O’Brien County mulls public health grant | News

PRIMGHAR—There were more questions and answers Tuesday, Sept. 27, about the O’Brien County Public Health Office’s proposal to apply for a grant that funds child, adolescent and oral health services.

The board of supervisors again declined to take action on approving the request from public health nurse administrator Kim Morran, who spoke to the board at its Sept. 20 meeting.

Morran previously asked if her department could apply for the $279,273 grant, the submission deadline for which is Oct. 17. If O’Brien County received the grant, it would cover nine other counties: Clay, Cherokee, Dickinson, Emmet, Lyon, Osceola, Palo Alto, Plymouth and Sioux.

O’Brien County would not be able to provide the services the grant helps pay for by starting its own individual program; it would need to be attached to a region that receives the grant dollars.

The county previously contracted with Webster County to provide child and adolescent health and oral health services. O’Brien County in turn subcontracted with Osceola County to administer the services there.

The contract with Webster County ended July 1 when the state public health collaborative service areas realigned. However, the contract was extended through the end of the year because no other applicants in O’Brien County’s new service area went for the grant during the two times it was made available this year.

Morran told the supervisors the public health office could collect extra revenue by applying dental sealants for $21.49 apiece and billing for dental screenings, oral hygiene instruction and fluoride treatments.

The county did 320 screenings last year through its contract with Webster County. If it repeated that number of screenings and billed for the other services, the county would bring in about $17,000. It also could keep a portion of what other counties in its grant service area would make.

If O’Brien County got the grant, it would need to hire extra staff members to provide the services. At the Sept. 20 meeting, Morran said those would be a registered dental hygienist, a dental assistant, a registered nurse and a biller. However, she said at Tuesday’s meeting the positions would not need to be full time. Her office possibly could look at hiring a part-time RN, two registered dental hygienists and a part-time biller.

“It’s going to take doing it a year to figure out if we’re going to need more hours or not. The coordinator — which would be an RDH — is only allowed to do eight hours a week of direct service care,” Morran said. “That’s why you’d have to have another one because they’d never be able to get the sealants done.”

O’Brien County would subcontract some of the services, such as preschool programs and Women, Infants and Children clinics, to other counties in the area. However, it would not subcontract dental sealant visits.

Supervisor Nancy McDowell asked if the county could hire a part-time dental worker who also works in the private sector. Morran said that could be a possibility for one of the positions. She also raised the possibility of a part-time, seasonal employee who would work during the academic year.

If the public health office struggled to hire the extra positions at first, Morran said the state would work with the office to fill those roles.

“He just said, ‘I think at this point, we just need somebody to apply and take this over,’” Morran said, referring to the coordinator for the state grant with whom she has been speaking.

Supervisor Dan Friedrichsen asked what the cutoff age is for patients eligible for services under the grant. Morran said some of the services — such as oral screenings and immunizations — can be administered to mothers or pregnant women during visits. Adult visits, however, can only be given and billed four times a year. The cutoff age for children receiving WIC services meanwhile is 5 years old.

McDowell asked what traveling would be like for the extra public health workers. Morran said the registered dental hygienist would travel throughout the 10 counties and likely would require their own vehicle. Public health staff in some of the counties, however, could be subcontracted to provide some of the grant services.

Friedrichsen asked why no other entities in O’Brien County’s service area have applied for the grant this year. He feared that if O’Brien County got the grant and was responsible for administering it, it could lose money.

Morran said Mid-Sioux Opportunity Inc. in Sioux Center applied for a maternal health WIC grant, which was “a huge undertaking” for that organization. The application period for that grant coincided with that of the child, adolescent and oral health services grant, so Mid-Sioux did not want to apply for both.

None of the 10 counties in the service area have applied for the grant before, so Morran said it would be a new experience for all of them.

“I would say, ‘Why are the other counties that have done this for years — why do they keep applying?’ Obviously, it’s not a money loser for them, or they would say, ‘We’re out,’” Morran said.

She also addressed questions about where the extra staff would work and how long the grant would last. The public health office’s existing space is cramped, but Morran said a worker could use environmental health specialist Jonathon Hintz’s desk when he is not there. A workspace could be set up in the adjacent assembly room too or the staff could work from home.

The grant could be renewed for five years, although Morran said the county could back out of it after a year if it proved too costly. The grant coordinator told her participant counties have to realize the intent of the program isn’t to make money but to serve residents.

“I know it would be putting a lot of faith and trust in me and the staff and, I’ll be honest with you, that even makes me nervous,” Morran said. “I want to do a good job. I don’t want O’Brien County to lose money either. I’d prefer to have it be the other way around.”

The county opted for a wait-and-see approach in case another county applies for the grant or if the state will provide more flexible program options for the service area should no applicants go for the grant.


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