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									  Dutchess County
 Department of Health
            AMP Draft 6/25/07
      2006 Annual Performance Report

William R. Steinhaus       Michael C. Caldwell, MD, MPH
 County Executive           Commissioner of Health
Annual Report 2006
Dear Community Residents:

We are pleased to provide you with the 2006 Annual Performance Report that reflects the
achievements of the Dutchess County Department of Health for the various programs
implemented during the past year.

The Department of Health’s competent, well-trained, and motivated employees continue to
make strides toward preventing and reducing the burden of chronic and infectious diseases,
informing and educating our residents about health issues, advancing community partnerships,
and protecting the health and lives of our residents. As you read this report, several
accomplishments can be highlighted:
 •   Building our Emergency Preparedness Capacity with an all hazards approach to planning
     and response,
 •   Launching the County Cancer Council, bringing together local Cancer stakeholders to
     facilitate dialogue and develop a comprehensive local plan,
 •   Addressing Childhood Obesity through several programs in collaboration with other
     community partners,
 •   Informing & Educating the public about important health issues,
 •   Protecting our Environment through the enforcement of sanitary codes, and
 •   Responding to and investigating Disease Outbreaks.

The Dutchess County Department of Health is accountable to its residents by communicating
what it does through its annual performance report. We welcome your input and your
participation in making Dutchess County a healthy community.


William R. Steinhaus                                          Michael C. Caldwell
County Executive                                              Commissioner of Health

                                         Annual Report 2006
Annual Report 2006
                         Dutchess County
                         Department of Health

                   2006 Organizational Structure

        Board                          Commissioner
       Of Health                         Of Health

                   Public Health                                Admin
                                                             Water Laboratory
                    Health Planning
                     & Education

                                                                  Public Health Nursing
Environmental              Medical            Clinical                     and
   Health                 Examiner           Physician           Communicable Disease

                Dutchess County Department of Health Offices
                             Poughkeepsie District Office
                       387 Main Street - Poughkeepsie, NY 12601
            Voice: 845.486.3400    TTY: 845.486.3417 Fax: 845.486.3447

 Millbrook District Office                  Collegeview                  Beacon District Office
       845.677.4000                         845.486.3526                      845.838.4800
(Fax) 845.486.3447                    (Fax) 845.486.3554                (Fax) 845.486.4824

                                        Annual Report 2006
                           VISION AND MISSION STATEMENTS

The Dutchess County Department of Health is a diverse group of capable
experienced individuals and motivated professionals whose Mission is to protect
and promote the health of individuals, families, communities, and the
environment of Dutchess County.

Our Vision is to build on our tradition of excellence, leadership, and compassion,
using the best available science and resources to promote the highest standards
of Public Health in response to emerging issues to protect and assist our

We Value …
   •   The practice of prevention
   •   The on-going assessment of the strengths and health needs of our community
   •   Research and its application to Public Health practice
   •   The pursuit of innovative solutions to Public Health practice
   •   Ethical principals in the work place
   •   Culturally sensitive, courteous and respectful treatment of people
   •   Excellence in all areas of Public Health
   •   Each other’s input to guide decision-making
   •   Encouragement of staff to develop to their full potential
   •   Community service and volunteerism
   •   Public and private partnerships
   •   Written policies and procedures to guide our daily operations
   •   Sensitivity and accommodation of special needs populations
   •   Open and honest communications
   •   Best use of people and resources
   •   Respect for and management of confidential information
   •   A quality work environment and safety in the work place

                                         Annual Report 2006
                             PUBLIC HEALTH CORE FUNCTIONS
The Dutchess County Department of Health is committed to the core functions of Public Health
and strives to deliver the essential services necessary for people to live healthy lives. The Core
Functions of Public Health are:
   1. Assessment and monitoring of the health of communities and populations at risk to
        identify health problems and priorities;
   2. Formulating public policies, in collaboration with community and government leaders,
      designed to solve identified local and national health problems and priorities;
   3. Assuring that all populations have access to appropriate and cost effective care,
      including health promotion and disease prevention services, and evaluation of the
      effectiveness of that care.

The 10 Essential Services: A Vision for Public Health was released in 1988 by the Institute
of Medicine, The Future of Public Health http://www.nap.edu/books/0309038308
/html/index.html ) identified both the core functions and 10 essential services required to
address the mission of public health.

The following text and graphic demonstrate how the ten essential environmental health
services align with the three core functions of public health (assessment, policy development,
and assurance).

   1. Monitor health status to identify
       community environmental health
   2. Diagnose and investigate health
       problems and health hazards in the
Policy Development
   3. Inform, educate and empower
       people about health issues
   4. Mobilize community partnerships to
       identify and solve health problems
   5. Develop policies and plans that
       support individual and community
       health efforts
   6. Enforce laws and regulations that
       protect health and ensure safety
   7. Link people to needed personal health services and assure the provision of
       environmental health services when otherwise unavailable
   8. Assure a competent public and personal health workforce
   9. Evaluate the effectiveness, accessibility and quality of personal and population-based
       health services
   10. Conduct research for new insights and innovative solutions to health problems

                                          Annual Report 2006
                                       Fiscal Information 2006

Total Receipts by Source                                  $ 17,118,281

       General Fund Subsidy
       Clinic Fees
       Environmental Health
       Other Charges
       Vital Statistics
       Home Visiting

Total Expenditures by cluster                             $ 32,443,625

       Assessment and Health Information
       Support Services
       Environmental Health
       Health Services

                  1999     2000       2001    2002        2003    2004   2005   2006

                                  Statistics as given by DCDOH Administration

These charts illustrate the Dutchess County Department of Health’s major sources of income
and expenditures for the fiscal years 1999 to 2006. They reflect all receipts and expenses
incurred by the Department. New York State Aid (Public Health Law, Article 6) continues to be
the major funding source for our various Public Health activities. However, the trend in recent
years illustrates more reliance on grants and fees for services. Due to the growth in our
revenues, we have been able to increase the level of services provided to the community.

In 2006, Dutchess County Department of Health received 16 different grants which totaled
$2,514,071. These grants have covered a variety of Public Health concerns including diabetes,
youth tobacco use prevention, nutrition, Bioterrorism and Emergency Preparedness, Lyme
disease, HIV/AIDS, lead poisoning, immunizations, and tuberculosis. The individual amounts of
these awards range from $10,500 to $667,000.

Note: This budget does not include the Ryan White Title I federal funding to provide services to
persons with HIV/AIDS, for which the Department serves as administrative agency.

                                             Annual Report 2006

Flu/Pneumococcal Vaccine Program (Flu Hotline - 845.486.3435)

For the 2006 flu season, 20 influenza/pneumonococcal clinics were held at various sites
throughout the county. A total of 3,362 individuals received Influenza vaccine at these clinics,
with 2,301 of participants being ages 65 and older. A total of 303 persons were immunized
against Pneumococcal, of which 268 were 65 and older. Additionally, the Dutchess County
Department of Health’s (DCDOH) Immunization program continued to work with providers to
ensure their efforts to vaccinate their high-risk patients.

Childhood Immunization Program (845.486.3409)

                      The Childhood Immunization Program provides all recommended
                      childhood vaccines to children in Dutchess County. The program offers
                      clinics throughout Dutchess County as well as educational opportunities
                      to schools, community agencies, health care providers, and parents. As
                      evaluation of immunization rates in private medical practices has been a
                      priority, data is collected from participating medical practices by
                      immunization program staff. The results of the analysis are used to
                      establish accurate immunization levels and to improve immunization
                      rates in private practices. This information is also used to target
                      programs and services to areas with the highest rates of under-
                      immunized children. In 2006, 88% of children seen at public clinics were
                      fully immunized by age two.

Adult Vaccine Program (845.486.3409)
Travel Vaccination Program (845.486.3504)

The International Travel Vaccination Program and the Adult Vaccination Program provide
vaccination and health information to travelers and other adults. In 2006, 426 individuals
received important travel advice and vaccinations against at least sixteen diseases: (e.g.,
typhoid fever, yellow fever, hepatitis A and meningitis). In addition, 318 individuals received
adult immunizations at the Adult Immunization Clinics conducted.            Immunizations for
international travel are available monthly on the second and fourth Wednesday by appointment
only at the Dutchess County Department of Health’s Poughkeepsie Office. Adult immunizations
are also available on these same days, individuals have the option of calling to make an
appointment, but no appointment necessary for the Adult Immunization Clinic.

Children in Foster Care (845.486.3419)

Public Health Nurses provide developmental surveillance on children newborn to age five years
who are placed in foster care. These nurses work with the foster care Department of Social
Services’ workers and foster parents to assure these children are provided routine health
assessments, developmental screenings and referral to needed services. A public health nurse
is regularly scheduled at the Dutchess County Department of Social Services to review medical
records. The nurse assists to have medical records ready for adoption proceedings and make
recommendations for needed medical follow-up. In 2006, the nurses have provided home
services to 32 children and devoted 200 hours for medical record review.

                                         Annual Report 2006
Rabies Program (845.486.3544)

During 2006, the Environmental Health Services Division
conducted or participated in three free rabies clinics, with
one each at Beacon Community Center (127 dogs, 100
cats), Milan Town Hall (109 dogs, 113 cats) and East
Fishkill Fire Training Center (111 dogs, 132 cats)
resulting in the inoculation of 692 domestic animals with
rabies vaccine.

The Department authorized the post-exposure treatment of 62 persons following their exposure
to rabid or suspected rabid animals with Public Health Nursing admininistering rabies vaccine to
31 individuals in 2006.

Tuberculosis Control Program (845.486.3505)

In 2006, the DCDOH served 94 individuals through the Tuberculosis Control Program’s
Pulmonary Clinic. Individuals receive medical evaluations to rule out active tuberculosis as well
as provide HIV testing and counseling services. There were 11 active cases of TB diagnoses in
Dutchess County in 2006. All active cases received directly observed therapy. One (1) was
managed through the TB control program, seven (7) were managed by their private physicians
and three (3) through the correction system.

                         Active TB Cases from 2002 to 2006

                     8                     8                        8
               6                5 5                     5                      Community

               4                               3                        3      Dept. of Corrections
               2         1

                     2002       2003      2004          2005        2006
       Statistics as reported by Dutchess County Department of Health Communicable Disease Control Division

Sixty-four (64) individuals were enrolled in the Tuberculosis Control Program’s Latent
Tuberculosis Infection (LTBI) Program. These individuals do not have the active form of
tuberculosis and are not infectious but are still recommended for treatment to insure they do not
develop active tuberculosis later on in life. Patients enrolled in the LTBI Program received a
regimen of prescribed medications and regular nursing assessments to evaluate and follow up
any complications or side effects from treatment.

Screening for tuberculosis through Mantoux Skin Testing continued to be done through weekly
clinics. In 2006, 882 individuals were screened through Mantoux clinic. Individuals attending
these clinics request screening for employment and school requirements, volunteer activities,
and entrance into drug/alcohol rehab centers and homeless shelters. The Tuberculosis Control
Program also collaborates with community health centers and the Dutchess County Jail to
provide targeted testing for high-risk individuals.

                                                   Annual Report 2006
Maternal Child Health Home Visiting Program (845.486.3419)

Public Health Nurses play an extensive role in
monitoring and improving maternal and child health
in the County. In 2006, public health nurses
received a total of 1,179 referrals and made a total
of 2,370 visits in the context of maternal child home

Maternal Child Health services are offered
throughout the County. In 2006, the following
shows the distribution of services by geographic

Metropolitan area     (Poughkeepsie C/T, Hyde Park)                                        61%
Southern area         (Wapp.Falls, E. Fishkill, Beekman, Pawling, Fishkill, Beacon)        22%
Rural area            (Pine Plains, Northeast, Washington, Amenia, Dover,                  17%
                      LaGrange, Pleasant Valley, Union Vale)

The year 2006 saw the continuation of collaborations with Vassar Brothers’ Medical Center in
Centering Pregnancy & Parenting classes, Postpartum Depression Screening and Referral with
Astor Early Childhood programs and provided trainings to lay-staff and consultation services to
Healthy Families and Teen Parent programs.

Newborn Screening Program (845.486.3419)

Public Health Law sections 2500-a and 2500-1 mandate that all infants born in New York State
receive metabolic testing for 44 diseases and an infant hearing screening. The testing and
blood specimens are done within the first 48 hours of the baby’s life. If repeat testing or
additional testing is needed the local health department is notified. A public health nurse follows
up to make sure all additional tests are completed. In 2006, there were 37 infants who received
these services.

Certified Home Health Agency - CHHA (845.838.4800 or 845.677.4000)
Long Term Home Health Care Programs – LTHHCP (845.838.4800 or 845.677.4000)

Our CHHA and LTHHCP provide skilled nursing, Home Health Aides (HHAs), and other support
services to Dutchess County residents in their homes. Increased regulatory requirements for
paperwork required by insurance companies and regulatory agencies continue to be a
challenge. In 2006, Public Health Nurses administered flu vaccine to 38 high-risk residents in
their homes in addition to their regular caseload.

The home care supervisory staff provides consultation and serves in advisory roles on several
planning committees, including: The Elder Abuse Task Force, The Hudson Valley Home Care
Providers Association, Eastern Dutchess County Rural Health Care Network, The Home Care
Association of Dutchess County, and the Sharon Primary Health Network.

                                          Annual Report 2006

          Type of Service                      2005                2006

  Nursing                                      7,900               5,783

  Physical Therapy                             1,292                670

  Occupational Therapy                           38                  12

  Home Health Aide                             2,078               1,393

  Medical Social Worker                          25                   1

    LONG TERM HOME HEALTH CARE (Unit of Services)

        Type of Service                        2005                 2006

Nursing                                       1,762                 1,205

Physical Therapy                                586                  612

Occupational Therapy                             11                   14

Home Health Aide

Personal Care Aide                             3539                 3.020

Nutrition                                        2                     3

Medical Social Worker                           213                  169

Home Delivered Meals                          2,641                 1,681

Personal Emergency                                                   291
Response Service (PERS)

Social Day Care                               1,620                 1,115
Statistics as reported by the Dutchess County Department of Health Nursing Division

                                Annual Report 2006
Eastern Dutchess Maternity Clinic- EDMC (845.677.4000)

In 2006, the EDMC enrolled 58 pregnant women for prenatal care. Of the women enrolled in
this program: 45 delivered lives births, four miscarried, and nine were transferred to other
Obstetric providers due to high-risk medical conditions. For the population served, 33% were
teenagers and 22% were Hispanic. Seventy-five percent the women enrolled were also
receiving services from the Women, Infant and Children’s (WIC) supplemental nutrition
program.     In 2006, 57% of the women enrolled completed postpartum care visits.

All of the participants were counseled on the effects of tobacco use on both the pregnant
woman and the unborn child, as well as received education and screening for Cystic Fibrosis.

The major goals for 2007 include interventions to increase the number of women who return for
postpartum visits and to begin including preconception health screening into the admission and
discharge process.

Children With Special Needs (845.486.3403)

The Early Intervention Program provided services to
over 1,339 infants and toddlers with disabilities and their
families with an expenditure of 5.8 million dollars.

The Preschool Special Education Program provided
services to 1,012 children ages 3-5 with an expenditure of
13.50 million dollars.

Both programs have responded to the growing number of
Spanish-speaking children and families in each program by
contracting with bilingual teachers and therapists in every discipline, and collaborating with St.
Francis Preschool on a program of speech therapy groups for young children with severe
speech delays in their native language. Parents also attend the sessions to learn techniques in
supporting their children’s language development. Busing is provided for families unable to
supply their own transportation.

Childhood Lead Poisoning Prevention Program (845.838.4800)

The focus of the Childhood Lead Poisoning Prevention Program (CLPPP) continues to be
increased testing. In 2006, 58 children were diagnosed with having a lead level between 10-14,
16 children with a lead level of 15-19, and 13 children diagnosed with lead levels of 20 or

                                          Annual Report 2006
                        Number of Lead Screenings and Number of Children
                        with Elevated Blood Lead Levels in Dutchess County

                                     # of children        # of children           # of lead
                                      10-19ug/dl           >=20ug/dl             screenings
                        1998               243                   15                  4,216
                        1999                68                   7                   3,835
                        2000                12                   16                  4,355
                        2001                37                   7                   4,905
                        2002                28                   8                   5,054
                        2003                98                   14                  4,894
                        2004               106                   18                  5,292
                        2005               121                   12                  5,808
                        2006                74                   13                  5,822
                               Data Source: Dutchess County Department of Health

Program staff conducted and/or participated in four educational programs and 169 outreach
efforts including health fairs for area health care providers, community agencies, parent groups,
and Women Infant and Children’s Nutrition program sites (WIC) throughout Dutchess County.
The major outreach events of the year included the “Greater Hudson Valley Home Show” and
“2006 Kid’s Expo” where materials and education were made available to the public. The
program reached more than 40,000 individuals.

Sexually Transmitted Infections Program (845.486.3401)

Testing, diagnosis, and treatment of sexually transmitted infections are available twice a week.
All services are free, confidential, and available without an appointment. Free Hepatitis A &B
vaccines are available to all clinic patients 18 years and older. Cervical and breast cancer
screening is available for high risk women who meet financial/medical criteria established by the
New York State Department of Health Healthy Women’s Partnership. Referrals are made for all
patients with need for additional services. In 2006, there were 1,433 visits to the Sexually
Transmitted Infections clinic.
                                          STD CLINIC VISITS

              1600                                                                    1,433
              1400                                                1,245     1,300
                                            1,113      1,152
              1000                 799
               800      704
                        2000      2001       2002      2003       2004      2005       2006
           Data as reported by Dutchess County Department of Health Communicable Disease Control Division

                                                 Annual Report 2006
                     Dutchess County DOH Sexually Transmitted Disease Data

                                     2000          2001          2002        2003         2004        2005          2006
Chlamydia                              89           391          433          383          444         483          462
Gonorrhea                             192           214          181          195          176         111          122
Primary and Secondary                  1              1            4            0            2           2           4
Early Latent Syphilis                  1              3            3            4            4           2           5
               Data as reported by Dutchess County Department of Health Communicable Disease Control Division

  •       Gonorrhea cases increased by 9% in 2006
  •       Chlamydia continues to be the highest reportable STD. It is second only to Lyme disease
          for all types of reportable communicable diseases.
  •       Dutchess County Department of Health designed and implanted a new STD report form
          as well as a caseload referral card system in an effort to address the significant
          Chlamydia morbidity.
      •    Hepatitis C virus screening services – 221 patients were screened for the HCV through
           the HIV/STD clinics. Seven (7) were identified as positive.

                                       Hepatitis Vaccines Administered

           2000           2001              2002           2003             2004            2005             2006

            316            413              323             440              457            455              324
           Data as reported by Dutchess County Department of Health Communicable Disease Control Division

Clinical Trials

The Department continued its involvement in clinical research projects by participating in the
development of innovative, safe, and effective clinical interventions with FDA approval. In 2006,
the Department was involved in the following two clinical trials:

  •       GlaxoSmithKline Pharmaceutical Cervical Cancer Vaccine Clinical Research Trial – This
          trial continues to monitor 12 cervical cancer vaccine participants at the DCDOH site.
  •       GlaxoSmithKline Influenza vaccine trial – The CDCD enrolled 150 persons into this trial.
          This is the second flu trial the county has participated in.

                                                     Annual Report 2006
HIV Counseling and Testing Program

HIV counseling and testing is available by appointment or walk-in. All testing is free of charge
and both "anonymous" and "confidential" testing is offered. Confidential counseling and testing
is also available in conjunction with STD and TB clinics. Partner Notification Assistance
Program (PNAP) and testing is available to persons living with HIV/AIDS who should inform
partners of possible exposure to HIV. HIV testing is offered at STD clinic, HIV clinic, Methadone
clinic, Camp Beacon and PNAP. In 2006 there were 1,272 tests done identifying 6 HIV positive

                                    2006 Number of HIV Tests
                             Given by DCDOH By Various Clinic Sites

                           Type of Clinic                        Number of tests given

                                 STD                                           981

                                  HIV                                          248
                             Methadone                                          24
                          Camp Beacon                                           8
                                PNAP                                            11
                                 Total                                         1,272
           Data as reported by Dutchess County Department of Health Communicable Disease Control Division

                   Number of HIV Tests given by DCDOH from 1999 – 2006
          1400                                                                                         1,272
          1200                                                         1,076     1,113
          1000     903                     946




                   1999        2000        2001         2002           2003      2004      2005        2006

           Data as reported by Dutchess County Department of Health Communicable Disease Control Division

                                                  Annual Report 2006
Rapid Testing: Rapid HIV testing was implemented in July 2004. Our primary purpose in
initiating this was to increase the number of persons tested for HIV who received their results.
Previous types of HIV tests had a one to two week turn around time for receiving results. An
increasing number of persons tested never returned to receive their results. Prior to beginning
the rapid testing, our return rate was approximately 60%. In 2006, out of the 1,272 tests given,
1,269 individuals returned for their test results. Our percentage of those receiving their results
has been 99%-100%.
HIV Prevention, Street Outreach, and Community Education: HIV/STD prevention education is
targeted to high-risk populations and offered regularly at multiple sites throughout Dutchess
County. These sites include substance abuse treatment centers, alternative to incarceration
programs, centers serving the homeless, soup kitchens, adolescent programs and mental
hygiene centers. In 2006, 54 presentation programs were given reaching 3,242 persons.
The Department restructured and intensified its outreach program in 2006. The summer
program focused on street outreach including high areas of concentration such as Main Street,
Poughkeepsie and various parks as well as programs serving the homeless populations such as
The Lunch Box (soup kitchen) and the Living Room (housing and other services). Outreach to
men having sex with men (MSM) was accomplished by outreach in two high traffic local
bookstores where sexual activity takes place. In the “off season” efforts are re-focused to target
local colleges, a population which is identified by DCDOH as high risk. In 2006 there were 19
outreach events reaching over 2,351 individuals.

Ryan White Care Act, Title I Program - (845.486.3475)

                          Prior to Dutchess County’s designation as an Eligible Metropolitan
                          Area (EMA) to receive Ran White federal emergency funds in 1995,
                          there was no established continuum of HIV/AIDS care. Many People
                          Living With HIV (PLWH) were first diagnosed in the hospital
                          emergency room, presenting with opportunistic infections, or through
                          Department of Health testing. There were few local support services.
                          With receipt of Title I funding in 1995, the Dutchess County HIV
                          Services Planning Council was created to establish an effective
                          compassionate and comprehensive system of health care and other
                          support for people living with HIV/AIDS in Dutchess County.

                          The prevalence of AIDS in Dutchess has steadily increased, from 536
                          cases in 2000 to 801 in 2005. The primary risk factors for disease
exposures are Intravenous Drug Use (47%) followed by heterosexual transmission and Men
having Sex with Men (14% each). The HIV prevalence rate is 361/100,000 people, which is
twice the national HIV rate. The burden of HIV infection falls on minority populations, with
approximately 46% of the cases among Blacks and about 28% Hispanics. The epi-centers of
HIV infection are the urban areas of Poughkeepsie and Beacon.

To face this epidemic, in 2006, the Planning Council allocated funds to a range of interventions
aimed at increasing access to the HIV continuum of care. Ryan White Title I funds were
allocated to services that would keep People Living With HIV/AIDS in primary care and get into
care those who know their HIV positive status but are not in care.

                                          Annual Report 2006
                                  2006 RYAN WHITE TITLE I PROGRAM REPORT
                                   (MARCH 1, 2006-FEBRUARY 28, 2007)

     SERVICE CATEGORY                                  ACCOMPLISHMENT/OUTCOME

Primary     Care,    including        Primary Care services were provided to one hundred and
individual          medication        ninety three (193) clients living with HIV disease, all of which
adherence support, medical            were also provided with appropriate specialty care referrals.
case management and mental
health     assessment     and         Fifty Four (54) clients received an individualized medication
treatment by a dedicated              adherence intake, assessment and adherence specific support
licensed social worker.               sessions.

AIDS     Drug     Assistance          In FY2006, thirty five (35) clients received assistance with
Program (ADAP)                        medications for the treatment of HIV disease.
Provides medications for the
treatment of HIV disease.

Mental Health                         Five (5) unduplicated clients were linked to licensed
Provides outpatient mental            psychiatric treatment.
health       treatment   and
counseling services to people         Eight (8) clients received mental health counseling sessions led
living with HIV disease.              by Certified Social Workers. The sessions provide intensive
                                      support for clients experiencing compounding problems in
                                      addition to their HIV diagnosis.

Substance Abuse                       Twenty-eight (28) received substance abuse treatment and
Provides substance abuse              counseling services.
treatment, counseling and
support services. Conducts            Twenty-eight (28) were linked to to primary medical care and
outreach and education to             HIV/AIDS service providers as necessary.
Intravenous drug users that
are living with HIV disease.          Twenty-eight (28) were assessed and provided with harm/risk
                                      reduction methods and partner notification assistance.

Case Management including             In FY 2006, a total of eighty-eight (88) clients were served
Assessment of client’s needs          between two providers. Sixty-three (63) of these clients were
and personal support system,          minorities (i.e. African American or Hispanics). Case managers
development of an individual          assess clients’ needs and personal supports; mutually develop
service plan, monitoring and          individual service plans, monitors and reevaluates to determine
reevaluation to determine the         the effectiveness of interventions.
effectiveness of interventions.
At intake, case managers              Medical and community case managers regularly case
confirm client’s linkages with        conference to support continuity of care and medical
primary care services.                adherence. An interdisciplinary team of providers case
                                      conferenced forty-three (43) clients during the reporting

                                              Annual Report 2006

Transportation                      The Transportation program provided six-hundred and twenty
Transportation is provided          six (626) rides to medical and psycho-social appointments for
only   for   medical,  case         fifty-nine (59) unduplicated clients.
management, mental heath
and      substance    abuse

Emergency            Financial      The program assisted thirty-three (33) eligible clients,
Assistance                          including that required emergency assistance for telephone,
provides    consumers      with     utilities and medications, and seventeen (17) clients
financial assistance for utility,   accessed the program’s food pantry. The program notes that
phone      and     prescription     all of the prescription assistance requested has been for non-
medicine.                           antiretroviral and other non-HIV related medication.

Home      Delivered    Meals        Eighteen thousand five hundred and sixty-eight (18,568)
provides    home    delivered       meals were delivered to fifty-five (55) eligible clients.
meals to those recently
released from the hospital or
home bound for medical

                                            Annual Report 2006
Lyme Disease & Other Tick-borne Infections (845.486.3534)

Lyme disease and other tick-borne diseases continue to be a major concern in Dutchess County
even though the number of cases has decreased since 2003. Dutchess County Department of
Health continues to offer education, prevention, and surveillance activities.

                              Confirmed Cases of Tick-Borne Disease
                           as reported to the NYS Department of Health
                                                               01/01/2004 to
 Disease                                   2003                                             2005                2006
 Lyme Disease                             1,284                        966                  1,400                 930
 Ehrlichiosis                                  61                      47                   175                   138
 Babesiosis                                    8                       8                     23                   50
       Data as reported by Dutchess County Department of Health Communicable Disease Control Division

                   Laboratory and Physician Reports of Tick-Borne Disease
                   as reported to the Dutchess County Department of Health
                                                                       01/01/2004 to
Disease                                             2003                                             2005               2006
Lyme Disease                                        5,783                  4,542                    3,605              2,775
Ehrlichiosis                                          87                    140                      366                475
Babesiosis                                           20                     42                       157                369
Rocky Mountain Spotted Fever                           4                     6                        7                  6
       Data as reported by Dutchess County Department of Health Communicable Disease Control Division

Other Common and Emerging Communicable Diseases (845.486.3402)

The Dutchess County Department of Health Communicable Disease Control Division continues
to respond to all common and emerging communicable disease with a timely response to
assure control measures are implemented rapidly. This response has resulted in significant
reductions for common reported infectious diseases such as giardiasis and salmonella.

                        Reported Cases of Giardiasis in Dutchess County, NY
      70                                64
                   48                           49
      50                  44     45                                                  45
      40                                                        34      35
                                                                              30                           31      29
      30                                                 25
            1992   1993   1994   1995   1996   1997     1998    1999   2000   2001   2002    2003   2004   2005    2006

            Data as reported by Dutchess County Department of Health Communicable Disease Control Division

                                                      Annual Report 2006
                       Reported Cases of Salmonella in Dutchess County, NY
      70   62
      50                                                                                          45
                  41            41                                            42
      40                                     33
                                      31            31    31
      30                                                                             22
                                                                 20     21                  21
           1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

                Data as reported by Dutchess County Department of Health Communicable Disease Control Division

West Nile Virus – WNV (WNV Hotline 845.486.3438)

In 2006, there were no reported human cases of West Nile Virus (WNV). The Department
continues to conduct surveillance of dead birds and mosquitoes.

A total of 272 dead birds were reported in 2006. Of the 272 birds reported, there were 13
bluejays, 78 crows, 13 sparrows, 9 raptors (hawks), and 159 other. Only one bluejay was found
to be positive for WNV. The bird was found in the City of Poughkeepsie and reported in
September. Refer to the table on the next page for birds per township.

A total of 2,307 mosquitoes were collected with 67 pools submitted to for WNV testing. No
pools were found positive for WNV. Both the mosquito collections and the number of pools
were down by 58% from 2005.

The Department continues to address the issue of the West Nile Virus during 2006 through
treatment of more than 17,000 catch basins throughout Dutchess County with biological
mosquito larvicide in order to reduce the transmission of this virus within the community.

                                                  Annual Report 2006
                            Bird Sightings by Township by Month - 2006

    Township           Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total Percent

 Poughkeepsie city     14    5    8   1            6      2     3    3             12   54    19.9

Poughkeepsie town      1     3    3   6     8      10     5     4    6    1    1        48    17.6

  Wappinger town                  1        12      7      1     2         5             28    10.3

 East Fishkill town    1          1   4     4      4      2     2    1         2        21     7.7

  La Grange town                  1   2             3     4     1    1    1    2   1    16     5.9

    Fishkill town                 1         3      7      2     1    1                  15     5.5

  Hyde Park town       1              1     5      4                 1    1             13     4.8

  Red Hook town              2        1     2      2      3                             10     3.7

    Dover town                        2            3      1     1    1    1             9      3.3

   Pawling town                                    4      2          1    1             8      2.9

  Beekman town                        1     2       2     1                              6     2.2

    Clinton town                      2            1      1          1                  5      1.8

Pleasant Valley town              4         1                                           5      1.8

    Beacon city              1              2                   1                        4     1.5

  Rhinebeck town                      1            1            1         1             4      1.5

   Stanford town                      1     2                                      1    4      1.5

  Union Vale town                           1             1          1             1    4      1.5

    Milan town                                            2     1                       3      1.1

 Washington town       1          1                                            1        3      1.1

   Amenia town         1                                                                1      0.4

  North East town                 1                                                     1      0.4

  Pine Plains town                          1                                  0        1      0.4

     Unknown                      3                2            2    1         1        9      3.3

       Total           19   11   24   22   43      56    27     19   18   11   7   15   272   100.0

                                           Annual Report 2006

Health information, health education, and health communication activities designed to reduce
health risk and promote better health are crucial to ensure a healthy community. Putting Public
Health on the community agenda is one of the critical tasks local health departments are called
to do. The Dutchess County Department of Health accomplished this by increasing its
communication with the public through the media, participating in health fairs and other
community events, as well as engaging in direct community educational presentations.

Health Communication Activities

The     Commissioner’s       Column        in     the
Poughkeepsie Journal appeared on the second
Sunday of each month during 2006. This regular
column provided ongoing communication with the
general public on a variety of health topics, raising
awareness, and understanding of public health

News releases and PSAs were sent out to weekly to
all local media. In 2006, a total of 32 news releases
and PSAs were sent out on a variety of topics.

The Dutchess County Department of Health’s web
page on the County website was also regularly
updated to provide information to the public. In 2006,
there were a cumulative number of 249,819 hits
recorded for all of the Dutchess County Department of Health’s pages.

Hotlines were set up and ran for Lyme and West Nile Virus as well as the Adult Public Flu
Clinic Program. All hotlines were heavily used, with variation during seasonal periods (i.e. an
increase during the summer months for WNV and Lyme; and fall for Flu).

Dutchess County Department of Health staff also organized and participated in special events
such as Lyme Disease Week, Breast Cancer Month, and World AIDS Day. The Dutchess
County Department of Health continues to receive requests for presentations for health
programs from day care providers, Pre-School, elementary, middle and high schools, colleges,
and camps.

Public Health Nursing staff, Public Health Advisors, Sanitarians, and Public Health Education
Coordinators combined provided more than 450 educational and outreach presentations during
2006, reaching more than 9,000 individuals (combined children and adults). Pre- and post-tests
as well as satisfaction surveys were utilized for 80% of these presentations and revealed an
overall good satisfaction as well as good retention of the information presented.

                                        Annual Report 2006
Community Education

In 2006, there were a total of 13 Tobacco Use Prevention educational presentations in schools
and Community-Based Organizations given reaching a total of 208 students/youths/adults.
Evaluation of the presentations conducted revealed the following:
    ♦ The programs were rated as excellent by 50% of the recipients and very good by 50%
    ♦ Pre and post tests surveys revealed an increased in awareness among the majority of
        the students (Maintained = 90% and Increased = 9%).

Several West Nile Virus educational activities were conducted, ranging from mailings to health
fairs, news releases, website posting, telephone hotline, and distribution of information during
public events. In 2006, there were a total of 254 calls received through the West Nile Virus
hotline. A total of 53 callers were mailed WNV literature on topics such as West Nile virus,
mosquitoes and public health, personal precautions, and steps that can be taken around the
home or business to prevent mosquito breeding.

A total of 129 Nutritional and Physical Activity educational presentations including Eat Well
Play Hard strategies, Fit4ever, Fit Kids, Hyde Park trails, portion distortion and portion size were
conducted, reaching 4,225 students/adults

Diabetes and Go Red Sunday education/awareness were offered seven (7) times at Faith-
Based Organizations during Sunday services reaching 1,245 parishioners in 2006. Diabetes
Sunday is a ten-minute educational awareness program offered to the faith community. A
simple definition of diabetes, current statistics, risk factors, signs, and symptoms are provided
for the audience. There were also 19 presentations offered with regards to diabetes and
healthy eating for people with diabetes, reaching 346 individuals.

In 2006, sixty-three (63) presentations were given on Stress Management and Cardio-
vascular Health and CPR Heartsaver classes to 547 employees, schools and at risk minority
populations in the community and at the local jail. Evaluations consistently reported increased
knowledge and satisfaction with the program.

In order to promote better life skill choices, a total of eighteen (18) teen pregnancy prevention
programs using the Empathy Belly were given to 427 middle and high school students
throughout Dutchess County.

Thirty-nine (39) presentations were given promoting good oral care to a total of 854 students
and teachers at various elementary and preschools within Dutchess County.

A total of sixteen (16) Lyme disease
educationals/health fairs were done
reaching over 2,100 students and adults
with between 80 to 100% verbal
satisfaction and increased knowledge.

                                           Annual Report 2006
Food Service and Outreach and Education - Since 2000, 17 food service facilities have
received food safety training after initial enforcement action (either informal or formal) was
completed by the Department. Notably, 14 of these facilities have not been subject to any
further enforcement action. This figure reflects an 82% compliance rate.

                                                 In comparison, 12 facilities have been subject to at
                                                 least two enforcement actions (informal and/or
                                                 formal) during the same time frame. Of these
                                                 facilities, nine did not receive any food service
                                                 training after the first enforcement action. This
                                                 reflects a 75% recidivism rate for food service
                                                 facilities that are staffed by personnel who lack the
                                                 information that they need to prepare food safely.

                                                 Together,     these    figures    emphasize     the
                                                 effectiveness of a food service training program as
                                                 a means of preventing additional enforcement
                                                 action and achieving code compliance.

                           Comparison of Follow-Up Enforcement Action at
                               Restaurants and Training Received

                   Restaurants with
                    Percentage of


                                                                  no food service training

                                                                  food service training
                                      20                          received


Bathing Facilities and Outreach and Education - Public Health Sanitarians within the
Environmental Health Services division began to provide drowning prevention seminars to
lifeguards in 1988, following a drowning at a permitted facility within the County. These
discussions highlight victim recognition and serve to raise lifeguards’ awareness of swimmers
who are in distress.

Between 1987 and 2004, there were five documented drownings at regulated bathing facilities
in Dutchess County; with the last occurred in 1995. During the 12 years since this last incident,
1,249 lifeguards have attended these annual drowning prevention seminars. During recent
years, local lifeguards have noted that information that they have learned during these seminars
has helped them to recognize and initiate rescues of distressed bathers. This reflects the
importance that this education program plays in saving lives.

                                             Annual Report 2006
                                                                     Comparison of Lifeguards Trained and
                                                                     Drowning Deaths at Permitted Bathing
                                                                         Facilities in Dutchess County

                                                Number of People
                                                                   600                                     Lifeguards
                                                                                                 427       receiving training
                                                                   400                                     Drownings
                                                                   200   79
                                                                              5         0              0
                                                                         1988-     1996-         2004-
                                                                         1995      2003          2006

Rabies Program and Outreach and Education - The Dutchess County Department of Health
and its community partners offer a number of rabies clinics throughout the year. The
Department, in cooperation with the Dutchess County SPCA, offers three clinics per year, free
of charge, to pets owned by county residents; DCDOH partners offer rabies shots at a nominal
cost at various times and frequencies.

Since 2000, 5,233 pets (domestic dogs, cats, and ferrets) have been vaccinated against rabies
at a Department sponsored clinic or at a community partner’s clinic. Between 2000 and 2005,
there has also been a fairly steady decline in the number of humans receiving rabies post-
exposure treatment due to contact with suspect animals.

                                                                   Comparison of Pets Vaccinated and Humans
                                                                   Receiving Rabies Post-Exposure Treatment

                    N u m b er o f P ets o r

                                               1000                                                         Number of Pets
                                                                                                            Vaccinated at Clinics
                          H u m an s

                                                600                                                         Number of Humans
                                                400                                                         Receiving PEP (not
                                                200                                                         including bat exposures)
                                                  0                                                         Number of Humans
                                                                     2000 2001 2002 2003 2004 2005          Receiving PEP (dog or
                                                                                                            cat exposures, only)

Notably, when comparing the figures for 2005 to 2000, the number of pets vaccinated in 2005
reflects a 40% increase in the number of pets vaccinated in 2000. As such, there was a 63%
decrease in the number of humans receiving rabies post-exposure treatment in 2005 in
comparison to those in 2000. Also, when comparing 2005 figures to 2000 figures, there was a
57% decrease in the number of humans receiving post-exposure treatment due to contact with
suspect dogs and cats.

                                                                                  Annual Report 2006
With respect to the financial cost of post-exposure rabies treatment, in 2000, approximately
$37,200 was paid out by the County for the treatment of individuals who were exposed to
suspect animals during that year. In comparison, in 2005, approximately $16,550 was paid out
for treatment of individuals with exposures during that year. This represents a 55% decrease in
treatment cost payments. (Note, in 2000, the County was reimbursed approximately $27,300 by
New York State for rabies shots that were authorized by the DCDOH, and approximately
$14,339 in 2005.)

In summary, these numbers indicate that the provision of rabies shots to pets at low or no cost
serves to protect the health and safety of County residents.

The Dutchess RX Prescription Drug Discount Program (1.877.321.2652)

Dutchess County launched a discount card program to help consumers cope with the high price of
prescription drugs. The Department of Health was assigned the responsibility for implementing the
program. Free prescription drug discount cards are available under a program sponsored by the
National Association of Counties (NACo) that offers average savings of 20% off the retail price of
commonly prescribed drugs. The program is administered by AdvancePCS, a division of Caremark
Rx, Inc. of Nashville, Tenn.

The cards may be used by all county residents, regardless of age, income, or existing health
coverage, and are accepted at 58 pharmacies throughout the county. A national network of more
than 54,000 participating retail pharmacies also will honor the NACo prescription discount card.
There is no enrollment form, no membership fee, and no restrictions or limits on frequency of use.
Cardholders and their family members may use the card any time their prescriptions are not
covered by insurance.

As of December 31, 2006, the program cumulatively has served 6,586 people, with 14,337
prescriptions covered, yielding a year-to-date price savings of $216,754.00 or 24.10% price savings
for prescriptions filled.

To find out more about this program, log onto www.Dutchessny.gov or call 877-321-2652.

                           Prescription Discount Drug Program - 2006 Status Report
                Total                          Total
                                Total                               Total          Price                      % Price
              Residents                    Prescriptions                                         Price
  Month                       Residents                         Prescriptions   Savings Per                 Savings Per
              Served Per                   Covered Per                                        Savings YTD
                             Served YTD                         Covered YTD       Month                     Prescription
                Month                         Month
 January         500            500            1,112                1,112        $15,949        $15,949       24.16%
 February        478            978             996                 2,108        $13,770        $29,719       24.40%
  March          526           1,504           1,158                3,266        $16,762        $46,481       24.78%
   April         550           2,054           1,184                4,450        $18,040        $64,521       24.76%
   May           529           2,583           1,177                5,627        $17,356        $81,877       24.35%
   June          550           3,133           1,177                6,804        $18,678       $100,555       25.40%
   July          538           3,671           1,171                7,975        $18,364       $118,919       25.31%
  August         572           4,243           1,272                9,247        $19,862       $138,781       26.01%
September        545           4,788           1,179               10,426        $18,704       $157,485       25.58%
 October         591           5,379           1,274               11,700        $19,694       $177,179       25.69%
November         592           5,971           1,261               12,961        $18,776       $195,955       24.04%
December         615           6,586           1,370               14,337        $20,799       $216,754       24.10%

Current totals include prior months adjustments received from NACo’s cumulative totals.

                                                 Annual Report 2006

Several initiatives addressing chronic diseases were implemented in 2006, including programs
addressing childhood obesity, healthy heart, tobacco use, asthma, and diabetes. All of these
initiatives were prevention programs involving the community through coalition building and
public private partnership. The Community Health Assessment (2005-2010) was also
completed by partnering with our community.

Operation Heart Beat

Dutchess County Department of Health is responsible for the County‘s PAD program. Through
this program nine Automated External Defibrillators (AEDs) were installed in eight designated
County buildings. In 2004, the final AEDs were installed and implemented in the Department of
Social Services, Office of Aging and Planning, Department of Mental Hygiene, and the Beacon
Health Center, bringing the total number of fifteen (15) strategically placed AED’s in County
office buildings and one (1) each at Bowdoin and Wilcox parks. Twenty-two (22) Heartsaver
AED classes were given in 2006, reaching 101 DC employees and 21 professional staff, who
were certified with Heart Care Provider (HCP) CPR.

SmokeFree Dutchess (845.486.3559 or 1.866.481.2345)

SmokeFree Dutchess (SFD) is a tobacco control community
partnership grant funded by the New York State Department
of Health’s (NYSDOH) Tobacco Control Program and is
administered through the Dutchess County Department of
Health.    SmokeFree Dutchess’ goals are to decrease
exposure to secondhand smoke, promote cessation from
tobacco use, to prevent youth initiation of tobacco use and to
decrease the social acceptability of tobacco by running
counter-marketing ad campaigns, education, and advocating for changes in societal norms
regarding tobacco.

Some of SmokeFree Dutchess’ highlights in 2006 include:

              Educated youth at the Mill Street Loft about the dangers of using tobacco and
              how the industry targets them;

              A breakfast honoring Peter Reilly, a landlord in the city of Poughkeepsie, for
              making his apartment building smoke-free;

              Produced a television commercial at a local bar celebrating the 3rd anniversary of
              the Clean Indoor Act using local residents as the actors.

              A media campaign about how cigarettes damage your body resulted in an
              increase of 500 more calls from Dutchess County to the NYS Smokers Quitline.
              The campaign also encourages and educates the public on making your car and
              home smoke-free.

                                        Annual Report 2006
Through the NYSDOH, a Tobacco Retail Advertising Survey was done to assess the amount of
tobacco industry point-of-purchase (POP) advertising in Dutchess County. Out of the 35 - 40
surveys done, the village of Fishkill and Beacon had the most POP advertising.        SFD is
educating tobacco retailers about POP advertising to encourage a decrease or elimination of
tobacco point-of-purchase advertising especially with our youth being the most vulnerable
population to this form of advertising. A major outreach for 2006 and 2007 is designed to
encourage business and non-profits to say, “No Thanks Big Tobacco.” This campaign aims to
prevent tobacco industry advertising and promotion by raising the awareness of local business
and organizations of the attempts by the industry to use sponsored events and programs, as
another venue to target and encourage our children to become users of tobacco products.

Children’s Health Initiatives

The Department continues to oversee the County-allocated funds for comprehensive Youth
Tobacco Use Prevention and Childhood Obesity Prevention and Intervention Programs under
the auspices of the Children’s Health Initiatives, a subcommittee of the Children Services
Council. The Department contracts with the United Way of Dutchess County for the
administration of these grants which includes the overseeing of the Request for Proposal (RFP)
process, as well as monitoring and evaluating the programmatic and fiscal activities of the
service providers.

In 2006, $294,000 grant funds served 4,905 youth in tobacco initiatives and $71,997 in grant
funds served 1,031 youths and 832 adults with obesity programs.

                AGENCY           PROGRAM            OUTCOME
                                                    Number of youth served: 72
   Tobacco      Children’s    Health: The Real      Outcome: Through Countermarketing students gained
   $40,000       Media           Glamour            knowledge and skills related to anti-tobacco and youth
                 Project                            activism crating 2 video public service announcements and 6
                                                    tee shirt designs.
                  CAPE          Tobacco free        Number of youth served: 2,640
   Tobacco                      youth initiative    Outcome: Provided tobacco, alcohol and other drug prevention
   $110,000                                         training to students aged 8-18 including LifeSkills (LST) and
                                                    teens Against Tobacco Use (TATU). In addition, they were
                                                    trained as peer educators.
   Tobacco      Girl Scouts     What We See         Number of youth served: 20
   $25,000      of America      What We Fear        Outcome: A six week instructional/workshop highlighting the
                                                    dangers of tobacco.       The “hook: was the film making
                                                    component where girls learned to interpret/decode tobacco
                                                    ads and created counter marking strategies to think critically
                                                    and work in groups.
   Tobacco        Martin         The Theater        Number of Youth served: 32
   $15,000      Luther King        Project          Outcome: After school program provided art/theater activities
                  Cultural                          designed to increase awareness of tobacco hazards and
                  Center                            promote positive life skills.     Three performances were
                                                    presented to 30 children and families.
   Tobacco     Mid Hudson       Teens against       Number of Youth served: 35
   $21,000      Children’s       tobacco use        Outcome: Educate teens about the negative effects of tobacco
                Museum             (TATU)           and train them to be able to present to the community. Video
                                                    was developed by the youth in 2005 and used in 2006 as well.

                                               Annual Report 2006
                  AGENCY         PROGRAM             OUTCOME
   Tobacco       Mill Street      Breathe            Number of Youth served: 104
   $43,000           Loft       Free/Respira         Outcome: Bilingual program served 11-18 yrs with emphasis
                                   Libre             on young women and Latino populations through Project
                                                     ABLE and PASWORD. A public mural was crated and
                                                     displayed at the Ice House at Waryas Park. as well as anti-
                                                     smoking TV commercial which airs countywide. Students
                                                     produced and delivered a stage production from personal
                                                     experience and poignant poetry.
   Tobacco       St. Francis      Preventing         Number of Youth served: 1,236
   $40,000        Hospital      Alcohol & drug       Outcome: Multimedia, age appropriate prevention lessons to
                                abuse through        school age children in their classrooms.                 Included
                                   primary           presentations over multiple years to ensure that anti drug
                                  prevention         norms, specifically tobacco are reinforced and social skills
                                  education          encouraged at an age appropriate level.
Obesity $5,000    Arlington    Step into Fitness     Number of Youth served: 350
                   Middle                            Outcome: Educate students about importance of physical
                   School                            activity and to improve individual fitness. With the purchase of
                                                     pedometers the students participated in Walk the Appalachian
                                                     Trail challenge – to walk 2100 miles or 5 million steps.
                                                     Success as they walked 7,803 miles or 15,608,315 steps. A
                                                     new after school walking club has been created as a result of
                                                     this program.
   Obesity       Girl Scouts     Body by me!         Number of Youth served: 102
   $12,000       of Dutchess                         Outcome: Eight week program incorporated variety of activities
                    County                           and education forums to learn about importance of physical
                                                     activity and good nutrition as well as the negative effects of
                                                     obesity. At the end the girls earned their Body by me! Badge.
Obesity $7,000   Mid Hudson       Activ8Kids         Number of Youth served: 127
                  Children’s    Playgroup and        Outcome:90 children ages 7-12 participated in summer camp
                  Museum        Summer camp          where healthy food were provided and physical activity done.
                                                     Playgroup was a 5 week program for children ages 5 and
                                                     under to gain knowledge about healthy food choices. Healthy
                                                     snacks were provided along with physical activites.
   Obesity       North East     Summer camp          Number of Youth served: 49
   $16,497       Community                           Outcome: Six week full day summer camp included nutrition
                   Center                            and physical fitness education, field trips and other activities
                                                     identified and selected by a student advisory council.
   Obesity          Violet     Vitality for Violet   Number of Youth served: 220
   $16,500         Avenue           Avenue           Outcome: All 4th and 5th grade classes ages 9-11 participated
                 Elementary                          in 10 session of a Lindy dance class which included a focus on
                   School                            healthy foods, obesity prevention and physical activity.        A
                                                     family dance concluded the event, was offered a second time
                                                     in the fall and a dance group “swing kids” was formed as a
                                                     result of this program.
   Obesity        Dutchess     Kidz Y Challenge      Number of Youth served: 165 and total people served was 795
   $10,000         County                            Outcome: Annual childhood obesity awareness walk for
                   YMCA                              October developed where information to general public about
                                                     childhood obesity, physical activity and good nutrition at
                                                     YMCA’s 25 bridge run and health kids day. Provided health
                                                     related physical activity and nutrition curriculum and
                                                     implemented use of it at YMCA’s 8 after school programs.
Obesity $5,000    Young          Connections         Number of Youth served: 18
                 Rhinebeck                           Outcome: After school health based program for 8 grade at
                                                     risk students. They worked with tutors from Bard College
                                                     incorporating nutritional counseling, healthy snack preparation
                                                     and physical exercise. It ran only in the Spring.

                                                Annual Report 2006
The use of counter-marketing was used to enhance and promote awareness and behavior
changes on the issues of obesity and tobacco use. The following is what was done:

         Three commercials were developed and produced by Children’s Media Project: Fruit is
         Fun, Violet Avenue Dance, and Harlem Valley Rail Trail. The target audiences,
         respectively, were for children & adults; children, middle-school students, and adults;
         and teens. Total costs for these commercials were $38,922. All of the commercials
         were aired on Cablevision and Time Warner for six months at a total cost of $15,540.

         In addition, Clear Channel created two radio commercials without production costs (ie.,
         for free). One was targeted to parents and the other was targeted to young adults. A
         total of $11,000 was spent on advertising costs to air these two commercials.

         A mix of Center for Disease Control (CDC) pre-produced commercials and
         commercials prepared by Children’s Media Project were used.          All of these
         commercials were aired on the local Cablevision and Time Warner cable stations at a
         total cost of $41,728.00.

Diabetes Coalition

The Dutchess County Diabetes Coalition continues to be proactive in our community. This
year, a professional educational program for health care professional (nurses, nutritionists,
physician assistants, and pharmacists) was offered through the Mid Hudson Catskill Coalition
for the Prevention of Diabetes. Approximately 100 professionals attended and had an
opportunity to meet the guest speaker, Joe Solowiejczyk , MSW., RN, CDE as he presented
“Family Dynamics & Diabetes Management in Children and Adults” for the annual professional
educational program.

The Department continues to offer community education programs to local residents in senior
housing and local churches. The programs are advertised through church bulletins and posted
in the senior centers and pharmacies. All sessions include the standards of care for person with

Other Coalitions

The Department’s personnel regularly participated in various other coalitions, including the
Eastern Dutchess Rural Health Network, Dutchess County Housing Consortium, American
Cancer Society, Healthy Women’s Partnership, Domestic Violence Prevention Coalition, Youth
Development Action Network (previously known as Teen Pregnancy Prevention Network),
American Heart Association, Children Services Providers Network, and the Dutchess County
Children Services Council.

                                         Annual Report 2006

Enforce laws and regulations that protect health and ensure safety

The Dutchess County Department of Health is responsible for the enforcement of sanitary
codes, especially in the food industry; the protection of our drinking water supply, the
enforcement of clean air standards, and the follow up of hazards and exposure-related diseases
identified in occupational and community settings.

                                  Enforcement Actions for 2006

            Number                                  Type                      Fines
               6                     Food service facility actions            $7,000
               2                   Sewage disposal system failures            $5,750
               1                         Public water supply                  $3,500
               13              Retail tobacco fines (10/1/05-9/30/06)         $8,650
                                                                          Total $24,900

                                  Community Sanitation for 2006
                                     Type                                   Number done
     Food service inspections and reinspections                                 3,207
     Nuisance FV and complaint investigations                                   1,081
     Subdivision and individual lot inspection/ reinspection                    1,231
     Residential Sanitation (housing) and complaint investigations               617
     Residential Lead investigation field services                                84
     Rabies investigations                                                       358
     Rabies specimens to Albany
                                                                             (8 positive)
     Rabies post-exposures to 12/14/06                                            59
     Drowning prevention seminars                                                 12
     Environmental spill events                                                  355

Clean Indoor Air, Tobacco Sales and Tobacco Use

The New York Adolescent Tobacco Use Prevention Act (ATUPA) prohibits selling cigarettes to
minors, and requires retailers to obtain positive proof that the person buying the cigarettes is
over the age of 18.

                                            Annual Report 2006
Additionally, the Dutchess County Sanitary Code requires retailers to obtain a Dutchess County
permit to sell tobacco products.

Dutchess County Department of Health conducts regular compliance inspections, including
compliance checks where minors attempt to purchase tobacco.

                                   Compliance Checks Results
                          From October 1, 2005 through September 30, 2006

   # of         # of vending          # of inspections              # of tobacco           Total fines
 retailers       machines                conducted                    violation             collected

                                      405 with minors             13 sales to minors
   360               23                                                                       $8,650
                                       54 with adults               2 sale to adult

Dutchess County Sanitary Code Article 25 requires all private schools and public school districts
each year to file a smoking policy with the DCDOH by September 30th. Additionally, public and
private schools that include grades 6 thru 12 are to report smoking/possession violations on
school grounds twice per year.

             Dutchess County Private School and Public School District Reporting
                          (September 1st 2005 - August 31st 2006)
                      % Submitting smoking        % Submitting violation        % Submitting violation on
                           policies                on 1st report period            2nd report period
   Public School
                               54%%                         75%%                          78%
  Private schools
      (N=32)                   33%                           53%                          66%

The public schools submitting reports on smoking/possession violations reported 152 students
to be in violation during the 2005/2006 school year. Among the private schools reporting on
smoking/possession violations, 30 students were found to be in violation. The number of
students referred to the DCDOH during the 2005/2006 school year was 2 of which 0 went to

Environmental Hazards

The Environmental Health Services Division conducts environmental lead assessments in
homes, schools, and daycares where a child with an elevated blood lead level greater than 20
micrograms per deciliter spends a significant amount of time. In 2006, the Department has
conducted 18 environmental investigations resulting in 15 Notice and Demand hearings
requiring the discontinuance of conditions conducive to lead poisoning.

                                             Annual Report 2006
The Dutchess County Department of Health conducted a review of all spill reports provided to
this Department in 2006 by the New York State Department of Environmental Conservation.
Spill reports are required to be made anytime there is a release of any petroleum products
regardless of quantity into the environment. These reports include reports of releases or spills
from petroleum bulk storage facilities, commercial facilities, tank test failures, contaminated soils
from tank removals, overfills to tanks, automotive accidents, improper disposal, abandoned
drums, and vandalism.


In 2006 the engineering staff approved more than 600 residential building lots with a total
housing value of approximately $250,000,000. Additionally, they provided approval of more
than 400 plans for subdivision, individual lots, commercial properties, water and sewerage
systems, and public swimming pools.

Investigations of soil pesticides in subdivisions built on lands previously used as orchards were
also completed. Staff completed a revision of the Dutchess County Department of Health
“Design and Construction Standards for Water and Wastewater Systems” guide which is
available at http://co.dutchess.ny.us/countygov/departments/health/reports/hddesignst.pdf .

Public Water Supplies

The Department regulates approximately 710 public water supplies (PWS). More than 50,000
people rely on water from the PWS at the cities of Beacon and Poughkeepsie; with another
45,000 individuals who obtain their water from the town of Poughkeepsie. These larger
community supplies, along with 85 others, are regulated by the engineering section of the
Environmental Health Services division. Water supplies at facilities under permit (restaurants,
motels, camps, day care centers, etc.) are inspected by the public health sanitarians assigned
to one of the three district offices. There are approximately 320 of these water supplies in
Dutchess County. The remaining 300 supplies are monitored by the Department’s Water
Enhancement Program staff.

During 2006, as a result of more than 700 inspections at public water supplies, more than 550
violations were issued. The most common violations cited were: unsatisfactory operation of
treatment equipment; source water pollution; incomplete or unacceptable reporting by the
supplier; the presence of a cross-connection between potable and non-potable water; failure to
maintain disinfection chemicals at proper concentrations; failure to monitor for contaminants in a
timely manner; modification to the treatment system without approval; and diminished quality or
quantity of source water.

Throughout the course of the year, organic chemicals were sampled by water suppliers (250
samples) and the Department (70 samples); inorganic samples were also collected by water
suppliers (260 samples) and the Department (234 samples). The combined number of
bacteriological samples taken by water supplies and this Department was 5,360, of which 10%
were repeat samples collected to determine if a violation existed.

Samples are taken regularly at PWS to analyze for a variety of organic chemical contaminants.
Among the many water supplies that are monitored in this fashion, 44 are at gasoline service

                                           Annual Report 2006
stations, generally in association with a “convenient mart” or a small plaza or mall. The organic
chemical of primary concern at these locations is the petroleum additive MTBE (methyl-tertiary-
butyl-ether). In the event of a petroleum spill or a leaking storage vessel, MTBE, being highly
soluble in water, finds its way quickly into drinking water sources. There were 41 separate
sampling events at the wells at these locations since January 2006. Of these samples, 13
returned without an MTBE detect. Nine samples indicated the presence of MTBE but at a
concentration below the Maximum Contaminant Level (MCL) value of 10 ppb (parts per billion).
The remainder (19) having a previous sampling history for MTBE exceeded the MCL. The
range of detects was wide: 0.5 ppb at the low end, to 2500 ppb at the high end. All the supplies
that exceed the MCL at the source, approximately 20, are currently treating the water to remove
MTBE. Although MTBE as a gasoline additive has been discontinued since January 2004, the
contaminant is persistent and must be closely monitored across the county. However, testing
has reflected the success of the MTBE ban as only one first time occurrence of a PWS
exceeding 10 ppb of mtbe occurred in 2006.

At water supplies not located at a service station or in proximity to one, 227 well samples were
collected for MTBE. Of these, 160 samples indicated the absence of MTBE; 35 indicated the
presence of MTBE but at a level less than the MCL. The range of MTBE detects at these wells
was 0.5 to 461 ppb.

                                                  A new emphasis has been placed on the
                                                  presence of chlorides in drinking water at public
                                                  water supplies. It is believed that the presence
                                                  of chloride is attributable to the spreading of salt
                                                  on roads in winter. Chloride is considered a
                                                  "secondary contaminant" by EPA in that its
                                                  presence is not generally a threat to health. It
                                                  does, however, impart an objectionable taste
                                                  and can contribute to corrosion of plumbing
                                                  fixtures and pipes. The overarching difficulty
                                                  with chloride is that once it reaches high levels
                                                  and must be removed, the treatment is most
                                                  often "reverse osmosis," which can be
                                                  expensive and place an undue burden on
                                                  sewage disposal fields. During 2006, 316
                                                  samples were analyzed for chloride, revealing a
                                                  range of 0 to 952 parts per million (ppm). Of
                                                  these, 216 were below the MCL of 250 ppm.
                                                  The average level detected was 190 ppm.
                                                  Based upon the results thus far, it appears that
                                                  chloride is a concern only in a few water

The greater share of the field investigations and data processing tasks involving public water
supplies is the responsibility of the Division’s Water Enhancement Program (WEP), which
operated under a grant of $374,000 from New York State. WEP is visited and evaluated
quarterly by the NYS Department of Health’s BWSP (Bureau of Water Supply Protection) and
evaluated across a spectrum of field and data processing issues.

                                         Annual Report 2006
Medical Examiner Program

The Dutchess County Medical Examiner’s Office investigates all occurrences of sudden,
unexpected, violent or suspicious death that occur within Dutchess County, in the interests of
the law, public health, and safety, as well as the community at large.

The purpose of the Medical Examiner’s investigation is to determine cause and manner of
death, and to render opinions as to mechanisms of death and injury patterns. On occasion, the
Medical Examiner’s Office is consulted when a victim of criminal violence sustains a non-fatal
injury or when child abuse or abuse of an elderly person is suspected.

The staff of the Medical Examiner’s Office includes a Chief Medical Examiner, a Deputy Medical
Examiner, a Chief Medicolegal Investigator, an administrative Principal Program Assistant, and
a Mortuary Technician. Contracted Medicolegal investigators under the supervision of the Chief
Investigator provide additional night time and week-end coverage.

Medicolegal Investigators respond to all calls reported to the Medical Examiners Office 24 hours
a day, seven days a week, and respond to the scene of any death occurring in a location other
than a hospital. If a death falls within the jurisdiction of the Medical Examiner, the deceased will
be transferred to Vassar Brother’s Medical Center at no cost to the next of kin. An autopsy or
an external examination will be performed, depending on the circumstances of death. If a
postmortem examination is not required and the decedent’s physician is unable sign the death
certificate, the Medical Examiner’s Office will issue a death certificate and release the body to
the funeral home.

The Medical Examiner’s Office is involved in the teaching and training of law enforcement
agency personnel, paramedics, and forensic nursing students on a regular basis. Lectures are
offered to forensic science students at local colleges and high schools upon request.

                  Medical Examiner’s Office Case Load (2003 to 2006)

           700                                          700             Total number of cases
                             641           623
           600   573                                                    reported to the
                                                                        medical Examiner
           400                                                          Postmortem
           300                   240           243              243     (autopsies and
                       170                                              external exams)
                                                                        Death Certifications
           100                        45          56             54
             0         0
                   2003        2004        2005           2006

                                           Annual Report 2006
                         PROGRAMS AND SERVICES DIRECTORY

Home Health Care Programs
Certified Home Health Agency – Services for homebound individuals who are under the care of
a physician include: Skilled nursing and case management, Physical, Occupational and Speech
Therapies, Home Health Aide services and assistance with medical supplies and equipment.
(845) 838-4800 or (845) 677-4000.

Long Term Home Health Care – Services for individuals who qualify for nursing home
placement and meet the financial eligibility requirements include: Skilled nursing, case
management, Physical, Occupational and Speech Therapies, Home Health Aide, Personal Care
Aide, Medical Social Worker, Nutritionist, Respiratory Therapy, Personal Alert System, Social
Day Care Services, Transportation, and Home Delivered Meals. Please call (845) 838-4800 or
(845) 677-4000.

Maternal and Child Home Visiting Program
Public Health Nurses are available to provide comprehensive home based services, to families,
that start during pregnancy or after a child is born. Home visits provide education, support and
case management services and are focused on assisting parents to meet the challenges of
parenting and to assure the healthy development of children. (845) 486-3419.

Childhood Lead Poisoning Prevention Program
Public Health Nurses provide individual case management and follow-up to children with
elevated blood lead levels. Community education and outreach Environmental investigations
are also available. (845) 486-3419.

Early Intervention Program
Families with infants and toddlers who have special needs may be eligible to receive services to
enhance the child's growth and development. (845) 486-3403.

Preschool Special Education Program
Services are provided for children with special needs, ages 3-5, in conjunction with the family's
school district. (845) 486-3403.

Perinatal Hepatitis B Program
Public Health Nurses provide individual case management and follow-up to infants born to
mothers who are Hepatitis B positive. (845) 486-3525.

Eastern Dutchess Maternity Clinic
Prenatal Care Assistance Program (PCAP) provides comprehensive prenatal care, delivery and
postpartum care to income eligible women. Includes individual case management, education,
counseling and referral services. Assistance with Medicaid application process is provided.
(845) 677-4000.

Physically Handicapped Children’s Program
Financial assistance program to parents of physically handicapped children based on eligibility
requirements that include both financial and physical conditions. (845) 486-3406.

                                         Annual Report 2006
Childhood Immunization Clinics
Clinics are held at sites throughout the county on specific days each month with no fee for
service. Children under 18 years of age must be accompanied by a parent or guardian. All
participants should bring with them any previous immunization records. (845) 486-3409.

Adult Immunization Clinic
Clinics are held twice a month to provide recommended vaccines to adults. Clinic is ideal for
those individuals who need immunizations for employment. (845) 486-3504.

International Travel Immunization Clinic
Clinics are held twice a month to provide vaccines and health information to adults and children
planning international travel. (845) 486-3504.

Flu and Pneumonia Immunization Clinic
Clinics are held throughout Dutchess County for adults who are eligible for the vaccines.
Medicare Part B is accepted or a small fee is charged, however, no one will be turned away
because of inability to pay. (845) 486-3435 (Hotline).

Communicable Disease Information/Case Reporting
Prevention and control of infectious disease. Health providers and the public may call to inquire
about infectious disease precautions, symptoms, diagnosis and treatment. (845) 486-3402.

Sexually Transmitted Infections (STI) Program
Testing, diagnosis, and treatment of sexually transmitted infections is available twice a week.
All services are free, confidential, and available without an appointment. Free Hepatitis B
vaccine is available to all clinic patients. Referrals are made for those persons needing
additional services. (845) 486-3401.

HIV Program
HIV counseling and testing is available by appointment or walk-in. All testing is free of charge
and both "anonymous" and "confidential" testing is offered. On-site educational presentations,
with or without testing, are available for schools and community groups. Partner Notification
Assistance Program (PNAP) is available to persons living with HIV/AIDS who want to inform
partners of possible exposure to HIV. (845) 486-3401.

Rabies Post Exposure Program
Administration of, or the arrangement for the administration of, rabies vaccine for treatment of
rabies exposure. (845) 486-3404.

Tuberculosis Control Program
Clinic and case management services for the diagnosis and treatment of Tuberculosis.
Tuberculosis (Mantoux) testing is provided at specific sites throughout the County at no charge,
however, persons under the age of 18 must be accompanied by a parent or guardian. Please
call (845) 486-3505.

Health Education Programs
Health education is provided on request to any group from preschool to seniors. DCDOH
educational programs are age appropriate, culturally sensitive and can be tailored to meet
specific needs.    For more information, contact the Public Health Information, Planning &
Education Division at (845) 486-3421.

                                         Annual Report 2006
Environmental Regulatory Services
The following are regulatory services carried out in accordance with the provisions of the NYS
Public Health Laws, NYS Sanitary Code and DC Sanitary Code. For information please call
(845) 486-3404.

Environmental Health Services
Permits and inspects food service facilities, children’s camps, hotels, motels, campsites, parks,
temporary residences, mobile home parks, public functions with 5000 or more people,
swimming pools, bathing beaches, migrant labor camps, daycare centers, and nursery schools.

EHS staff also arrange for pre-construction conferences and inspection of individual water
supplies and sewage disposal systems for conformance to approved plans; investigate
complaints regarding foodborne illnesses, rental dwellings, sewage failures, vermin infestations,
and offensive materials; and reports of animal bites and human contact with suspect rabid

Engineering Services
Conducts inspections, monitors, regulates, reviews, and approves plans for sewage collection,
treatment and disposal systems, realty subdivisions, bathing beaches, residential and
commercial sewage disposal systems, individual and public water supplies. Conducts a
NYSDOH approved certification course for water treatment plant and distribution system

Radiation Services and Environmental Health Assessment Program
Inspects registered x-ray facilities, conducts investigations and provides technical assistance
regarding radon, radiation and chemical emergency response plans, petroleum and chemical
spills, asbestos, occupational health, hazardous and medical waste disposal sites, indoor air
quality, environmental lead assessments and potential exposure to chemicals and hazardous
substances. Also conducts West Nile Virus surveillance and control activities.

Tobacco Control Program
Permits tobacco retailers and conducts inspections to enforce state and local regulations.

Environmental Water Laboratory
NYS certified testing lab (ELAP#10189) which provides analysis of samples from municipal,
government entities, and the private sector. Fees for services. For more information please call
(845) 486-3411.

Clinical Research
The Department is involved in various clinical research projects. The goal is the development of
successful, safe, and effective health interventions with FDA approval. The Department has
been and is involved in an investigational adult and pediatric Lyme Disease vaccine, an
investigational Herpes Simplex vaccine, a HIV vaccine, and a new combined Hepatitis A and B
vaccine. The Department was also involved in an investigational treatment for Hepatitis C
(HCV) patients. For information, call (845) 486-3451.

Medical Examiner Program
Investigates and determines the cause of death in instances of accidental, violent, and
suspicious deaths. Call (845) 486-3414.
** Some graphics in this document were obtained through the internet, for more information, please contact

                                                   Annual Report 2006

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