CORE BUSINESS FUNCTIONS

The Department of Public Health is responsible for the management of:

→ Assessing the health status of the population and making information available to the public on communicable and chronic diseases, emerging epidemics, and the social and structural determinants of health

→ Assessing the environmental status of the community and making information available to the public on conditions that may contribute to health outcomes

→ Preparing for emergencies that may affect the health of the public and participating in deploying a trained public health workforce in the event of any emergency, disaster, or epidemic

→ Ensuring the effective enforcement of all codes, ordinances, and best practices related to protecting the health of the public

→ Ensuring the availability of services, programs, and access to care necessary to the population based on their health needs either through the direct provision of services or through effective community linkages and partnerships

→ Controlling or contracting the operation of all direct clinical services provided by the county including medical care, dental care, preventative care, mental and behavioral health, and treatment of infectious diseases

→ Informing and educating the population and acting as a community resource on health‐related topics

→ Recommending to the governing entities from time to time such policies as will tend to preserve or promote the public health of the county

→ Promoting community partnerships and cooperative relationships with neighboring jurisdictions, state and federal agencies, and local and national organizations for the promotion and protections of the public health of the population

Program Descriptions

Administration

Administration is responsible for the high‐level operations and policies of the department. This division supports many of the constituent functions across DPH’s many programs and DPH’s many constituent‐facing access points. Additionally, this division is responsible for DPH‐specific personnel needs, such as clinical placements for practicum students and accreditation requirements. This division includes several offices to accomplish our work.

Office of Communications

This team centralizes DPH’s communications to the public and the media, through traditional media, social media, and educational campaigns.

Office of Strategy and Quality Management

2023 Allocation Of Resources

This staff is responsible for the long‐term strategic planning, accreditation, workforce investment, and many of the grant‐writing functions of the department. This office also coordinates with other offices and divisions in the department to identify performance management metrics, monitor clinical metrics, and identify opportunities for efficiencies and division and departmental improvements.

Strategic Priorities and Performance Metrics:

 Decrease staff turnover rate to 20% for 2022 (GG –

Improve Effectiveness)

Performance Metric: 2020 2021 2022 2023

Staff turnover % rate (excludes temp and seasonal turnover) x 27% 20% 20%

Note: an “x” included in a performance metric data field means that data has not historically been reported. The 2023 business plan includes many new performance metrics where the department will capture and report data going forward.

Fiscal Services

Fiscal Services provides accounting and financial support to the divisions and programs operated by the department. Financial support includes budgeting, accounting, grant management, reporting, and program compliance. Accounting activities include accounts receivable and payable, invoicing, check processing, purchase requisitions, financial statements, patient accounts, and budget presentations. The offices of Vital Records, Facilities Management, and Contracts, Grants, and Legislative Affairs are located under Fiscal Services as well. Fiscal Administrators are responsible for all DPH financial matters, and monitor the department’s compliance with county policies, administrative regulations, and the requirements of state and federal agencies.

Health Promotion & Public Health Research

This division works to address all chronic disease surveillance and prevention issues and integrate health promotion messages throughout all aspects of the division’s work. Behavioral health and health equity are two significant department concentrations. This division is also responsible for developing policies, plans, and interventions in close collaboration with partner agencies and academia, activating county resident participation by lifting community voice to drive community engagement strategies. The St. Louis County PDMP, Opioid and Overdose Action Plan, Violence Prevention Action Plan, and department‐wide scientific support for chronic disease, substance use, and mental health surveillance and prevention efforts are all critical functions of this division. In 2022, this division coordinated updates to the Community Health Assessment (CHA), the Community Health Improvement Plan (CHIP), DPH’s strategic plan, and initiated support for the Public Health Accreditation Board (PHAB) reaccreditation process using an equity and social determinants of health lens.

The Public Health Nursing (PHN) Program is a community‐based program that promotes healthy behaviors and disease prevention. Due to its cross‐functional collaboration, the PHN program transitioned under the Division of Health Promotion and Public Health Research umbrella. This transition provides deeper community relationships and interactions related to public health by providing nursing and home visiting services.

Strategic Priorities and Performance Metrics:

 Increase the number of Health education community engagement events to an average of 8 per month (HS –Reduce Health Disparities)

 Increase Narcan units distributed to the community (HS – Curb Opioid Epidemic)

Communicable Disease Response (CDR)

This division detects, manages, and responds to communicable diseases and other public health threats in St. Louis County. The programs under this division are the Sexually Transmitted Infection (STI) program, Emerging Infection

Response (i.e., COVID‐19 and Monkeypox) Case Investigators and Contract Tracers, the Tuberculosis program, and the Hepatitis programs:

STI Program

The STI program, located at the North Central Community Health Center, is one of the region’s only safety net providers of comprehensive STI testing and treatment services for underinsured and uninsured residents. The clinic screens patients for all STIs including chlamydia, gonorrhea, syphilis, and HIV and sees between 4,000 and 8,000 visits per year.

The STI program is essential in the effort to reduce STI infection and transmission in the region and increase the accessibility of free and low‐cost sexual health resources for residents of St. Louis County.

Emerging Infections Case Investigators and Contact Tracing

The Emerging Infections Case Investigation and Contact Tracing team plays a key role in minimizing the spread of COVID‐19 and Monkeypox in St. Louis County by reaching out to residents that have tested positive for COVID‐19 or Monkeypox, conducting an investigation, and ensuring that they follow the proper isolation protocols. In addition, the contact tracing team reaches out to possible contacts of those who have contracted COVID‐19 or Monkeypox, educates them on quarantine protocol, and enrolls them in a monitoring program for symptoms to prevent further infection and transmission.

Tuberculosis

The Tuberculosis (TB) program treats nearly all cases of active TB in St. Louis County. The program monitors and ensures adherence to the treatment regimen and conduct contact investigations to prevent spread. In addition, this program serves as the foremost source of knowledge on TB in the region and collaborates with the local healthcare community to educate and screen the public to prevent TB infection and transmission.

Hepatitis

The Hepatitis program works with at‐risk residents to ensure testing, vaccination, education, and referral to care. The program also provides case management services for pregnant females infected with Hepatitis B virus and ensures healthy outcomes for their babies.

Communicable Disease Prevention (CDP)

The programs under this division include Animal Care and Control (ACC), Vector‐borne Disease Prevention (VDP), Emergency Preparedness (EP), Communicable Disease Nursing, and Communicable Disease Epidemiology.

Animal Care and Control (ACC)

ACC is responsible for protecting the health and welfare of people and animals in St Louis County. This is accomplished by: controlling populations of stray and feral animals; enforcing county ordinances; education outreach for responsible pet acquisition and ownership, including abidance to relevant county ordinances; promoting adoption or rescue of as many animals under care as possible; and providing exemplary care for animals housed at the shelter.

Vector-borne Disease Prevention

Vector‐borne Disease Prevention (VDP) is responsible for the prevention and control of 11 different vector borne diseases in St Louis County, through field surveillance, evidence‐based larval and adult mosquito abatement, tick surveillance and abatement, arboviral disease testing, pesticide resistance monitoring, rodent abatement. VDP also provides critical public education on reduction of risk factors for mosquito breeding and other pest proliferation on private property. Finally, VDP plays an integral role in disaster mitigation and recovery during flooding events.

Emergency Preparedness

Emergency Preparedness (EP) is responsible for strategic directions and implementations of EP efforts across DPH, including drills and other preparedness exercises and training, and inventory management of emergency supplies. EP also coordinates and collaborates with other emergency preparedness agencies in the St. Louis region, including the

Office of Emergency Management, SEMA, and FEMA to provide subject matter expertise on emergency plans and during emergencies; building resilient communities through engagement and training; planning and implementation of regional exercises.

Communicable Disease Nursing

The Communicable Disease Nursing team is a dedicated team of communicable disease experts investigates all cases of reportable conditions and diseases in St. Louis County. Their investigation is the first line of defense to detect and contain cases of communicable diseases like E‐coli, rabies, and measles, and prevent them from becoming a large outbreak in the community. Therefore, they play a key role in the early detection of dangerous public health threats and ensure reduced morbidity and mortality.

Communicable Disease Epidemiology

Communicable Disease Epidemiology is responsible for surveillance of communicable diseases, including curation and interpretation of data for internal DPH reports, policy development, program evaluation, quality assurance, and public‐facing dashboards. It provides support to other programs within DPH, in the form of collection and analyses of data in areas other than communicable diseases, and provision of technical expertise for architecture of tools for contact tracing and monitoring. Communicable Disease Epidemiology is also widely engaged in local and national community partnerships key to evidence‐based public health practice, from the Academic Health Department, the Saint Louis Areas Regional Response System (STARRS), and the National Association of County Health Officials (NACCHO), on which staff serves in five different workgroups (Epidemiology, Injury Prevention, Immunizations, Surge Management, and HIV, STI, and Hepatitis).

Environmental Health Services

Air and Waste Management

This team provides waste reduction education and enforcement of codes related to solid waste and air pollution through permit writing, inspection, and complaint investigation. This branch also manages the residential waste hauler contracts for unincorporated St. Louis County.

Food and Environmental

This team provides inspections of food establishments, tobacco and kratom retailers, body art, onsite sewage, and public water recreation facilities.

Environmental Health Laboratories

Staff in the labs evaluate air, water, soil, and dust samples for levels of environmental toxins known to cause harm to human health for which county, state, and federal government have set a maximum contaminant level, test building materials to determine asbestos content, and conduct clinical blood lead and sexually transmitted illness testing.

Healthy Homes

This team provides in home education and assessments for asthma and lead and conducts lodging and childcare facility inspections.

Strategic Priorities and Performance Metrics:

 Increase the percentage of Waste Field Services concerns resolved within 72 business hours to 90% in Q4 2022 (GG – Improve Effectiveness)

 By the end of 2022, 100% of the food establishments have at least one routine inspection, 50% inspected according to risk level (12.5% quarterly) (HS – Reduce Health Disparities)

The Office of the Medical Examiner

In Missouri, the authority and responsibilities of medical examiners are mandated by statute. The Office of the Medical Examiner is charged with determining the cause and manner of death in all sudden, unexpected, traumatic, and suspicious deaths that occur in St. Louis County.

The number of deaths requiring investigation by the Office of the Medical Examiner continues to increase. Homicides and drug‐related death continue a steady climb year‐over‐year. The increase in cases this office is responsible for have continued to strain the systems, staff, and supports in place to successfully complete the essential work of the office.

The Medical Examiner’s Office also shares appropriate information with other organizations working to improve and save lives. The data collected in the course of the investigation of deaths that fall within the Medical Examiner’s jurisdiction is available to provide on‐going surveillance, documentation and monitoring, identification of changes and trends, and to inform public health approaches and other local, state, and federal agencies, and the public.

Clinical Services

DPH provides direct clinical services in a primary care interdisciplinary care model across three outpatient locations and a jail medical practice. The clinics were recognized federally as a Patient‐Centered Medical Home (PCMH) in 2020. The PCMH designation aligns with the division’s continued development and implementation of programs that integrate comprehensive interdisciplinary services (nutrition, pharmacy, social services, mental health, substance abuse) into the primary care delivery model. Clinical services provided around 73,000 clinical encounters to around 36,000 individuals in 2019. In the 2020, the division provided comprehensive COVID‐19 clinical care, including over 31,000 COVID‐19 tests for county residents. The Corrections Medicine practice has continued to update and innovate its service delivery model to adapt to the changing care needs of incarcerated patients, including increasing 24/7 coverage models, adding paramedics and EMTs to the care team, and providing substance use clinical services including medication assisted treatment for opioid use disorder.

Strategic Priorities and Performance Metrics:

 Increase the number of clinic visits per quarter (HS – Reduce Health Disparities)

Performance Metric:

Average quarterly # of clinic visits

*This number is low because of staffing/turnover, specifically among Health Center Providers.