community health services - Kendall County Health Department

2013 ANNUAL REPORT
SERVING KENDALL COUNTY RESIDENTS SINCE 1966
“We aspire to educate, motivate, inspire, and empower citizens of Kendall
County to make healthy choices by offering optimal opportunities for
access to health care/health services, while encouraging citizens to
demonstrate healthy lifestyles and social well-being that positively
contributes to a common and growing community spirit.”
Kendall County Health Department Community MAPP
(Mobilizing for Action through Planning and Partnership) Committee
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PRESIDENT
Joseph Gruber, III, D.D.S.
MEMBERS
Jeff Wehrli
John Palmer, M.D
Justin Kwak, M.D.
Cathy Kavanaugh
Jim Friedrich
VICE PRESIDENT
Christina Cooper
SECRETARY
Jan Kellogg
Amaal Tokars, Ed.D, Executive Director/Public Health Administrator
MISSION STATEMENT
The mission of the Kendall County Health Department is to provide population based programs
and services to promote physical, mental and environmental health, protect the community’s health,
prevent disease and promote family self-sufficiency.
VISION STATEMENT
The Kendall County Board of Health is committed to promoting healthy people and healthy
communities by:
Encouraging a climate for healthy behaviors with emphasis on prevention, education and public
safety.
Challenging the population to develop healthy attitudes about themselves and others to the end
that each may be encouraged to be the guardians of good health.
Collaborating with other health systems to identify health and human services and to develop or
coordinate appropriate services to assure public safety and wellness.
Acting as the “safety net” for all who may be unable to access health and human services
(elsewhere) without fostering dependence on our systems of support.
Providing the leadership to manage and deliver health and human services efficiently and cost
effectively.
STRATEGIC PLAN PRIORITIES
In 2012 The Board of Health adopted the 2016 Strategic Plan and set the following priorities:
Community education targeting strategic priority
Stakeholder interrelationships strategic priority
Position for financial solvency strategic priority
Special population’s engagement strategic priority
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KCHD PROFESSIONAL STAFF & ADVISORY BOARDS
INDEPENDENT CONTRACTORS
ADMINISTRATION/FISCAL
(Independent contractors are not employees of KCHD)
Jayne Ballun, M.S., M.P.H., Emergency Response Coordinator
Marlin Hartman, B.A., Solid Waste Coordinator
Sandeep N. Gaonkar, M.D., Psychiatrist, Mental Health Medical
Director (Conventions Psychiatry and Counseling)
Joseph M. Nemeth III, M.D., Psychiatrist (Child/Adolescent)
Lorna London, Ph.D, Clinical Psychologist
Amaal Tokars, Ed.D, Executive Director/Public Health Administrator
Thomas E. Thomas, M.S., Operations Administrator
Steve Curatti, M.P.A., L.E.H.P., Program Administrator
Rebecca Rudolph, Executive Assistant
RaeAnn VanGundy, B.S., Grants/Information Officer
Renee Mason, A.S., Fiscal Assistant
Kathy Lewis, Data Entry/Billing Specialist
VOLUNTEER(S)
COMMUNITY HEALTH SERVICES
Sam Tessitore, Community Action Services
Karen Cotter, L.P.C., Mental Health Services
Rebecca Mueller, R.N., B.S.N., Director
Kelly Jordan-Licht, R.N., B.S.N., Assistant Director
Cheryl Ciston, R.N., B.S.N., Public Health Nurse
Mary McCarron-McGinniss, R.D., L.D.N., C.L.C., WIC Coordinator
Brandy Lehman, R.N., B.S., Public Health Nurse
Cindy Kathe, L.D.N., Nutritionist*
Nancy Villa, Community Health Administrative Assistant
Gladys Huerta, WIC Caseworker
Sandy Cortez, A.S., WIC Caseworker
Richard Larson, In-Person Counselor
Virginia Moore, M.S., R.D.N., L.D.N., Community Educator
INTERN PROGRAMS IN COLLABORATION WITH THE
FOLLOWING UNIVERSITIES
Northern Illinois University
Benedictine University
University of Illinois Chicago
University of St. Francis
Roosevelt University
National Louis University
Illinois State University
Adler School of Professional Psychology
Aurora University/George Williams School of Social Work
ENVIRONMENTAL HEALTH SERVICES
COMMUNITY HEALTH SERVICES ADVISORY BOARD
COMMUNITY ACTION SERVICES
ENVIRONMENTAL HEALTH ADVISORY BOARD
Jennifer Jones, Chair
Dottie Smith
Joanne Abens
Jennifer Speckman
Maribeth Surma
Beckie Frieders
Kerstin Villalobos
Aaron Rybski, B.S., L.E.H.P., Director
Todd Drefcinski, B.S., L.E.H.P., Assistant Director
Erich Hess, B.S., L.E.H.P., Food Program Coordinator
Amy Serby, B.S., L.E.H.P., Sanitarian
Lauren Bellville, B.S. Associate Sanitarian
Adam Johnson, B.S., Associate Sanitarian
Priscilla Ard, Environmental Health Administrative Assistant
Dan Reedy, Chair
Ted McCannon
Wes Morris
Megan Andrews
Rachel Conover
Jim Ratos
Diane Alford, B.S., Director
Melissa Creamer, M.A., Community Action Unit Coordinator
Kathy Chronister, Community Action Coordinator-Grundy Office
Vicky Torgerson, B.S., Weatherization Coordinator
Sandra Lambert, Community Action Advocate
Bradley Wiesneth, B.S., Energy Conservation Tech
Kim Hatcher, Energy Conservation Tech
Dan Misener II, Energy Conservation Tech
Norma Maisonet, B.S.W., Energy Conservation Tech
Andrew Bobbitt
Laura Barr
Donna Palmer
Rachel Rosenwinkel
Larry Stefanski
Cara Marie Wahmann
John Church, Vice Chair
Tim Kellogg
Valerie Burd
Evelyn Givens
Craig Weber
MENTAL HEALTH ADVISORY BOARD
Kay Shaw, Chair
Gloria Mathewson
Chris Cooper
Rosie Carbajal-Romo
Jim Jensen
Cathi Mundsinger
Robyn Timmerman
MENTAL HEALTH SERVICES/SUPPORT SERVICES
Jason Andrade, M.S., Ed., L.C.P.C., Director
Michelle Hawley, M.P.A, C.R.A.D.C., MISA I, Assistant Director
Miguel Rivera, M.S.W., L.C.S.W., Mental Health Clinician
Billy Ray Williams, M.S.W., C.A.D.C., Mental Health Clinician
Rose Romero, M.S., L.C.P.C., Mental Health Clinician
Penny Booher, M.A., L.M.F.T., Mental Health Clinician
Jan Smallwood, M.S., L.C.P.C., Mental Health Clinician
Cindy Vey, M.S., L.C.P.C., C.A.D.C., Mental Health Clinician
Keith Bielema, B.A., Transitions Coordinator
Rhonda Matlock, Admissions Coordinator
Evelyn Hull, M.S., L.C.P.C., Admissions Counselor
Kerri Fuentes, Mental Health Administrative Assistant
Christina Villegas, Support Staff
Mary Tschannen, C.A.D.C., Support Staff*
Timothy Shoonover, Support Staff
Jennifer Emmer , Vice Chair
Dawn Auriene
Shirley Briggs
Deanna Cross
Erica Lamb
Brenda Ulrich
COMMUNITY ACTION ADVISORY BOARD
(TRIPARTITE ADVISORY BOARD)
Jane Swinney, Chair
Jim Porter
Gina Hauge
Janet Goehst
Rev. Bruce Booher
Sharon Schultz
Rev. Kim Hulen
Cathy-Jo Puccia
Vicki Geiger
*Part-Time Staff
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Joyce Best, Vice-Chair
Richard Joyce
Jocelyn Herren
Kathy Braden
Arnetta Dean
Jim Homa
Ken Miller
Christi Heberer
FINANCIAL REPORT DECEMBER 1, 2012 - NOVEMBER 30, 2013
REVENUE:
EXPENDITURE:
Levy &General Revenues
Public Health Property Tax Levy
Interest Income
Miscellaneous Income
Coffee Revenue
State Grant Health Protection
Facility Utilization Contract
Total Levy & General Revenues
Mental Health Services/Service Coordination
Mental Health Counsel Fees
We Choose Health Grant
708 Mental Health Grant
Mental Health Grants
Senior Citizens Fund Transfer
Fox Valley United Way
Title III NEIAA Grant on Aging
DCFS Counseling
Total Mental Health Services/Service
Environmental Health Services Coordination
Septic Inspection Fees
Restaurant Inspection Fees
Tanning Fees
Kendall Co. Well Permit Fee
Solid Waste Fee
Electronic Solid Waste
West Nile Virus Grant
Non-Community Well Grant
Radon Grant
Total Environmental Health Services
Community Health Services
Immunization Clinic
Adult/Travel Clinic
State Family Case Mgt (FCM)
Public Aid FCM
Public Aid Immunizations
Women, Infant and Children
TB Board Contract
Flu Clinic
State Lead Prevention Grant
Total Community Health Services
Community Action Services
Community Action Grants
Total Community Action Services
Community Education
State Grant Tobacco
Total Community Education
Emergency Response
Emergency Response Grants
Total Emergency Response
Total Revenues
Personnel
Administration
Community Action Services
Mental Health Services
Community Health Services
Environmental Health Services
Total Personnel
Contractual & Client Assistance
Dues/Subscriptions
Conferences & Training
Contractual Services
Printing & Publications
Telephone
Personnel Advertising
Advertising – Other
Direct Client Assistance
Solid Waste
Total Contractual/Client Asst
Other
Postage
Educational Reimbursement
Mileage
Non-Medical Supplies
Medical Supplies
Vehicle Maintenance
Refunds
Rent for Bond Payment Obligation
Insurance Reimburse to County
IPLAN / CARF
Adult/Travel Clinic Vaccine
Total Other
Capital Expenditures
Capital Expenditures
Total Capital
$749,435
51
29,400
800
63,201
15,296
858,203
94,009
60,626
798,802
90,574
58,631
26,425
7,464
4,350
1,140,881
(a)
7,700
175,032
975
8,220
1,725
9,760
22,724
1,213
1,199
228,548
7,595
30,435
94,288
162,011
33,094
173,706
1,828
910
2,826
515,693
2,507,280
2,507,280
$555,703
347,300
617,655
418,949
324,283
2,263,890
8,498
15,939
160,342
13,275
6,510
517
4,163
2,048,000
1,526
2,258,770
4,826
1,058
17,097
25,257
4,038
1,775
6,363
387,761
13,600
6,062
23,099
430,936
21,408
21,408
Total Expenditures
$4,975,004
Revenues over Expenditures
$493,913
(b)
39,655
39,655
178,657
178,657
$5,468,917
(a)Includes $24,936 for DASA-Public Aid, $65,638 DASA State Grant and several other small grants
(b)Includes $2,014,684 for energy assistance, $325,784 for home weatherization, $148,569 client assistance, and $18,246 for
homeless prevention assistance
Funding provided by Department of Commerce & Economic Opportunity, Illinois Department of Health Care & Family
Services, Department of Alcohol & Substance Abuse, Fox Valley United Way, Illinois Department of Human Services, Illinois
Department of Public Health, Northern Illinois Area Agency on Aging, 708 Mental Health Board and local property tax levies
set by the Kendall County Board.
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IPLAN (ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS)
In June of 2011, the Kendall County Health Department commenced with the implementation of a five year community
health plan referred to as the 2011-2016 IPLAN. The 2011-2016 IPLAN was strategically crafted to provide for the
education, motivation, inspiration, and empowerment of the citizens of Kendall County to make healthy lifestyle
choices. This would be achieved by offering our citizens optimal opportunities for access to health care/health care
services, while encouraging citizens to actively pursue and maintain healthy lifestyle choices and social well-being that
positively contributes to a common good and growing community spirit.
“The legitimate object of government is to do for a community
The 2011-2016 IPLAN is rooted in four carefully selected health of people, whatever they need to have done, but cannot do at
priorities. It was with great intentionality that these four health priorities all, or cannot so well do for themselves, in their separate and
represent health and well-being initiatives unduplicated in our current individual capacities. ”
Abraham Lincoln
public health system, yet are set apart by innovation from efforts yet
established in the public health system. Originally selected through a
participatory community engagement process, these four health priorities embrace the World Health Organization
definition of health in that they are diverse and reflect community driven health priorities. Our four health priorities are:
Reduction of Obesity through Participatory Health Education
Reduction of Indoor Radon Exposure through Health Education and Mitigation
Increase of Socio-Economic Well-Being through Participatory Health Education
Prevention of Youth High Risk Behaviors through Early Intervention
Following is a summation of IPLAN activities and accomplishments fulfilled in 2013. Much has been learned, including
opportunities for improving strategy as we move ahead. The ongoing assessment of our IPLAN methods and results
will serve to ensure that maintaining and increasing efficacy remain a focus over the next year and beyond.
REDUCTION OF OBESITY THROUGH PARTICIPATORY HEALTH EDUCATION
Community Health Services Unit is actively promoting the reduction of obesity thorough participatory health education.
Specifically, by 2016, seeks to work with community partners to increase the number of Kendall County residents in a target
group who have a healthy BMI, by 5%. Community Health Services has approached this goal by partnering with the
Oswego Senior Center, the University of Illinois Extension, Rush-Copley, Oswego Park District, Agency on Aging and
Meijer Food Stores by crafting a 14 week program called Healthy Habits. This program was designed to touch on a number
of healthy weight-related topics including: nutrition education, physical activity tips, stigma awareness and coping, and
methods to achieving healthful lifestyle modifications. This program has been offered twice during 2013. Participants had
blood pressure, glucose, cholesterol, weight and BMI measured and completed a participant perception questionnaire at the
beginning and end of each session. The results from the first session showed a slight decrease in BMI and weight loss, but
the important results were found in the participant’s surveys showing improved knowledge of how healthy foods and
lifestyles can make a difference in their well being. There were high marks on subjects such as: how to shop for and cook
healthier meals, understanding the importance of movement, and just a general feeling of confidence in their knowing how
to choose healthier foods at home and eating out. Since the second session just ended, all the results have yet to be
tabulated. The lessons learned from the previous year were also incorporated into 2013 sessions. We now have more of an
emphasis on person-centered counseling, along with group support, and had several sessions where participates could
actually engage in physical activities such as chair yoga and stretching. Participants were also given free trial sessions to try
new types of activities through the Oswego Park District. The program will be continued in 2014 and carefully evaluated
for continued success.
REDUCTION OF INDOOR RADON EXPOSURE THROUGH HEALTH EDUCATION & MITIGATION
Environmental Health Services Unit is promoting the reduction of residential indoor radon gas exposure with the
implementation of a multifaceted radon education campaign; tracking and monitoring radon-related policy; and radonrelated surveillance conducted via collection and analysis of residential radon test data. Environmental Health Services aims
to work with the community to increase the number of Kendall County homes testing for the indoor of radon gas, while
encouraging the mitigation of radon in those homes revealing harmful levels, by 3% annually through 2016. In 2013, 31%
of Kendall County homeowners who tested and discovered harmful levels of indoor radon gas took action to successfully
mitigate their risk of indoor radon exposure. Other homeowners expressed an interest in conducting further testing.
Public radon education campaign was expanded with the use of powerful messaging shared through local print media, and
KCHD’s website and Facebook page. Environmental Health Services partnered with a local, licensed radon mitigation
professional to provide an educative seminar, accessible to the public, on the dangers of indoor radon gas, and the ease of
testing for and mitigating harmful radon levels. The discovery of an alarmingly high local indoor radon gas statistic was
revealed and shared with the public:
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47% of Kendall County homes testing for radon gas reveal levels at or above the US Environmental Protection Agencyestablished action limit for harmful levels of indoor radon gas. In response, Environmental Health Services is crafting a 15
second movie theater trailer, to share with Kendall County movie goers in 2014. A health department lobby bulletin board,
local radio and TV appearances will also serve to raise public awareness of this health risk.
Finally, the Health Department continues to monitor radon-related policy at national and state levels. Two such laws went
into effect in 2013. Illinois’ Child Care Act: Radon Testing went into effect in January, requiring Illinois’s child daycare
centers to perform and post results of radon testing as a condition of licensure renewal. Environmental Health Services
reached out to local daycare centers, offering factsheets and guidance on this new law. Also enacted was the Illinois Radon
Resistant Construction Act, requiring radon resistant construction in all newly constructed homes. This too was
communicated to local stakeholders.
PREVENTION OF YOUTH HIGH RISK BEHAVIORS THROUGH EARLY INTERVENTION
Mental Health Services Unit is actively promoting the prevention of youth high risk behaviors through early intervention.
Specifically, by 2016, seeks to improve by 60% the behavioral health well being of a target population of Plano High School
youth in four of the five following domains: academic responsibility, domestic responsibility, healthy social connectedness,
refraining from delinquent behavior, and behavioral health resilience. The students were made up of male and female
freshman, sophomores, juniors, and seniors. The class make-up was diverse in terms of culture/ethnicity, academic
performance, connectedness to the school, and level of delinquency contacts with the school office.
For school year 2012/2013, 17% of students assessed showed improvement in four out of five domains. 22% of students
assessed showed improvement in three out of five domains. Specifically, 41% of students (7/17) showed improvement in
academic performance on report cards from the 1st and 2nd semester; 83% of students (5/6) showed improvement in
domestic responsibility as evidenced by bi-annual parent psycho-social change surveys; 80% of students (12/15)
demonstrated increased healthy social connectedness as evidenced by bi-annual school staff psycho-social change survey;
50% of students (9/18) showed refraining from delinquent behavior as evidenced thought analysis of school discipline
referrals compared between 1st and 2nd semester; and 38% of students (5/13) showed an increase in mental health resilience
as evidenced by bi-annual psycho-social change survey.
Moving forward, it is imperative that thorough data collection occur for all domains. To achieve this requirement, KCHD
staff will utilize a spreadsheet tracking tool to help ensure all required measurement data has been collected for each student
across all domains. The process of initial and final psychosocial change survey completion will be monitored more closely
and will occur even if not on the day of group administration. For parent psychosocial change survey completion, staff will
continue to send the survey home with students and make phone calls home to offer completion over the telephone.
INCREASE SOCIO-ECONOMIC WELL-BEING THROUGH PARTICIPATORY HEALTH EDUCATION
Community Action Services Unit is committed to increasing socioeconomic well-being among a target population through
educative opportunities and accessible systems of support. Specifically, by 2016, seeks to improve by 70% the
socioeconomic well-being of a target population of Kendall County residents through the provision of a measureable,
comprehensive ‘Financial Fitness’ curriculum. The six week curriculum was designed to educate young adults and seniors,
on the importance of achieving and maintaining financial self-sufficiency, offering a variety of user-friendly tools to
accomplish this goal. Community Acton Services partnered with Centrue Bank and the Illinois Internal Revenue Service to
deliver this potentially impactful financial literacy program. Unfortunately, this attempt did not yield any participants.
Despite careful and thorough planning and preparation, it was surmised that the length of a six week commitment posed a
possible barrier. Another barrier considered was the possibility that discussing one’s financial matters in a group setting
might be intimidating, especially to those individuals struggling with finances and family self-sufficiency.
In 2013, Community Acton Services consulted with the Health Department’s four advisory boards to gain input and further
insight into how best to attract and increase participation in Financial Fitness education. It was discovered that another
local organization conducts a similar program for their employees. Staff met with Castle Bank to discuss their “First-atWork” financial wellness seminars. Realizing some success, Castle Bank’s Business Development Specialist suggested
offering these educational seminars in-house, as a pilot program, targeting KCHD and other County employees.
In 2014, the Financial Wellness program will be promoted to this target group. Individual sessions will cover a variety of
financial self-sufficiency-related educative topics, such as: Saving and Budgeting, Identity Theft Protection, and Buying a
Home. Special attention will be given to delivering sessions in a manner in which attendees will feel comfortable and
confident engaging. The results of this new approach will be carefully evaluated for strengths, and weaknesses. This
valuable information will serve to inform on how best to expand outreach and secure increased community participation,
beginning with local schools and churches, in an effort to increase the socioeconomic well-being of those in need.
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COMMUNITY ACTION SERVICES
The Kendall County Health Department Community Action Services is one of 37
Community Action agencies in Illinois. Community Action agencies equips low-income
citizens with tools and potential for becoming self-sufficient. Community Action provides
the Low-Income Home Energy Assistance Program (LIHEAP), Illinois Home
Weatherization Assistance Program (IHWAP), Community Service Block Grant (CSBG) and several other selfsufficiency programs. The mission of Community Action is to help people to help themselves in achieving
self-sufficiency.
The structure of Community Action is unique – federal dollars are used locally to offer specialized programs in
communities. Coordination is the bedrock of Community Action, using resources of all kinds in combination to
solve community problems. It is a coordinated effort to address the root effects of poverty and to move families
and individuals towards a life path of self-sufficiency.
Community Action has been servicing the community for 30 years, starting with two programs; the Low Income
Home Energy Assistance and Illinois Home Weatherized Program serving a total of 500 households in 1983. The
population in 1983 for Kendall County was 37,093 and Grundy County 30,519. The population in 2013 for Kendall
County is now at 118, 105 and for Grundy County is 50,281. In 2013 Community Action has 13 programs
servicing over 2,281 households.
LOW INCOME HOME ENERGY ASSISTANCE (LIHEAP)
Since 1983, the Low Income Home Energy Assistance (LIHEAP) has provided an average of $2,600 per client to
local HVAC contractors for emergency furnace assistance and an average of $1,500 to local propane vendors for
heating assistance.
WEATHERIZATION
The Weatherization Program uses local contractors to weatherize low-income homes with an average of $5,500
per household. In 2012, 122 homes were weatherized with a total funding of $582,650 of tax dollars being
returned to Kendall and Grundy counties. American Recovery and Reinvestment Act (ARRA) dollars
weatherized 199 homes with a total funding of $896,289.00.
COMMUNITY SERVICES BLOCK GRANT
The Community Service Block Grant started in 1986. Each agency is given the ability to evaluate community
needs and design programs unique to their area. Such as:
Small Business Loans – since 1987 Community Action has helped 12 small businesses with loans. The small
business loans have been for a variety of services for a total of $134,667 being added to our local economy.
The Scholarship Program began in 1986. Since that date, Community Action has assisted 144 area students
with a total of $101,250 to Illinois accredited colleges.
Drive to Success began in 2003. This funding is used to repair cars or provide $500.00 for a down payment
to 291 clients with a total of $110,850 to local auto repair shops and dealers.
There have been two new Community Service Block Grant programs since 2010;
MD HELP – has assisted 65 clients with 218 visits to a physician with an average of $106 per client.
Shoes for School -- Provides Payless gifts cards of $25 each to assist clients in the purchasing of shoes for
their children going back to school
Homeless Prevention Program – since 2006 - 69 households have been served. This program assists those
about to be evicted from their homes. This program has provided $71,722 of rent or mortgage payments.
Emergency Services Program – This program assists clients in crisis situations. After receiving assistance,
their life situation becomes stabilized. Assistance includes counseling, referrals, provision of food,
transportation, shelter, rent utilities, etc.
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COMMUNITY ACTION HIGHLIGHTS
COMMUNITY ACTION RESPONSE TO NATURAL DISASTERS IN 2013
In 2013 Community Action met the challenge of the Community Action Promise when our communities were
hit twice with disasters. First in April came the floods and in November came the tornados.
The 2013 Flood Disaster in Kendall and Grundy Counties:
On April 17, 2013 Kendall and Grundy counties became
official disaster areas. The storm brought over seven inches
of rain to some parts of the counties in a short period of
was gone in minutes. You people have been a ray of
sunshine through this nightmare.”
time. The hardest hit town in our service area was Minooka,
IL. The residents of Shady Oaks Mobile Home Park were in
disbelief and uncertainty in the weeks following the flood, with no insurance and all their belongings destroyed.
SHADY OAKS MOBILE HOME PARK RESIDENT:
“It’s been awful, my whole life is falling apart. Everything
Community Action assisted 40 residents in Kendall and Grundy Counties with rental assistance, furnace
replacement of, mold remediation, utility bills, clothing, food and household goods. The residents were
assisted with funds from Community Services Block Grant, Low Income Energy
Assistance, and the Illinois Home Weatherization Program totaling $37,777.58.
The 2013 Tornado in Coal City and Diamond:
On Nov. 17, 2013, a normal Bears Game Sunday morning, a tornado cut a three
mile path of destruction in Grundy County. The tornado damaged more that 200
structures in the area. Community Action was involved with three multi-agency
disaster assistance events to reach all the residents impacted by the tornado.
Community Acton assisted 71
residents with mini-grants totaling
$15,199.00 from the Community
Service Block Grant recaptured funds.
Community Action was a part of a Multi-Agency Resource
Center (MARC) in Diamond, one of the first resource centers of
this kind in Illinois. Sara Echols of The American Red Cross
reported that on Dec. 3, 2013 over 113 clients were served by 36
agencies.
Sara Echols, The American Red Cross:
“That time and time again the residents told her they will
never forget the hugs, Community Action, and the
compassion and guidance they received in the MARC. It
was truly amazing the teamwork, collaboration and
problem-solving that grew as we all worked together.”
Community Action staff assisted Kendall County Transitions
Elder Care client with Christmas Baskets for the Share Your Blessings Program.
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COMMUNITY HEALTH SERVICES
Community Health Services focuses on improving health by encouraging and educating its residents about
healthy lifestyles. This is accomplished through our specialized services.
FAMILY CASE MANAGEMENT (FCM) & WIC (WOMEN, INFANTS & CHILDREN) PROGRAMS
FCM and WIC are integrated programs helping ensure that women have the necessities to have a healthy
pregnancy so they can give birth to healthy babies.
WIC is a special supplemental nutrition program. In 2013 we served over 1000 income eligible clients per month.
Our clients receive healthy food along with nutrition education and breastfeeding support. These benefits begin
during pregnancy and continue for the baby/children until they reach five years of age.
Our FCM program offers education on prenatal care, post-partum care, breastfeeding, infant growth and
development; and home safety. We also provide referral and linkage for prenatal medical care, pediatric care,
applying for Medicaid, preparing for labor and delivery, well baby care and immunizations, early childhood
intervention, hearing and vision screening, behavioral health resources, employment assistance, transportation
assistance, emergency food and shelter Client Statements:
programs, and day care assistance. We
“I just wanted to say thank you to everyone at the office, you’ve all been extremely kind
partner with WIC and also provide
and helpful, giving us answers to questions when asked and support when needed. It
nutrition education and the promotion of
is appreciated.”
healthy habits for families we serve.
“I really like the service because it has helped us as parents to establish an active role
in our children’s health and life!”
We also offer counseling and support for
qualifying families for Easter Seals Jump
Start Program. This program offers parents support, education, group play activities, and developmental
assessments, home visits and referral for physical, speech and occupational therapies.
Lastly, we offer referral services for pregnant women considering adoption. We partner with Cornerstone Young
Women’s Center in Plano, IL for counseling and supportive services.
Recent studies show that WIC and FCM participation reduces fetal and infant deaths, low birth weight babies and
iron deficiency anemia. This year we are proud to report that we were able to assist approximately 85 women per
month to successfully breastfeed their babies.
HEALTHWORKS
HealthWorks helps foster parents to meet the health care
needs of children placed in their care and improves access
to services. The medical case manager assists foster
parents in finding a physician, understanding the child's
health problems and ensuring that children receive the
routine and specialized health care services they need in a
timely manner. The medical case manager follows up on
medical concerns, and is available to answer questions
about the health care needs of their foster children.
IMMUNIZATION PROGRAM & TRAVEL CLINIC
Immunization and Travel Clinic Program is a program that provides necessary immunizations to infants, children
and adults at minimal or no costs to help protect the county residents from preventable diseases. The travel clinic
provides vaccines for travel outside the United States. Nurses help the person needing inoculations for travel by
doing a consultation and making recommendations of necessary vaccines.
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TUBERCULOSIS CLINIC
Tuberculosis Clinic performs TB testing, screenings and referrals. Direct Observation Therapy (DOT) visits are
also provided to ensure that people being treated for TB are taking their prescribed medications.
COMMUNICABLE DISEASE & SEXUALLY TRANSMITTED DISEASE (STD) PROGRAMS
These programs are done along with reporting and follow-up by the health department’s nurses which results in
lower numbers of Illnesses in our community. As cases are found and followed up on we reach out to who may
have been exposed and recommend follow up and early treatment. This helps decrease the spread of
communicable diseases.
Communicable Disease Reported/Investigated
Chikungunya Virus
Chlamydia
Giardiasis
Gonorrhea
Haemophilus Influenzae Invasive Disease
Hepatitis A
Hepatitis B Acute
Hepatitis B Chronic
Hepatitis C Virus Infection Chronic or Resolved
Hepatitis C Virus Infection Unspecified
Histoplasmosis
Influenza with ICU Hospitalization
Legionellosis – Legionnaires Disease
Lyme Disease
Malaria
MRSA in infants less than 61 days
Pertussis
Rabies, Potential Human Exposure
Salmonellosis
Shiga Toxin-producing E. coli (STEC) 0157:H7
Streptococcal Disease Invasive Group A
Streptococcal Toxic Shock Syndrome
Tuberculosis
Varicella (Chickenpox)
West Nile Fever
Total Reported/Investigated
2013
1
147
3
18
3
2
2
6
29
1
1
2
1
10
2
2
12
2
12
1
2
1
1
13
1
275
10
ENVIRONMENTAL HEALTH SERVICES
The Environmental Health Services Unit is responsible for protecting the public from specific potential
adverse environmental factors that can lead to the outbreak and spread of disease. This unit works to provide
public health education, surveillance, and where applicable, enforcement of public health laws to protect the
public in order to lessen or eliminate the threat of disease from specific environmental factors present in the
county.
FOOD PROTECTION PROGRAM
Environmental Health Services ensures that food is safe at all points where it is sold and served to the public
throughout the county. To that end, in 2013, Environmental Health Services staff conducted 855 routine
inspections of food facilities and 142 follow up inspections for items that needed immediate attention. All
routine inspections are announced except in the rare situations that don’t allow for such an arrangement. This
unit is also responsible for approving the design of all new and remodeled food service facilities. Staff saw an
increase in the number of plan reviews for new facilities and those being remodeled with 86 preoccupancy
inspections performed.
The Kendall County Food Ordinance is also undergoing revision to address recent emerging issues not addressed
in the current version and the State Food Code (namely outdoor grilling, food trucks and shared kitchens).
Research is ongoing in order to ensure that tested best practice approaches are incorporated into new ordinance
language.
WELL & SEPTIC PROGRAM
Environmental Health Services is charged with ensuring that well and septic systems are installed per code
requirements and that they are maintained so as not to fail. A formal permit process is in place to ensure that this
takes place. In 2013, Environmental Health Services completed their first year managing all these permit records
in a geographic information system (GIS). Environmental Health
Services, with assistance from the County GIS Coordinator, has
added visual layers to the system, enhancing it and even allowing
for some inspections to be conducted from office computers,
saving time and mileage. This system allows for local surveillance
and research to be conducted much more efficiently than was
ever possible before.
In the spring of this year, Environmental Health Services
formalized the process for site evaluation inspections linked to
building permit applications. Environmental Health Services
works closely with the Kendall County Planning, Building and
Zoning Department (PB&Z) establish this process and conduct
these inspections on properties where wells and septic systems exist. These inspections are conducted in order to
ensure that these utilities are still accessible for service and to protect them from potential damage during
construction. Since spring, Environmental Health Services has conducted over 80 site evaluations and expect this
number to rise to approximately 140 evaluations in 2014.
WEST NILE VIRUS SURVEILLANCE & EDUCATION PROGRAM:
During the warm months of the year Environmental Health Services maintains mosquito traps at strategic
locations throughout the county and tests mosquitoes for the presence of West Nile Virus. Dead birds suspected
of carrying the virus are collected and sent to the state lab for testing.
11
Local surveillance has been enhanced this year by increasing the number of traps set. Traps were spread further
throughout the county to areas that have not been a part of surveillance in the recent past. This year, special
attention was paid to effectiveness of each trap. If some traps were discovered to be underperforming, these
locations were abandoned and the traps were relocated to new locations based on regional surveillance data
provided by Illinois Department of Public Health and surrounding local health departments.
During the fall, Environmental Health Services incorporated WNV surveillance data into the GIS system. Trap
locations were identified on aerial maps and by utilizing existing layers in the system, staff have started
determining proximity to nearby potential mosquito breeding sites such as shallow rivers or streams or even low
lying areas likely to collect water. This information, coupled with data from these traps, may open a new
dimension of trend identification and allow for more effective predictions of the annual spread of this disease in
years to come.
Environmental Health Services staff attended the Kendall County Natural Resources Tour, held in the spring at
Hoover Forest Preserve. For the first time, WNV education was offered as part of the program. Approximately
480 local elementary and middle school students were educated on WNV and tick borne diseases. Live ticks were
displayed allowing for students to learn what to look for even as they spent time at the educational event.
Kendall County Healty Department is scheduled to repeat this education at the 2014 event.
INDOOR RADON PROGRAM
Environmental Health Services is continuing its efforts to educate the public about the dangers of radon gas
concentrating in the home. Tests kits are sold at the Health Department to the public for a nominal cost. In
2013, 46 tests were run in Kendall County through this program. Work was also done to provide information at
various health fairs and at local clinics. Upon receiving a renewal of our Radon Grant, Environmental Health
Services started work on a new movie trailer to run at Kendall 10 Theaters emphasizing the alarming statistic that
47% of the tests run in Kendall County show dangerous levels of radon gas. Additional efforts are currently
underway to educate the public about this alarming statistic in hopes that it may cause for more testing and
ultimately, more mitigation of this harmful indoor air hazard.
SOLID WASTE & RECYCLING PROGRAM
Work is currently underway providing updated recommendations to the Kendall County Solid Waste Plan.
Representatives from local municipalities, the Environmental Health Advisory Board, the Board of Health, the
County Board and the public-at-large have been invited to attend as members of this Solid Waste Plan
Committee. This group will craft and ultimately approve recommendations for the Solid Waste Plan to be sent to
the County Board. Several meetings were held over the course of 2013 and work will continue through the next
year and a half. Recommendations are to be approved in the spring of 2015.
The Unit concluded work in the Solid Waste (E-Waste) grant which ended in October. Efforts were made to
educate the county (specifically those more rural areas) on a new e-waste law that banned the waste from
landfills. A website was created and incorporated into the Kendall County Health Department web site,
presentations were made throughout the year at school assemblies, township meetings and health fairs. News
articles appeared in local papers as well as in the Farm Bureau newsletter. A final report was written outlining
the successful outreach of the program. This report was shared with our stakeholders
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MENTAL HEALTH SERVICES
Mental Health Services delivers comprehensive and holistic treatment designed to meet diverse needs of the
child, adolescent, adult, and elder populations. Services are strength focused, recovery driven, and vary in
intensity depending on individual need. An integrated approach is taken in all service endeavors, so that
individuals with multiple diagnostic features may be served by a primary clinician in one treatment setting.
Client Comment:
“The kindness and caring I receive here is
Active consideration for the mental, physical, and social wellbeing is
provided in all treatment interventions.
very calming and soothing. I feel cared for
here.”
Outpatient mental health treatment is the core of service provided.
Treatment is designed to promote growth, development, and
achievement of individualized goals. Clinicians take a strength based and family
systems approach. Clinicians also take an integrated approach to treatment of mental health and substance abuse
conditions, ensuring that all aspects of wellbeing are considered in the treatment process. Services are provided
by: Licensed Clinical Psychologist, Licensed Clinical Social Workers, Licensed Clinical Professional Counselors,
Masters Level Clinicians, Certified Health and Addiction Counselors, and Mental Health Professionals.
CLIENT INSIGHT SURVEY INSTRUMENT HIGHLIGHTS
In fiscal year 2013, Kendall County Health Department Mental Health Client Comment:
Services demonstrated outpatient clinic efficacy by achieving a mean
“This place has changed my life.”
score of 3.57 out of 4.0 on our Client Insight Instrument. The Client
Insight Instrument was administered during the month of October to serve as a point in time client perspective
on the efficacy of service. The Client Insight Instrument asked clients to reflect on and rate their experience in
relation to the ease with which they were able to schedule an initial appointment, how comfortable they found the
agency to be, and the effectiveness of their treatment providers. The survey also asked clients to consider their
treatment progress in the following areas: alcohol/drug use, emotional stability/duress, decision
making/impulsive behavior, personal relationships, work/school problems, and if services were considerate and
respectful toward their cultural identification.
When clients were asked to what extent they were treated with respect by all health department staff, clients
provided a rating of 3.91 out of 4.0
When asked to rate the effectiveness/helpfulness of help received, clients rated 3.68 out of 4.0
When asked of positive changes made in the area of alcohol/drug use, clients rated 3.70 out of 4.0
When asked of positive changes in the area of emotional stability/duress, clients rated 3.38 out of 4.0
When asked of positive changes in the area of decision making/impulsive behavior, clients rated 3.37 out of
4.0
When asked of positive changes in the area of personal relationships, clients rated 3.25 out of 4.0
When asked of positive changes made in the area of work/school problems, clients rated 3.31 out of 4.0
When asked if services were considerate and respectful toward cultural identification, clients rated 3.93 out of
4.0
COMPREHENSIVE AND INTEGRATED TREATMENT APPROACH
MENTAL
Kendall County Health Department Mental Health Services supports
the World Health Organization’s definition of Health. The WHO
indicates that “Health is a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.”
SOCIAL
PHYSICAL
To this end, Kendall County Health Department Substance Abuse
and Mental Health Treatment Clinicians take an integrated approach
in the treatment of mental health and substance abuse issues. Care
and attention is provided to ensure that treatment is comprehensive and holistic. Issues of work, education,
healthy social connectedness, and refraining from high risk behavior are integral to the treatment process and
seen as being necessary for promoting long lasting change.
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PREVENTION & DIVERSION SERVICES
Prevention and Diversion Services are designed to reduce individual, family, and environmental risk factors,
increase resiliency, enhance protective factors, and achieve individual and community wellness.
Client Comment:
The Mental Health Unit has worked to provide
“This is a very helpful and needed service. It’s nice to be able to
meaningful early intervention education in Kendall
discuss issues with someone who understands the needs of
County schools on topics ranging from substance abuse,
seniors.”
bullying, mental health wellbeing, youth enrichment, and
abstinence from tobacco. Mental Health staff has established strong working relationships with the schools and
provide leadership on mental health and wellbeing topics
Plano School District – Early Intervention, Project
Alert, Presentation to Preschool Parents on Mental
Wellbeing
Oswego School District – Tobacco Prevention
Education, Parent Curriculum Event, Bullying
Prevention
Newark School District – Conflict Resolution
Strategies for Students, Substance Abuse
Prevention
Yorkville School District – Promoting Youth
Wellbeing, Presentation to Parents
Opportunity School – Substance Abuse Education
Youth Offender Education in Collaboration with
Kendall County Probation
Operation Snowball presentations
Local Church Stephens Ministers presentations
Presentations at Kendall County PADS
MENTAL HEALTH OUTPATIENT TREATMENT/SUPPORT SERVICES
Kendall County Health Department Outpatient Mental Client Comment:
Health Services deliver comprehensive and holistic
“All of the staff has been helpful, it is a very nice place to be,
treatment services designed to meet diverse needs of the
and being here has truly helped.”
child, adolescent, and adult populations.
Comprehensive Intake and Assessment
Counseling – Individual, Group, Family, Marital/Couples, Grief and Bereavement
Addictions Treatment – Adolescent and Adult Substance Abuse Treatment: Early Intervention through
Intensive Outpatient, Tobacco Cessation, and Jail Services
Transitions Elder Care – Mental Health Counseling, Support, Education and Outreach
Psychiatric Treatment – Adolescent and Adult Services
Evaluation Services – Psychological Testing, Anger Evaluations, Fitness for Duty, Fitness to Stand Trial, Drug
and Alcohol and DUI Evaluations
Crisis and Suicide Intervention/Prevention Services
Forensic Interviews for Child Advocacy Center - 89 Victim sensitive interviews were conducted in 2013
MENTAL HEALTH CLIENT PROFILE
CLIENTS BY AGE
AGE
PERCENTAGE
0-4
1%
5-12
6%
13-18
17%
19-59
53%
60-74
23%
CLIENTS BY GENDER
GENDER
PERCENTAGE
Female
55%
Male
45%
MENTAL HEALTH SERVICES
Outpatient Services (Includes Substance Abuse Services)
Transitions Elder Care
Crisis/Suicide Intervention
14
1,134
306
41
PUBLIC HEALTH EMERGENCY PLANNING & PREPAREDNESS
Our county faces numerous hazards everyday that include natural, technological, and societal incidents. Should any
of these hazards occur, they could impact the health and safety of the county’s citizens and responders. Kendall
County Health Department staff work every day to monitor to health status of the public, ensure safe food and
water/wastewater practices, mitigate mold and weather exposure, and provide a wide array of counseling services.
Through their daily work, the health department’s staff collaborates with community partners to effectively reach
and serve the public. These partners include the usual first responders of Sheriff’s Office/local police, fire
departments, and Emergency Medical Services (EMS). Staff also works closely with schools, service agencies,
community groups, churches, local and State government, senior programs, area hospitals, and many more. The
goal of this collaborative effort is to build resiliency within our
communities so that potential incidents can be mitigated or order
can be restored quickly after an incident occurs.
Public Health Preparedness
Capabilities
Resiliency within our communities is the focus for Kendall County
CDC identified the following 15 public
Health Department’s Emergency Planning and Preparedness health preparedness capabilities as the basis
program.
Staff continues to assess and build the health for state
department’s preparedness program by implementing the fifteen & local public health preparedness:
1. Community Preparedness
public health preparedness capabilities identified by the Centers
2. Community Recovery
for Disease Control and Prevention (CDC). Through these
3. Emergency Operations Coordination
capabilities, the health department is structuring its staff and
4. Emergency Public Information &
procedures in accordance with the National Incident Management
Warning
System (NIMS). Partnerships are being formed within the county
5. Fatality Management
and regionally to ensure the needs of the public are met effectively
6. Information Sharing
and efficiently before, during, and after an incident. Skills of the
7. Mass Care
8. Medical Countermeasure Dispensing
health department staff are being developed to be able to identify
9. Medical Materiel Management &
emerging public health events, manage public health incident,
Distribution
communicate with partners, provide information to the public,
10. Medical Surge
and implement response strategies.
11. Non-Pharmaceutical Interventions
12. Public Health Laboratory Testing
TRAINING & EXERCISES
13. Public Health Surveillance &
Training in and exercising emergency preparedness procedures
Epidemiological Investigation
are important to develop necessary skills and identify areas for
14. Responder Safety & Health
15. Volunteer Management
improvement. In addition to conferences hosted by the Illinois
Department of Public Health, Illinois Emergency Management
Agency, and the Illinois-Indiana-Wisconsin Combined Statistical Area focusing on emergency preparedness and
needs of the whole community, staff attended specific training on Behavioral Threat Assessment, Active
Shooters, Radiological Emergency Preparedness Core Concepts, and the Master Exercise Practitioner program.
Staff also facilitated on strategic planning at the Illinois Public Health Performance Improvement Conference.
Other trainings included working with other County departments in the development of an Incident Action Plan
for the Forest Preserve’s Fall Fest and the Emergency Management Agency’s Search and Rescue exercise.
15
Several training opportunities provided health department staff and volunteers the opportunity to implement
plans and practice procedures. A mass dispensing exercise with Grundy County Health Department, called
Mission Impossible, allowed each health department’s command center to work together to direct a combined mass
dispensing operation and practice incident management, communications, public information, medical materiel
management, mass dispensing, coordinate response operations, and successfully test a streamlined medication
consent form.
Other exercises staff participated in were the Exelon Dresden Nuclear Power Plant exercise and the Illinois
Department of Public Health statewide exercise. Both exercises provided experience for the health department’s
staff in incident management, communications, and public information activities.
REAL EVENT
April showers brought us flooding throughout the county. Kendall County Health
Department provided support to the County’s Emergency Operations Center
(EOC) for response and recovery operations. During the response phase of the
flood response, health department staff assisted in the EOC and with pertinent
public health public information messaging. Public health recovery operations
assisted the public with information and well test kits for mitigating contaminated
wells, coordinated dispensing of flood clean-up kits provided by the American Red
Cross, addressed mold issues, and provided small stipends for flood damages to low income families. Valuable
lessons for response and recovery operations were learned through this incident.
EVALUATION
This year’s annual assessment of the health
department’s emergency preparedness program was
conducted by the CDC electronically through
IDPH’s web-based program called CEMP. The
assessment provided a welcomed opportunity to
review our mass dispensing plans, discuss important
issues and strategies with the CDC’s evaluator, and
confirm that our planning for public health hazards
is on the right path.
COMING YEAR
The focus for the coming year continues to further develop the health department’s skills and activities within the
15 public health capabilities and the department’s mission to protect the community's health, prevent disease, and
promote family self-sufficiency.
16
WE CHOOSE HEALTH
We Choose Health is a multi-year Illinois Department of Public Health
initiative encouraging and supporting local implementation of proactive
health programs addressing topics including Healthy Eating and Active
Living, and Smoke-free Living. We Choose Health funding is provided
by a $25 million Community Transformation Grant from the Centers
for Disease Control and Prevention (CDC).Created by the Affordable Care
Act, the Community Transformation Grant supports states and
communities, such as Kendall County, willing to tackle the root causes of
poor health so Americans can lead healthier, more productive lives. By
promoting healthy lifestyles, especially among population groups
experiencing the highest rates of chronic disease, these grants aim to
improve health, reduce health disparities, and control health care spending.
Using a competitive grant application process, We Choose Health funding was awarded to 21 grantees, covering 60
counties with the potential to impact an estimated 3 million Illinoisans. Kendall County Health Department
(KCHD) was honored to be awarded a We Choose Health grant in August of 2012; the grant is intended to last
through 2016. KCHD, collaborating with a number of its stakeholders, is implementing We Choose Health by
actively promoting and modeling two public health strategies: Smoke-Free Multi-Unit Housing, and Worksite
Wellness.
Healthy smoke-free spaces for children and adults are essential to good health.
Secondhand smoke poses harmful health threats to people of all ages. Studies have
shown that as much as 60 percent of airflow in multi-unit housing facilities comes
from other units (CDC). According to the U.S surgeon General (2006), secondhand
smoke kills an estimated 65,000 people in the U.S. who do not smoke; is responsible
for 46,000 premature deaths from heart disease; and 3,400 deaths due to lung cancer,
among non-smokers. Promoting smoke-free multi-unit housing serves to protect nonsmokers from unintended
secondhand smoke exposure in their homes. We Choose Health funding has allowed KCHD to successfully
promote smoke-free policies in multi-unit housing facilities.
Every Illinois community deserves to have access to healthy food choices and safe opportunities for physical
activity. Getting proper nutrition and exercise are essential for building and maintaining a healthy lifestyle, and for
preventing obesity and other illnesses. Workplaces are an ideal opportunity to support healthy eating and active
living considering how much time adults spend at their worksites. Worksite wellness programs give employees
opportunities to be physically active, eat healthful foods and live tobacco free. Employers and their employees can
both benefit from such programs. In addition to physical benefits, an employer may be able to save an average of
$3.27 for every $1 spent in a wellness program (American Heart Association, 2011). We Choose Health funding has
allowed KCHD to model, and to promote to our local employers, the benefits of worksite wellness.
17
TEN ESSENTIAL PUBLIC HEALTH SERVICES
All Local Health Departments, as governmental entities, derive their authority and responsibility from the state
and local laws that govern them. Accordingly, all Local Health Departments exist for the common good and
are responsible for demonstrating strong leadership in the promotion of social, economic and environmental
conditions that improve health and well-being and prevent illness, disease and injury. However in the absence
of specific consistent standards regarding how Local Health Departments fulfill this responsibility; the degree
to which the public’s health is protected and improved varies widely from community to community.
Monitor health
Diagnose
Inform,
status to identify community health problems.
and investigate identified health problems and health hazards in the community.
educate, and empower people about health issues.
Mobilize
community partnerships to identify and solve health problems.
Develop
policies and plans that support individual and community health efforts.
Enforce laws and regulations that protect and ensure safety.
Link people to needed personal health services and ensure the
provision of health care when
otherwise unavailable.
Ensure
a competent public health and personal health care workforce.
Assess effectiveness,
Research
accessibility and quality of personal and population-based health services.
for new insights and innovative solutions to health problems.
KENDALL COUNTY HEALTH DEPARTMENT IS A MEMBER OF THE FOLLOWING PROFESSIONAL
ORGANIZATIONS:
PROFESSIONAL ORGANIZATIONS
APHA
CAP
(American Public Health Association)
Groundwater
IAPHA
$325.00
Behavioral Healthcare Association
Companeros en
$786.00
Salud
$50.00
Foundation
$35.00
(Illinois Association of Public Health Administrators)
ICAA
(Illinois Community Action Agencies)
ICAF
(Illinois Community Action Foundation)
IEH
$200.00
(Community Action Partnership)
Community
$100.00
$240.00
(Illinois Public Health Association)
Illinois Ventures for Community
NACCHO
$500.00
Action
$100.00
(National Association of County & City Health Officials)
National
Association of Local Boards of Health
National
Environmental Health Association
National
Groundwater Association
$700.00
$1,500.00
A (Illinois Environmental Health Association)
IPHA
ANNUAL DUES
$616.00
$175.00
$95.00
$140.00
NIPHC
(Northern Illinois Public Health Consortium)
$1,637.00
Product
Stewardship Initiative
$1,000.00
18
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