommunities.naccho.org/climateactiontoolkit/home. Milton and Ruth Roemer Prize for Creative Local Public Health Nominate a colleague for APHXs Milton and Ruth Roemer Prize for Creative Local Public Health Work! According to the organization, this is "awarded to a local health officer of a county, city or other unit of local government, in recognition for outstanding creative and innovative public health work: https://www.apha.org/about- apha/apha-awards/milton-and-ruth-roemer-prize. CDC released a new MMWR that highlights the changes in the case definition and reporting requirements for states with high -incidence Lyme disease in certain regions in the United States. https://www. cdc.gov/mmwr/volumes/73/wr/mm7306al.htm. Learn to Manage Mosquitoes in Disaster Situations: A NACCHO and CDC Preparedness Workshop As an updated national framework to protect people from vector-borne diseases emerges from CDC, NACCHO is already working to enact solutions at the local level: https:H www.cdc.gov/ncezid/dvbd/framework.html. Local vector control program leaders in North Carolina, South Carolina, Florida, and Puerto Rico affected by 2022 Hurricanes Fiona and Ian are invited to attend the 2024 Vector Control Hurricane Crisis workshop in April to get hands-on training ahead of the next emergency. General registration is open. The theme for the workshop, Managing Mosquitoes in Disaster Situations: Best Practices and Partnerships, focuses on best practices and partnerships that can help vector control professionals implement and maintain effective integrated vector management programs. Learn more and register: https://virtualcommunities.naccho.org/vectorcontrol/ home. For questions, contact vectorcontrol@naccho.org. ■ Public Health Dispatch • April 2024 f RA '�` PUBLIC HEALTH INFRASTRUCTURE & SYSTEMS Data Modernization Stories From the Field CSTE recently introduced DMI r� Stories From the VIA Field, a multimedia project highlighting the great work of our state, tribal, local, and territorial wj health departments; CSTE members; their teams; and applied epidemiologists across the country who've efficiently leveraged the Data Modernization Initiative (DMI) funding and principles to improve public health at the jurisdictional level through meaningful and innovative use of data to help people and communities thrive. Funded by the Centers for Disease Control and Prevention Office of Public Health Data, Surveillance, and Technology, DMI Stories From the Field is hosted on the new CSTE website: stories.CSTE.org. NACCHO to Launch Revamped Roots of Health Inequity Online Course The Roots of Health Inequity Online Course Series, offered by NACCHO, is a free online resource ROOT5, designed to equip Df Health Inequity public health professionals with the ON knowledge and skills needed to address the root causes of h+'alth inequities in their community. Revamped for 2024, the (course explores topics such as the historical influences of public Health Dispatch • April 2024 health, root causes in race, gender, and class struggles, and power building to advance equity in public health practice. The all-new platform will allow users to tailor their learning experience, view stories from the field, and facilitate group conversations about the content, online and in-person. The new Roots of Health Inequity will launch at NACCH0360 in July. Learn more: https://www.naccho.org/blog/articles/naccho-to- lau nch-revamped-roots-of-health-i nequ ity-onl ine-course. New NACCHO Resource: 5 Strategies to Strengthen Marketing of Local Health Department Recruiting Efforts With invaluable input from NACCHO's Workforce and Leadership Workgroup and support from CDC, NACCHO is pleased to present this new resource to help facilitate efforts to expand and improve the public health workforce and attract the next generation of public health professionals. The 5 Strategies to Strengthen Marketing of Local Health Department Recruiting Efforts is designed to provide tangible ideas for promoting health departments as a great place to work and getting job openings in front of viable candidates. It provides actionable information, helpful links, and real-world examples from local health departments and private sector recruitment efforts. Access this new resource here: https://www.naccho.org/uploads/downloadable- resources/Marketing-Recruitment Toolkit_NACCHO.pdf. l Medical Reserve Corps Volunteers Supporting to public health threats and emergencies, and recover from Behavioral Health Needs in Communities them. Applications are due April 24. Learn more about Volunteers skilled in behavioral health can play an important role in Medical 'i' edical Reserve Corps (MRC) A( reserve units in times of Corps disaster and stress, supporting both residents and responders. See how statewide MRC units in Oklahoma and Minnesota are supporting behavioral health needs locally at https://www.naccho. org/blog/articles/mrc-behavioral-health-needs. CDC Releases 2024-2028 Public Health Emergency Preparedness (PNEP) Cooperative Agreement Notice of Funding Opportunity CDC has released the 2024-2028 PHEP Cooperative Agreement Notice of Funding Opportunity (NOFO).This funding program aims to strengthen the :apacity and capability of state, tribal, local, and territorial )ublic health systems to prepare for, respond to, and recover 'rom public health threats and emergencies. This funding )pportunity provides a roadmap for PHEP recipients to iesign, develop, and implement strategies and activities hat will improve their readiness to execute plans, respond this opportunity and how to contact NACCHO to share any thoughts, questions, or concerns about the NOFO at https://www.naccho.org/blog/articles/cdc-phep-nofo. Health Sector Publishes Guide for Coordinating Privacy and Security Partnerships The Healthcare and Public Health Sector Coordinating Council (HSCC) Cybersecurity Working Group has published a guide for health providers and companies to coordinate privacy and cybersecurity functions for improved overall compliance and operational efficiencies and effectiveness. The intended audience for this document includes healthcare privacy, security, and compliance leaders, their accompanying teams, and others looking to develop best practices for privacy and security programs and policies. Learn more and access the guide at https:// www.naccho.org/blog/articles/health-sector-security-guide. Meeting the Needs of People Experiencing Homelessness During Local WASH -Related Emergencies Vulnerable people experiencing homelessness are often not included in preparedness planning for water, sanitation and hygiene (WASH) -related emergencies. NACCHO, with support of CDC, worked with five local health departments to update their emergency plans to address this gap and capture their lessons learned. See findings from this project in a new article in the March/April 2024 issue of the Journal of Public Health Management and Practice (JPHMP). Access the article at https://www. naccho.org/blog/articles/journal-wash-homelessness. Public Health Dispatch • Anril2024 nl+rrr �iwrf+ -.. FROM WAS H I N GTO N Local Public Health on the Hill By Lauren Mastroberardino, MPA, Government Affairs Senior Specialist On February 28, local public health leaders from across the country joined NACCHO for our annual Local Public Health on the Hill event. We visited 101 Congressional offices in Washington, D.C. to speak with elected officials and senior staff about the public health workforce, infrastructure, as well as unique needs within communities. Among the elected officials we met with are Senator Kelly (AZ), Senator Ernst (IA), Senator Cantwell (WA), Senator Blackburn (TN), Rep. Tokuda (HI), Rep. Hoyer (MD), Rep. Carson (IN), Rep. Crow (CO) and many others! Local Public Health on the Hill participants discussed the vital role that health departments play in the health and safety of communities. They also identified challenges faced when recruiting and retaining staff. While federal support during the height of the pandemic allowed health departments to hire additional temporary workers, those funds are expiring, and health departments need consistent funding to build a pipeline of staff. Congress passed bipartisan legislation to authorize the Public Health Workforce Loan Repayment Program, but the program needs funding. It offers loan repayment for public health professionals who agree to serve at least three years in a local, state, or tribal health department. Participants asked Congress to support NACCHO's request for an annual appropriation of $100 million to start and sustain the program in FY2025. This could help recruit as many as 2,000 public health professionals to these important jobs in health departments. Local health leaders also identified the need for the strongest possible funding for CDC's Public Public Health Dispatch • April 2024 Health Infrastructure and Capacity Program and asked Members of Congress to support an annual appropriation of $1 billion in FY2025.This would strengthen our nation's ability to address all public health needs at the community level and make public health work more efficiently. The funding currently appropriated by Congress for public health has a variable reach to local public health departments. States make decisions about how those dollars are allocated, which means many local health departments may not receive the funds they need. NACCHO appreciates recent efforts to expand direct funding to the 50 largest local health departments, bu that only reaches counties of at least 2 million people (about the population of Nebraska) or cities of at least 500,000 people (about half the population of MontanE We know that a majority of local health departments are unable to rely on federal investments to support their local community. Local health officials asked for support of report language that directs CDC to better ensure funds reach local health departments and track federal funds after they are sent to states. To increase the visibility of these important issues, NACCHO highlighted these meetings across social media platforms, featuring photos of local public heal - leaders with their elected representatives. NACCHO wi continue to provide members with opportunities to highlight the public health needs in their communities J Q W PATCH _V J m � p=.. Resources and Information about Local Public Health UproNAING EVENTS Public Health Law Practitioners Convening April 30—May 2, 2024 New Orleans, Louisiana https://phlawpractitioners.org/phlawpractitionersconvening 2024 NACCHO360 July 23-26,2024 Detroit, Michigan http://www.naccho360.com/home PHl*con July 22- 23, 2024 Detroit, Michigan https.//virtualcommunities.naccho.org/2024phicon Frankfort/Franklin County Just Say Yes: Stopping Youth Substance Use Before It Starts Franklin County is home to the Kentucky state capitol, Franklin County Health Department (FCHD), and a population of approximately 51,118. In 2018, the community experienced a 16 overdose deaths, leading to a ranking of 17 of 118 across the state. The Kentucky Injury Prevention and Research Center (KIPRIC) also reported 184 non-fatal overdoses. In addition, the 2019 Kids Count Report showed a local youth incarceration rate of 48.1 per 1,000. Taking these alarming rates into consideration, FCHD and partners developed the Just Say Yes (JSY) program to decrease substance use among youth. It adapted the evidence -based Icelandic Prevention Model (IPM) to the local community. JSY is characterized by data -driven methods and trauma - informed perspectives to address the high burden on Adverse Childhood Experiences (ACEs) that residents experience. The primary prevention strategy was to give middle -school -aged children $400 YES Cards, which were used at venues offering activities during unsupervised hours.The number of students in the pilot group doubled between the first and second year of the program, and regular youth participation in sports and arts activities increased. Learn more about FCHD's JSY program here: https:// nacchoapplication.secure-platform.com/a/gallery/rounds/47/details/6006. www.naccho.org LARAJA KANAGA Christopher W. Kanaga* Attorneys at Law John C. Kanaga** 46 South Orleans Road, PO Box 236 Orleans, MA 02653 April 18, 2024 Brewster Board of Health Attn: Amy Von Hone, RS, CHO 2198 Main Street, Brewster, MA 02631 Dear Ms. Hone: Re: Notice of Variance Request: Seacoast Nominee Trust APR bfCbui�el:"' - .r F_ I thought you should know this about the extent of the current mail delivery delays. The attached notice was mailed on April 6, 2024 from Eastham, Massachusetts, and delivered on April 17, 2024, to an address five miles away. In light of the incredibly long and inexplicable delays, it may be time for a change of policies, to require concurrent delivery by email or in -hand delivery, or just require it to be sent 3 weeks before. (Alternatively, I suppose we could revert to pony express, which could probably navigate the five miles in a day). In any event, receipt of a notice on the day of the hearing is not really "notice;" its just informational at that point. If you could make a slight procedural change, it would be very helpful. Best regards, Christopher W. Kanaga CWWIgi Enclosure A Professional Corporation I p:5082555500 I f.5082558844 I www.capelaw.com *Also admitted in Colorado I **Also admitted in Kansas and Missouri I ***Also admitted in Virginia April 6, 2024 J.C. ELLIS DESIGN COMPANY, INC. SEPTIC SYSTEM DESIGN & ENGINEERING — SEPTIC INSPECTION — SITE PLANNING — WETLAND CONSULTATION & PERMITTING P.O. BOX 81, NORTH EASTHAM, MA 02651 PHONE 508-240-2220 FAX 508-240-2221 EMAIL jason@jcellisdesign.com Re: Board of Health Variance Request Seacoast Nominee Trust 4053 Main Street Brewster, MA 02631 Assessor's Map 138 Parcel 45 Dear Abutter, The Seacoast Nominee Trust is proposing to upgrade the existing cesspool at the property referenced above. Due site restrictions such as depth to adjusted high groundwater levels, the following variance is required to install the new septic system: The following variance is sought to install the new septic system. 1. 310 CMR 15.227 5 — Inlet and outlet invert elevations for septic tanks and pump chamber proposed less than 12" above high groundwater elevations. The Brewster Board of Health will hold a public hearing regarding the above request on Wednesday, April 17, 2024 at 6:30 P.M., should you be interested in attending. Please contact the Brewster Health Department for confirmation of the hearing date, time and location at 508-896-3701 if you plan to attend. Plans may be reviewed at the Brewster Town Offices located at 2198 Main Street, Brewster, MA during regular business hours. Thank you for your attention to this matter. Thank you for your attention to this matter. Jason C. Ellis, RV, L.S.I.T. J.C. Ellis DesiO Co., Inc. �i2 q