Drafter
Clerk 5/7/2007
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A MOTION relating to children's health; adopting policies and a measurement and evaluation plan for a Children's Health Initiative and accepting a report on the health of children in King County, in accordance with the requirements of the 2007 Budget Ordinance, Ordinance 15662, Section 83, Proviso P4.
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WHEREAS, King County's mission for the health of the public is to identify and promote the conditions under which all people can live within healthy communities and can achieve optimum health, as adopted in Motion 12475, and
WHEREAS, King County's goal is to protect and improve the health and well-being of all people in King County, as defined by per person healthy years lived, and
WHEREAS, whenever possible, King County will employ strategies, policies and interventions to reduce health disparities across all segments of the population, and
WHEREAS, it is the intent of the county to improve the health of children, and
WHEREAS, significant disparities in children's health by race, ethnicity, region, and income persist in King County and in some cases are growing, and
WHEREAS, research shows that effective policy for ensuring healthy children, resulting in healthy, productive adults, rests on removing barriers that prevent children from achieving consistent access to comprehensive health care, and
WHEREAS, the main barriers children face in receiving consistent access to comprehensive health care are lack of insurance, failure to enroll in an insurance plan and failure to access a consistent source of high quality health care services, and
WHEREAS, Washington State, through enactment of Senate Bill 5093, has expanded health care insurance coverage to thousands more children and simplified the enrollment process, and
WHEREAS, the State intends to provide affordable insurance coverage options for all children by 2010, and
WHEREAS, fifteen thousand children in King County are uninsured, and
WHEREAS, under the expanded State eligibility requirements, approximately nine thousand of the uninsured children in King County will be entitled to State-funded health insurance programs in July 2007, with an additional one thousand children becoming eligible in 2009, and
WHEREAS, in 2006, the King County executive demonstrated leadership in addressing children's health by convening the King County Children's Health Access Task Force, comprised of child health experts and advocates, to recommend an approach for assuring children in King County are able to obtain the health care coverage and services they need to achieve optimal health, and
WHEREAS, the task force's recommendations included an outreach strategy to enroll children in insurance coverage and link them to a regular source of medical and dental care, and
WHEREAS, the task force's recommendations reflect evidence-based best practices that demonstrate a proven ability to provide children with health and dental insurance coverage and access to a usual doctor and a regular dentist, resulting in children receiving the health care services they need when they need them, leading to an increase in healthy years lived, and
WHEREAS, the executive, upon recommendation from the task force, developed a proposal addressing children's health for transmittal to the council, and
WHEREAS, this motion is the result of a true partnership between a work group made up of council staff, executive office staff and public health staff, and
WHEREAS, the executive's proposal and the task force's recommendations are reflected in this motion, which establishes policies for the County's Children's Health Initiative ("CHI"), and
WHEREAS, the CHI is designed to surmount the barriers children face in receiving consistent access to health care services by: assertively locating and enrolling children in public health insurance programs for which they are eligible; disseminating messages about the value of early prevention and insurance in many languages; using trusted messengers from the community to deliver these messages; linking families and children to a regular source of medical and dental care; and encouraging quality integrated service delivery within clinics by utilizing case managers, and
WHEREAS, the CHI is a foundational and cost-effective strategy for the county to embark on for improving the health of children because of its holistic approach to the child and because it directly connects children to existing public health insurance programs funded by the state and federal government, and
WHEREAS, through the CHI, King County has the opportunity to leverage funding from public and private entities in order to continue to provide leadership by piloting strategies that will build evidence for statewide efforts in areas including, but not limited to, best practices in outreach and linkage, oral health quality improvement and integration, mental health integration pilot programs, and on-line enrollment application, and
WHEREAS the measurement and evaluation plans that are part of the CHI will allow the county to assess progress toward meeting the vision, mission and goals of the CHI and build an evidence base for future State public health interventions, and
WHEREAS, the CHI is consistent with the adopted Policy Framework for the Health of the Public, and
WHEREAS, the CHI is a reasonable and financially sustainable strategy, and
WHEREAS, this motion and the attached report on the health of children in King County fulfill requirements of the 2007 Budget Ordinance, Ordinance 15652, Section 83, Proviso P4, as amended;
NOW, THEREFORE, BE IT MOVED by the Council of King County:
A. Vision and Mission. The county hereby adopts the following vision and mission statements for the Children's Health Initiative ("CHI"): King County's vision is for every child in King County to achieve optimal health and grow into a healthy adult. Recognizing that regular access to health care is necessary to achieving optimal health, the mission of the county's Children's Health Initiative is to create conditions under which children have consistent access to comprehensive, preventive-focused primary health care, prioritizing those activities which will have the most significant impact on health or reduction in health disparities. Activities shall be based on need and consistent with the adopted Policy Framework for the Health of the Public.
B. Program Components. To achieve the vision and mission, the county hereby adopts the following components for the CHI:
1. Advocacy for insurance coverage for children. The county will actively advocate at the state and federal level to ensure that children and their families have options for affordable health care coverage;
2. Outreach to children. The county shall fund and conduct outreach to enroll children in the state and federal insurance programs for which they are eligible. The county's outreach efforts shall also include ensuring that children receive appropriate preventive-focused primary care once they are enrolled in insurance, through both education and care coordination;
3. Health innovation pilot projects. The county will partner with private sector donors on creating pilot projects that will strengthen linkages in the health care system and reduce barriers children face in accessing comprehensive health care.
C. Goals. The county hereby adopts the following goals for the CHI:
1. Advocacy goals:
a. Ensure that the state fulfills its adopted goal to extend health care insurance coverage to all children by 2010; and
b. Ensure that the state fulfills its goals to connect children to a medical home and assure that high-quality, cost-effective care is provided;
2. Outreach goals. The county will:
a. Improve insurance access by increasing the number of insured children by identifying and enrolling eligible children in public insurance programs.
b. Improve health knowledge by training parents and staff at community agencies to identify children's health problems and encourage families to seek preventive care;
c. Improve access to health care by connecting children to regular sources of medical and dental care; and
d. Improve health status by ensuring that children receive appropriate evidence-based preventive health care services; and
3. Health innovation pilot projects goals:
a. Ensure that children receive appropriately integrated services for the mouth, the mind and the body by strengthening linkages in the health care system;
b. Reduce barriers children face in accessing health care services by developing systems that assure children receive timely coordinated preventive care; and
c. Leverage current opportunities to build evidence for future state-funded efforts by demonstrating innovative approaches and measuring effectiveness with carefully designed and implemented evaluations.
D. Resources. The county shall dedicate the following resources to achieve the goals of the CHI:
1. Advocacy resources. The county will continue to maintain the appropriate resources to develop, advocate for and respond to state policies affecting the health of children;
2. Outreach resources. The county intends to dedicate the following resources to the outreach component of the CHI:
a. One million dollars annually from the county general fund in 2007, 2008 and 2009. The executive shall reserve these funds in the county's general fund financial plan until such a time as they are appropriated. Thereafter, the county shall evaluate whether there is continued need for county funds to support the outreach goals of the CHI;
b. Four outreach teams comprised of contracted community health workers, health educators, application workers and contracted care coordinators. The outreach teams shall be located in those geographic areas that contain the highest number of uninsured and low-income children, currently identified as:
(1) East King County;
(2) Seattle, White Center and North King County;
(3) South King County - Des Moines to Renton; and
(4) South King County - Federal Way, Kent and Auburn;
c. The county will continue to maintain the existing resources to support management and evaluation of the outreach component; and
d. Should the county receive additional funding from the state to conduct outreach, the county may choose to apply those funds to current outreach efforts, thereby reducing the county contribution of one million dollars annually, or may choose to use state funds to augment the county's outreach effort; and
3. Health innovation pilot projects resources. With the exception of staff support that is primarily dedicated to managing the other components of the CHI or other existing county functions, the health innovation pilot projects component shall be funded solely with funds donated to the county and not with county general fund resources.
E. Governance and Management. The county hereby adopts the following governance and management structure for the CHI:
1. Any changes or additions to policies for the CHI shall be established and adopted by the Metropolitan King County Council.
2. An outreach implementation committee comprised of experts in King County representing participating community-based organizations and their communities shall provide oversight to the implementation of the outreach component of the CHI. The committee shall adopt a charter that shall describe committee roles and responsibilities; membership; reporting structure; meeting frequency; deliverables; and the manner in which recommended changes or additions to policies resulting from the committee's oversight of the implementation of the CHI shall be proposed to the council; and
3. A health innovation implementation committee comprised of private sector donors, child health experts, health care system and public health representatives shall design and provide oversight to the implementation of pilot projects to support the mission, vision and goals of the CHI and that adhere to the policies in subsection G. of this motion. The committee shall adopt a charter that shall describe committee roles and responsibilities; membership; reporting structure; meeting frequency; deliverables; and the manner in which recommended changes or additions to policies resulting from the committee's oversight of the implementation of the CHI shall be proposed to the council.
F. Measurement and Evaluation.
1. The county hereby adopts the measurement and evaluation plan, Attachment A to this motion, for the outreach component of the CHI.
2. The executive shall develop a measurement and evaluation plan(s) for the health innovation component and related pilot projects of the CHI. In accordance with subsections D and G of this motion, development of these plans shall be supported by funds donated to the county.
3. The executive shall develop semiannual and annual measurement and evaluation reports based on the measurement and evaluation plans referenced in this section to report to the implementation committees and the council on progress in meeting the CHI vision, mission, and goals. The executive shall transmit these reports to the implementation committees semiannually and to the council annually by August 15 of each year. The reports shall include key performance measures, targets, baseline data and benchmarks. The annual report to the council shall also include: (1) the implementation committee charters; (2) updated measurement and evaluation plans for the outreach component of the CHI, to include objective and performance measure targets for years two and three of the program; (3) measurement and evaluation plans for the health innovation pilot projects component, to be updated annually; (4) a summary of related activities being undertaken or funded by the state; and (5) recommendations on changes to the CHI based on the measurement and evaluation data or changes in state activities. Twelve copies of the annual report to the council shall be filed with the clerk of the council, for distribution to all councilmembers and to the lead staffs for the board of health and the law, justice and human services committee or their successors.
G. The county hereby adopts the following policies governing the health innovation pilot projects component of the CHI:
1. As county contributions are necessarily limited to the levels set forth in this motion, the county encourages public and private sector organizations to donate funds to supplement the county's contribution to this initiative. In accordance with K.C.C. chapter 2.80, the council shall accept such donations by motion and, recognizing the particular importance of such donations, shall appropriate the funds by ordinance before their expenditure;
2. Health innovation pilot projects shall be designed such that donated funds are assured to complete each project;
3. Health innovation pilot projects shall be designed to coordinate and support state and county efforts to increase children's access to preventive medical and dental care;
4. Health innovation pilot projects shall include defined goals, objectives and measurement and evaluation plans in order to develop an evidence base for future interventions by the state;
5. Health innovation pilot projects shall be consistent with the adopted Policy Framework for the Health of the Public; and
6. In requesting appropriation of funds donated to the county for health innovation pilot projects, the executive shall transmit to the council information that demonstrates the projects adhere to the policies adopted by this motion.
H. The council hereby finds that the CHI as defined in this motion is consistent with the adopted Policy Framework for the Health of the Public. The council recognizes that children's health is affected by many factors not directly related to health care. The council supports the development of strategies through the public health operational master plan process that will further our communities' ability to protect, promote, and provide for children's health.
I. The report, A Report on the Health of Children in King County, Attachment B to this motion, is hereby accepted as information supporting the policies contained herein.