Self-assessment of Department of Public Health
Effectiveness in Promoting Community Living for Persons with Disabilities

I.   Introduction

A. Agency Organization

The Iowa Department of Public Health tracks its roots to the Eighteenth General Assembly in 1880.  Then it formally created a State Board of Health to “provide for the collecting of vital statistics and to assign certain duties to local boards of health.”  Since then, its duties have greatly expanded.  Today’s department administers over 100 programs and employs over 350 people.  In addition, nearly 300 Iowans serve on various boards and commissions associated with the department. 

The department’s vision, mission, and guiding principles were defined in a broad-based strategic planning process completed in 1999.  As reported in the department’s strategic plan for 2000-2005, its vision is, “Healthy Iowans living in a healthy environment.”  Its mission is “Promoting and protecting the health of Iowans.” 

The department’s administrative offices are located in the Lucas State Office Building, 321 E. 12^th Street, Des Moines, Iowa.  Most employees are located in the Lucas Building although community health consultants, emergency medical service personnel, and disease prevention specialists are located in area offices across the state.  Administrative staff for emergency medical services; radiological health services; and nursing, pharmacy, medical, and dental boards are located in Des Moines, but not within the Capitol complex. 

Agency staff includes professionals with degrees in the disciplines of medicine, public health, epidemiology, sociology, communications, education, policy development, social work, and law.  People skilled in information technology, research, clerical services, data analysis, and financial management provide support services for the department.  Educational preparation of the staff varies according to duties. 

 The nine-member State Board of Health provides policy direction for the department.  It has final approval over administrative rules that protect the health and well being of Iowans.  The director of the Iowa Department of Public Health is appointed by the governor (and approved by the legislature).  The department director works closely with the board in developing state health policy.  The nine-member Commission on Substance Abuse provides policy direction for substance abuse treatment and prevention.  The 20-member Tobacco Commission develops policy and provides direction regarding tobacco use prevention and control.  The 20-member Advisory Council on Brain Injuries’ charge is to study the needs of Iowans with brain injuries and their families; to make recommendations regarding the planning, development, and administration of a comprehensive statewide service delivery system; and to develop, promote, and implement injury prevention strategies.    

Department services are divided into seven divisions: Tobacco Use, Prevention, and Control; Community Health; Administration (including the State Medical Examiner’s Office); Health Promotion, Prevention, and Addictive Behaviors (including the State Substance Abuse Commission and Tobacco Commission); Health Protection and Environmental Health; Communications, Planning, and Personnel; and Disease Epidemiology and Disaster Preparedness.  In addition, the department provides administrative support for 22 professional boards that regulate and license various health professions.   

B. Overview of Department Programs

1. State level

The department is involved in all stages of the health-care system through individual, targeted-population, and population-based services.  Customers for the department’s services include Iowa’s county and city health agencies; county boards of health; public and private contractors; public and private health care providers and provider organizations.  It also includes health-care payers; other federal, state and local entities collaborating in health-care delivery; businesses; schools; department employees; and individual Iowans.

Funding for the department’s services comes from a variety of sources including federal and state governments and foundations. While most of the department’s services are provided through contracts with community-based providers, the department does offer a limited number of direct population services.  These include assistance in investigating sexually transmitted disease cases, and the health inspection of swimming pools, wells and water. 

According to the Institute of Medicine’s publication, The Future of Public Health, government public- health agencies safeguard the community’s health through three core functions: assessment, policy development, and assurance.  The department implements these functions through the following essential public health services:

• monitoring health status;
•  diagnosing and investigating health problems and health hazards;
• informing, educating, and empowering people about health issues;
• mobilizing community partnerships to identify and solve health problems;
• developing policies and plans that support individual- and community-health efforts;
•  enforcing laws and regulations that protect health and ensure safety;
• linking people to needed personal health services;
• assuring a competent public health and personal health-care workforce;
• evaluating effectiveness, accessibility, and quality of personal- and population-based health services; and
• conducting research for new insights and innovative solutions to health problems.

The Division of Administration provides administration and oversight to the programs and activities within the department.  The division is responsible for department activities in the areas of fiscal management, information management, purchasing, policy development, federal legislative relations, vital records, health statistics, state medical examiner, and professional licensure.

The Division of Community Health promotes and supports development of a public health infrastructure and provides resources to assure that Iowa’s public health system has the capacity to perform the core functions of public health, deliver the essential public health services, and to respond to current and emerging public health needs.  This includes technical assistance with local boards of health and providers who contract with the department to deliver local public health services.

This division is concerned about access to health care by all Iowans and addresses access through the Office of Minority Health and the Bureau of Health Care Access.  In addition, the division assures the delivery of a wide range of personal and population-based services including public health nursing, home care aide services, family health services, oral health care, nutrition services, disease prevention services, immunizations, child death review team, and genetic services.

The Division of Health Promotion, Prevention, and Addictive Behaviors provides a wide variety of programs that focus on the development of a healthy lifestyle.  The division consists of the following programs: arthritis, asthma, brain injury, breast and cervical cancer early detection, cardiovascular risk reduction, comprehensive cancer control, diabetes, disability prevention, gambling prevention and treatment, medical substitute decision-making board, substance abuse prevention and treatment, and regulation for substance abuse treatment facilities.  The division also provides administrative support for the Governor’s Advisory Council on Brain Injuries.

The Division of Health Protection and Environmental Health contains a wide variety of programs with a primary purpose of ensuring a safe and healthy environment for Iowans.  The division consists of the following program areas: lead poisoning prevention, toxicology and environmental health, and radiological health.  Programs within these areas provide education, technical assistance, and regulatory functions.

The Division of Communications, Planning, and Personnel is responsible for coordinating the department’s communications, administrative rules promulgation, and strategic planning.  It also administers the Certificate of Need program and is responsible for the department’s internal and external communications to market the department and public health.  This division is also charged with coordination of the agency’s annual reports and other publications and administration of a document-review system for all materials meant for external consumption.

The Division of Disease Epidemiology and Disaster Preparedness was established in October 2001 incorporating the Bureau of Emergency Medical Services, The Center for Acute Disease Epidemiology and creating a new Center for Disaster Operations and Response.  The mission of the division is to develop and implement a system of health and public health services ready to respond to disaster/terrorism incidents, disease outbreaks, and other public health threats and emergencies.

The mission of the Division of Tobacco Use Prevention and Control is to curb tobacco use and to assist the state in the enforcement of underage tobacco laws.  This division works at the county level to establish local coalitions to provide tobacco education programs to youth and pregnant women.  The division has developed counter-marketing strategies and advertisements to educate the public on the harmful effects of tobacco and assists local law enforcement as they perform compliance checks on tobacco retail outlets.

2. Community level

The department contracts with all 99 Iowa counties to provide population-based health services and a limited array of personal health services.  In total, more than 300 entities have department contracts to provide health services, such as those included in the list of essential public health services (see Section I, B., 1.)  These contractors include county boards of health and boards of supervisors, non-profit organizations, community-action programs, public health nursing agencies, maternal and child- health agencies, substance abuse prevention agencies, emergency medical services providers, and HIV/AIDS prevention and care providers.  The department also contracts with private vendors and targeted small businesses, when appropriate, for services such as printing, technical writing, and meeting planning.

C.   How department services relate to the Olmstead Decision and community living for people with disabilities.

1.  State level

The Iowa Department of Public Health provides for a broad array of services to support persons with disabilities living at home or in the community.  In particular, the department is responsible for emergency management, domestic security and public health disaster preparedness; health communications, intervention/treatment, prevention, support services, assessment, surveillance and epidemiology; regulation and compliance; child and adult protection; research, analysis and information management; and resource management.

In 1998, Iowa’s governor designated the department as the lead agency for brain injury and called on other state departments and agencies to work with the department in meeting the needs of Iowans with brain injury.  The department has mandated memberships on the Governor’s Developmental Disabilities Council and the Advisory Council on Brain Injuries.

2. Community level

Potentially, every Iowan, including every Iowan with a disability, is a customer of the department’s essential public health services (see Section I, B., 1.)  Information and funding often drive the creation and implementation of programs for specific target groups in the general population. 

The department contracts for multiple services that support persons with disabilities living in the community.  Support services include service coordination; in-home and personal support services; educational services; early intervention services; disability services; community substance abuse treatment; and other children’s services.

The department holds contractors accountable for progress on contract terms including the requirement that contractors must comply with all federal laws and regulations including the Americans with Disabilities Act.  Department staff monitor program reports and auditors conduct reviews to ensure that expenses are appropriate.  Staff conduct site visits and hold regular meetings with contractors to provide feedback on program performance. 

The department works with many communities to support and strengthen health initiatives.  Many bureaus have field staff such as emergency medical services program planners, disease protection specialists, and community health consultants who live and work in the geographic areas they serve.  Community-based department employees meet regularly with health professionals and consumers in their local service areas and report back on consumer concerns at regular staff meetings with department management.  All of the department’s divisions and bureaus glean information specific to their own operations through these communication channels. 

To facilitate direct consumer feedback and communication, the department has set up an Internet e-mail link on the department’s web page through which customers can send requests for assistance or ask questions of department staff. 

The department provides communities with data and planning resources; assists with grant mining and funding; provides conferences and continuing education, leadership development, and community forums; and provides data registries such as the trauma registry to assist in planning to better meet Iowans’ emergency medical service needs and the needs of persons with disabilities. 

All 23 Healthy Iowans 2010 chapters, including the Disabilities chapter, are products of collaborative planning among key stakeholders.  Individual chapter teams developed goals and action steps, wrote the chapter, and agreed on responsibility for goal and action step implementation.  At the community level, planning groups defined local plans to implement Healthy Iowans 2010 goals and action steps in response to community health status and service system needs assessments.  All department programs with a prevention component integrate planning with Healthy Iowans 2010 goals.  Annual reports on progress toward accomplishing action steps is submitted to the Healthy Iowans 2010 coordinator, a member of the Division of Communications, Planning and Personnel, and is shared with the department’s executive team, chapter team members, program managers, and Healthy Iowans 2010 community implementation teams. 

Press releases are often used to announce new funding and subsequent programming.  Community visits, the department’s local community health consultants, the biennial public health barn raising conference, program-specific conferences, and the department’s monthly FOCUS newsletter are commonly used to communicate new and/or enduring objectives to local health providers.

D.  Description of existing department services, programs or activities that already promote and support community living.

1.  State level and community Level

The department’s customers consist of two general types.  First and most importantly, there is the end customer, consisting of the state’s general population and specific subpopulations within the state that receive public health services.  One subpopulation is persons with disabilities.  Second there are several groups of intermediate customers such as the 300 contractors that deliver department services; interagency partners at the national, state, and local levels who facilitate better service to customers; and department employees who are customers of the department’s internal functions such as personnel services.

Potentially, every Iowan is a customer of the department’s essential public health services (see Section I, B., 1.)  Within the general population of Iowa, however, are subpopulations or “customer groups” with specific health needs that are different from the rest of the population.  These are based upon demographic variables such as age, gender, race and ethnicity, and income.  Other defining characteristics operative in Iowa include geographical proximity to health services, physical and mental ability, and spoken language.  The department provides many different programs that serve these target populations. 

The department’s work is divided into seven core functions where services, products, and activities that impact all Iowans including persons with disabilities are outlined.  Many of the department’s services are provided through local providers who are contractually responsible for providing services that support and promote the department’s mission and support and promote community living for persons with disabilities.

E. Emergency Management, Domestic Security and Public Health Disaster Preparedness 

The desired outcome of department services, products and activities in this core function is to provide public health disaster preparedness services to all Iowans, including people with disabilities, in order to develop and implement a system of public health and health care services in response to disaster/terrorism incidents or other public health emergencies.  The department’s services, programs or activities in this core function that promote and support community living are listed below.

1.  Center for Disaster Operations and Response - responsible for the development and implementation of emergency plans and operating procedures for the department.

The desired outcomes of department services, products and activities in this core function are to assure individual, community- and facility-based prevention, intervention, treatment, and support services to all Iowans, including people, with disabilities in order to 1) maintain/improve health status and access to health services; 2) provide disease epidemiology services to families and communities in Iowa in order to develop and implement a system of public health services ready to deal with outbreaks of infectious disease, food borne illness, and other public health threats or emergencies; 3) provide emergency medical and trauma services to Iowans including people with disabilities in order to develop and implement a system of health services ready to respond to health emergencies; and 4) provide risk reduction and prevention services to all Iowans including people with disabilities in order to ensure improved health status. 

 The department’s services, programs or activities in this core function that promote and support community living are listed below.

1.  Center for Genetics - provides a system for genetic health care services in Iowa.  One program of the center, the Iowa Birth Defects Registry provides statewide surveillance and monitoring of birth defects, conducts research to identify genetic and environmental risk factors, and promotes birth defects prevention and education activities.

2.  Center for Local Public Health Services and Health Improvement - strengthens the public health delivery system in Iowa at both the state and local level.  The center works to strengthen the capacity of Iowa’s local boards of health, which, through local health departments, public health agencies, programs and services, strive to create healthy people and communities in Iowa.  The center promotes and supports development of a public health infrastructure at the local and state level to assure that Iowa’s public health system has the capacity to respond to current and emerging public health issues.  Funding for local boards of health, public health nursing, and home care aides is provided through the center.

3.  Center for Rural Health and Primary Care - facilitates and advocates for access to quality health services for Iowans in rural and medically under-served areas.

4.  University of Iowa Child Health Specialty Clinics - offer a variety of direct services and care coordination to children with special health care needs and their families.

5.  Chore Program - provides services to people who, due to incapacity or illness, are unable to perform home-maintenance functions.

6.  Dental Care for Persons with Disabilities - serves low-income children and young adults with developmental disabilities, up to age 21.  The University of Iowa and the Iowa Department of Public Health jointly sponsor the program.  Treatment is made available through the University Hospital School Dental Clinic and a network of 13 private dental offices throughout the state.

7.  Disease Prevention Specialists - work with local public health agencies, health care providers and the public to provide education, technical assistance and disease intervention in all areas of communicable disease control.

8.  Early ACCESS - assists families with young children and providers of local public health to work together in identifying, coordinating, and providing needed services and resources that will help the infant or toddler grow and develop.

9.  Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) - prevents chronic illness through examinations, identification of conditions and intervention early enough to provide effective treatment and ensure that eligible children in Medicaid receive a screening examination.

10.   Empowerment Areas – a cooperative effort among the departments of public health, human services, education, and other state agencies to reduce duplication of services to families and children and identify ways of coordinating funding to provide the most services with available funding with the ultimate goal of creating local service systems that enable children to be healthy and ready to learn.

11.   Maternal Serum alpha-fetoprotein Screening Program (MSAFP) - identifies pregnancies in which the fetus may be at risk for having neural tube defect or other abnormalities.

12.   Family Planning - promotes the health of people of reproductive age and families by providing access to family planning and reproductive services.

13.   Food Stamp Nutrition Education Plan - provides nutrition education to food stamp eligible families through grants to local nutrition coalitions and target social marketing.

14.   Healthy Child Care Iowa - provides training, technical assistance, and consultation to child care providers to improve health and safety in childcare environments.

15.   Healthy Families Line - a 1-800 phone line that supplies families with information on various health care issues and programs.

16.   HIV/AIDS Program - monitors the HIV/AIDS epidemic in Iowa and coordinates statewide HIV/AIDS prevention and care programs.

17.   Home Care Aide Program - helps prevent inappropriate institutionalization of patients and preserves families by providing supportive services or trained and supervised paraprofessionals.  Services provided might include personal supervision for the tasks related to personal skill development, assistance with personal care, meal preparation, community integration, and monitoring of medication.

18.   Immunizations Program - provides and promotes vaccines for Iowa’s children, adolescents, and adults.

19.   Iowa Neonatal Metabolic Screening - identifies newborns with selected metabolic disorders so that early diagnosis and treatment can be started to avert metabolic crisis, neurological and developmental damage, and death.

20.   Iowa Nutrition Education Network - encourages Iowans to increase the variety of foods in their diets; increase consumption of fruits, vegetables, and grains; choose a diet lower in fat; and increase their physical activity.

21.   Iowa Review of Family Assets - offers a computerized self-assessment of family strengths by parents of newborns.  Through the program parents receive information on resources in the community.

22.   Maternal and Child Health Program - collaborates in a statewide system that provides access to community-based, culturally competent, coordinated child health, perinatal and obstetrical indigent services.  Both programs maintain databases: maternal health database (WHIS) and the child and adolescent database (CAReS.)  Data that is collected and analyzed helps local maternal and child health contractors to develop plans to address clients’ needs.  Both programs provide case management and care coordination to link clients and their families to appropriate community resources. 

23.   Neuromuscular and Related Genetic Disease Program - provides comprehensive health services statewide to individuals and families with a variety of neuromuscular disorders and performs educational outreach.

24.   Newborn Hearing Screening System - tests, on a voluntary basis, the hearing of newborns before leaving the hospital or birthing center.

25.   Prescription Drugs Program - provides prescription drugs at no cost for people who have sexually transmitted diseases, tuberculosis infection and tuberculosis disease.

26.   Bureau of Health Care Access - promotes expansion of health care resources for vulnerable populations and those living in areas with no access to primary care.  Activities of the office include primary care access analysis and intervention planning, shortage area designation assistance through the Office of Shortage Designations, project development and grant application assistance, and education and advocacy for network development for primary care systems; works in conjunction with the statewide advisory committee to improve access to care for Iowans in rural areas.  The office consults with communities and health care providers on health care needs assessments and planning and the availability of grants and programs; develops certified rural health clinics; and provides grant writing, technical assistance and health data and information to communities to improve access to health care providers and services.

27.   Public Health Nursing Program - helps prevent illness, promote health and wellness, and prevent or reduce inappropriate institutionalization of low-income, disabled, and elderly persons.

28.   Regional Genetic Consultation Service - provides comprehensive genetic health care services and educational outreach statewide.

29.   Sexually Transmitted Diseases Prevention Program - works to provide an effective system of services and information to prevent STDs and ensure comprehensive, high-quality STD-related health services.

30.   Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) - provides nutrition education, supplemental foods, breast-feeding promotion and support, and referrals for health services to low-income women and their children.

31.   Tuberculosis (TB) Control Program - provides support to four regional TB coalitions; close contact investigations, outreach activities reimbursement, free medication, and professional education and consultation.

32.   Asthma Control Program - reduces asthma by planning and implementing scientific health-behavior models, effective management and education.  The program also supports a statewide surveillance system.

33.   Cardiovascular Health Program - works to reduce Iowans’ heart attack and stroke risk through community-based screening, education, and intervention that promotes behavior change. 

34.   The Bureau of Health Promotion and Disability - has a disabilities prevention work unit that includes the arthritis program, the disabilities program, and the brain injury program, which provides staff for the Governor’s Advisory Council on Brain Injuries.  Staff and other resources of the bureau are responsible for the department’s major programming efforts on behalf of persons with disabilities. 

The Living Well with a Disability Program is a collaborative effort with the University of Iowa.  The eight-week wellness program for persons with disabilities is offered at each of the four Centers for Independent Living (CIL) in Iowa and in a separate staff-supported site in Cedar Rapids/Iowa City.  The program is intended to improve the health and quality of life of persons with disabilities and prevent secondary health conditions that can occur as a result of a disability.  A separate “refresher course” Continuing to Live Well with a Disability Program is offered one month after the completion of the original Living Well program.  A rural model of the Living Well program will be piloted in 2003 in one area of the state not covered by a CIL.  The adolescent version of Living Well with a Disability will be conducted in three pilot project sites in the fall of 2003. 

Another initiative of the bureau that supports community living for persons with disabilities is the building accessibility survey.  This project is a cooperative effort between the Iowa Department of Public Health and the Iowa Department of Human Rights, Division of Persons with Disabilities.  Through the project, Iowa’s acting Americans with Disabilities Act compliance officer, John TenPas, analyzes completed Building Access Surveys submitted by several of the department’s local program facilities in order to identify and resolve access problems.  Technical assistance is available to local programs to improve Americans with Disabilities Act compliance.  Currently, the department’s substance abuse treatment programs and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs are using the survey process.  Future efforts include a plan to market the survey service to local boards of health, visiting nurse services, public health nursing agencies, and homemaker/home health programs. 

The Brain Injury Program operates the Iowa Brain Injury Resource Network (IBIRN) in cooperation with the Brain Injury Association of Iowa, and the Advisory Council on Brain Injuries provides project oversight.  The IBIRN is an information and support system created to meet the needs of Iowa families experiencing brain injury and the providers that assist them through the various stages of recovery and beyond.  The IBIRN locations across the state distribute the IBIRN tote bag that contains important brain injury information and other information that families need to begin linking with necessary services and supports.  Families are also provided relevant contacts and phone numbers for community-based resources.

The IBIRN also benefits Iowa’s service providers, agencies, and communities by providing brain injury technical assistance, case-specific assistance, a variety of brain injury educational forums and trainings, and public awareness presentations.  The network is a federally funded project, which originated from a statewide needs assessment of Iowans experiencing brain injuries, their families, and a variety of service providers.  The needs assessment, Coming Into Focus, was the first step in a cooperative planning process that involved several state agencies and the Governor’s Advisory Council on Brain Injuries.  Finalized in 1997, the yearlong assessment process provided information for the development of the Iowa Plan for Brain Injury.  The 1998 plan was Iowa’s first effort to improve services and supports for people with brain injury and their families and has been used to justify IBIRN funding and systems improvements over the last six years. 

In February 2002, the department organized the Iowa Brain Injury State Plan Task Force to update the 1998 plan.  Public comment was requested from over 17,500 people asking how the system of services and supports has changed for persons with brain injury since 1998.  Respondents included persons with brain injuries and their families, professionals, advocates, county officials, state employees, brain injury advisory council members, and service providers.  Information collected in this process helped the task force to identify four priority areas that will drive programming over the next three years.  The priority areas are 1) Education/Training/Public Awareness/Information and Resources – Expansion of the Iowa Brain Injury Resource Network; 2) Advocacy Collaboration/Training Activities – Promote a Legislative and Policy Agenda while increasing legislative strength; 3) Data – Enhance Data Collection; and 4) Funding – Increase Funding and secure long-term funding of the IBIRN system.

35.   Iowa Arthritis Program - provides a statewide, comprehensive approach to arthritis and conducts intervention and awareness activities for professional and public audiences.

36.   Iowa Substance Abuse Information Center - provides statewide resources and information about alcohol, tobacco, other drugs, gambling and health.

37.   Substance Abuse Programs – provide funding for community-based programs to reduce alcohol, tobacco, and marijuana use in 12 to 17 year-olds; services to people who have completed primary treatment for substance use; substance abuse treatment to Iowans in all 99 counties; training on alcohol, tobacco, and other drugs for health professionals and the public; and collects data to identify gaps in the treatment system.  Programs provide interpretation services if needed and complete joint treatment planning for clients with co-occurring diagnoses.

38.   Substitute Medical Decision-Making Board - makes decisions for patients in need of medical care, but who cannot provide their own informed consent because they do not understand the nature and consequences of the proposed care, and who do not have other substitute decision-makers available.

39.   Well-Integrated Screening and Evaluation for Women Across the Nation Program (WISEWOMAN) - conducts research to test the impact of nutrition and physical activity behavior modification intervention on women 40 to 64 years of age.

40.   Adult Lead Epidemiology and Surveillance Program - collects results of all blood-lead testing on Iowans 16 and older and provides information to those who have high blood-lead levels.

41.   Childhood Lead Poisoning Prevention Program - collects results of all blood-lead testing on Iowans under age 16.  Tests to identify lead-poisoned children reduce lead hazards in older homes and provide medical case management to lead-poisoned people.

42.   Environmental Health Programs – protect citizens by monitoring fluoridation levels of in community water systems, provide consultation and assistance to the public and professionals on indoor air quality, and regulate water quality and safety of public pools and spas. 

43.   Iowa Statewide Poison Control Center - uses a statewide 24-hour emergency hotline that provides immediate poison-prevention information and treatment guidance to the public and health care professionals.

44.   Abuse Education Review Panel - reviews and approves curricula for mandatory reporters of child and dependent adult abuse.

45.   Certificate of Need Program - ensures through a proposal review process that growth and changes in the health care system occur in an orderly, cost-effective manner, and that the system is efficient.

46.   Communications and Marketing - disperses numerous internal and external communications and marketing products to inform, protect, and promote improved health of all Iowans.  The department maintains several tool-free telephone numbers to alleviate the cost of calls for customers and to provide immediate access to referral information about local services.  The division’s director recently distributed the document “Working with Persons with Disabilities – A Guide for State Supervisors and Managers” with the department’s senior staff and supervisors.

47.   Healthy Iowans 2010 Plan - Iowa’s health plan - a comprehensive set of health goals developed by more than 500 individuals and over 200 groups.  This road map is being followed and action steps are being tracked at the end of each year to assure that there are advances in the health status of Iowans, regardless of their age, race, ethnicity, gender, or disability. 

48.   In particular, Healthy Iowans 2010 chapter 4, Disabilities, is dedicated to the concept that people with disabilities must be recognized as whole and healthy beings.  The chapter contains 35 goals that are the work plan for the department’s disability prevention work unit that is in the Bureau of Health Promotion and Disability. 

49.   While this chapter of Healthy Iowans 2010 has a specific focus on persons with disabilities, many of the 22 other chapters of the plan include strategies to prevent disease and promote health in the special population of persons with disabilities.  Currently, the Bureau of Health Promotion and Disability is planning a fall 2003 conference on disability and health.  The goals of the conference include: 1) heighten awareness of the health and quality of life issues of persons with disabilities; 2) recognize the need to include people with disabilities in state and community health planning activities; 3) develop recommendations for including people with disabilities in Healthy Iowans 2010 activities at the agency, community, and state level; and 4) provide the recommendations developed to Healthy Iowans 2010 and Healthy People 2010 committees for inclusion in the midcourse review.  In addition to the disabilities chapter, other chapters that will be reviewed include nutrition, physical activity and fitness, substance abuse and problem gambling, access to quality health services, violent and abusive behavior, and the public health infrastructure chapter that includes health data issues.   

50.   Reception - greets department visitors to the Lucas Building administrative offices, answers incoming phone calls, routes calls to the appropriate person/division/department and answers general questions.  The receptionist has first contact with customers and provides an important link with the department’s customers and its resources.

51.   Training and Education Outreach Unit - assists with training coordination and educational system development.  The unit provides educational opportunities and facilitates the placement of public health and health science student internships with the department.

52.   Tobacco Programs - coordinates Just Eliminate Lies (JEL) activities of Iowa youth united to fight tobacco use through counter-marketing, prevention, and cessation activities; provides funds to counties to prevent tobacco use among youth and help pregnant women to quit smoking; and provides tobacco cessation information to members of the general population.

53.   Trauma System - matches patients’ medical needs or injuries to the existing medical resources thereby reducing costs, disability, and death associated with traumatic injury.  The statewide trauma registry not only counts the incidence of trauma-related injuries, but also records data on the anticipated impediments to hospital discharge for persons with injuries and resulting disabilities.  Thus, barriers to community living can be analyzed and diminished at both the state and local levels.

54.   Center for Acute Disease Epidemiology - responsible for communicable disease surveillance in Iowa.  Specific programs include surveillance for influenza, food-borne illness, West Nile virus, and hepatitis C.  The center also provides consultation on rabies, vaccine preventable diseases, antibiotic resistance, and infection control.

55.   Emergency Medical Services Program - serves Iowans by reducing suffering, disability, death and costs from injury and illness.

56.   Iowa Communications Network - permits real time video and audio communications between remote sites; thus facilitating participation of customers that might not otherwise take place.

The desired outcome of department services, products and activities in this core function are to provide enforcement of the Code of Iowa and Iowa Administrative Code to ensure and protect the health, safety, and welfare of Iowans, including people with disabilities.  The department’s services, programs or activities in this core function that promote and support community living are listed below.  Many professionals regulated by the department’s licensure programs provide the first and successive links between persons with disabilities and appropriate community resources.

1.  Professional Licensure - administers and enforces laws and administrative rules with counsel from the Attorney General’s Office.  The bureau oversees 18 licensure boards, including many that directly impact persons with disabilities including Behavioral Science, Chiropractors, Dietitians, Hearing Aid Dispensers, Massage Therapy, Nursing Home Administrators, Optometry, Physical and Occupational Therapy, Physician Assistants, Podiatry, Psychology, Respiratory Care, Social Work, and Speech Pathology and Audiology. 

2.  Iowa Boards of Dental Examiners, Medical Examiners, Nursing Examiners, and Pharmacy Examiners - license professionals, develop and enforce professional practice standards, conduct complaint investigations and hearings, and approve continuing education for their licensees.  The Board of Medical Examiners is actively engaged in assisting physicians with disabilities to maintain safe and active medical practices.  The board accomplishes this through the Iowa Physician Health Program.

The desired outcome of department services, products and activities in this core function are to provide administrative, financial, and support services to department personnel, programs, and contractors to support improved services and results for Iowans, including people with disabilities.  The department’s services, programs or activities in this core function that promote and support community living are listed below.

1.  Chronic Renal Disease Program - provides financial assistance to eligible clients with end-state renal disease who are receiving dialysis or who have received a kidney transplant.

2.  Fiscal, Accounting, and Purchasing - manages and coordinates various support services, including accounting, budgeting, contract administration, internal audits, and purchasing.  The proposed language of the general conditions for the department’s numerous contracts demands compliance with the Americans with Disabilities Act and states:

“The Contractor, its employees, agents, and subcontractors shall comply with all applicable federal, state, and local laws, rules, ordinances, regulations, and orders when performing the work and services under this agreement, including without limitation the following: all laws applicable to the prevention of discrimination in employment, all laws applicable to the nondiscriminatory provision of services or benefits, all laws applicable to accessibility of facilities, and all laws applicable to the use of targeted small businesses as subcontractors or suppliers.”

The department makes every effort to comply with the Iowa Targeted Small Business (TSB) Act, Iowa Code sections 73.15 through 73.21, which directs every state agency to purchase goods and services supplied by small business and targeted small businesses in Iowa.  Targeted small business owners include minorities, women, and persons with disabilities.  The statute also directs agency directors to establish a procurement goal of procuring at least ten percent of goods and services from certified TSBs. 

3.  Information Management - provides information-technology support services to internal and external customers.  To accomplish its goals, the department uses appropriate equipment and technologies, such as an interactive web site that includes information on current topics and on public health data, with links to multiple local, state, and federal web sites.  Certain department services can be rendered directly over the Internet, such as online renewal of professional licenses.  

The desired outcome of department services, products and activities in this core function are to provide health information and information assistance to Iowans for health assessment, planning, and decision-making to promote efficient and effective use of resources.  The department’s services, programs or activities in this core function that promote and support community living are listed below.

1.  State Center for Health Statistics - collects, analyzes, and distributes data for development of health policy at the state and local levels.  The department is responsible for much of the data collection that supports both internal requests for funding and data resources available to customers for their own funding requests.  One of the department’s responsibilities is to monitor the morbidity and mortality patterns and trends indicating the population’s health.  This enables identification of current and emerging health needs and can be a pertinent source of information for program development.

The desired outcome of department services, products and activities in this core function are to provide prevention, protection, and support services to families, communities, and people with disabilities in Iowa in order to ensure strong families and safe communities.  The department’s services, programs or activities in this core function that promote and support community living are listed below.

1.  Emergency Medical Services for Children - works to improve pediatric emergency care through injury prevention, assessment of community resources, and by making improvements in emergency room, hospital, and rehabilitative services to better meet the needs of children.

2.  Healthy Opportunities for Parents to Experience Success (HOPES) - develops healthy, safe, strong, and self-sufficient families by assessing a family’s assets in order to promote child health and development through family education and support.

The department has many examples of partnering including interagency initiatives such as Healthy Iowans 2010 planning groups; the Iowa Community Empowerment Initiative; Enterprise Planning Teams including health, education, and safe communities; Tobacco Use Prevention and Control Commission; Scientific Advisory Council; and Healthy and Well Kids in Iowa (HAWK-I).  Functions of partnerships include grant writing, health policy planning, implementing program objectives, sharing information and training, and in-kind collaboration, such as sharing personnel, facilities, and services. 

The department provides staff for several consumer-oriented councils and task forces.  These include the Governor’s Health Consumer Advisory Council, the Governor’s Advisory Council on Head Injuries, and the Minority Health Advisory Task Force.  These groups provide regular input into the department’s policy development and program planning, into its implementation, and into the department's evaluation efforts.

The department has established collaborative relationships for training and for research and development with the University of Iowa, Drake University, Iowa Substance Abuse Research and Evaluation Consortium, the University of Northern Iowa, Iowa State University, and Des Moines University.

II.  Self-Assessment Methodology and Barrier Identification - A plan for a systematic self-evaluation process pursuant to Executive Order 27, in conjunction with the Olmstead Real Choices Consumer Task Force

*The survey will be distributed to all participants of the May 1, 6, and 13^th discussion groups and any other program managers identified during the discussion sessions as potentially involved in supporting community living for persons with disabilities.

The survey will ask participants to complete and respond to the following:

Identification and review of the program’s policies, procedures, and regulations as to

1) how the program’s supports the provision of community living for persons with disabilities;

2) what barriers to community living for persons with disabilities are found in the way that program services are delivered; and

3) what are the proposed solutions to barriers identified.

III. Strategic Action Plan Development Process