Board of Health — Skokie, IL
Date: 2017-02-09

Skokie Board of Health
 Thursday February 9, 2017

 Village Hall - 1st floor Conference Room A
 7:00 p.m.


 AGENDA
 U




 I. Call to Order


 II. Approval of Minutes


 III. Stan Sonu, MD
 Internal Medicine and Pediatrics
 Preventive Medicine / Public Health Program
 Cook County Health and Hospitals System
 Adverse Childhood Experiences and Trauma-Informed Care


 IV. Chair’s Report



 V. Director’s Monthly Report



 VI. Old/New Items of Business


 VII. NOTE MARCH MEETING LOCATION:

 Thursday, March 9, 2017

 Catherine A. Counard, MD, MPH
 David Clough, MPA
 Skokie Health Department

 Community Health Plan Update

 7:00 p.m.
 Skokie Village Hall
 2nd Floor Conference Rooms D & E
496112 v.8

Skokie Board of Health
 February 9th, 2017

Present Dr. Sood Excused Absent
Mr. Abbasi Ms. Jones Thorne Dr. Dave Mr. Nidetz
Dr. Drachler Dr. Topouzian Dr. Werner Dr. Polin
Dr. Gaynes Ms. Urbanus
Ms. Nickisch Duggan Dr. Usman
Mr. Pandya Ms. Varma
Dr. Prince Dr. Vernon
Dr. Shim Dr. Williams

Dr. Catherine A. Counard, Director of Health
Bruce A. Jones, Staff
Guest, Dr. Edward McCarron – Family Services Commission
Guest, Megan Hoffman – Student


1. Call to Order: The meeting was called to order at 7:01 p.m. by Dr. Drachler, Chairman.

2. Approval of Minutes: The minutes of the previous meeting were approved.

3. Presentations (a copy of the presentation is attached)
 Stan Sonu, MD
 Internal Medicine and Pediatrics Preventive Medicine / Public Health Program; Cook County Health and
 Hospitals System: Adverse Childhood Experiences and Trauma-Informed Care.

 Dr. Sonu gave a very comprehensive and detailed presentation on The Adverse Childhood Experiences
 Study or “THE ACEs STUDY”

 Below are some of the highlights from these reports

 Dr. Vincent Felitti
 • 1985 - Kaiser Permanente in San Diego
 • Obesity Clinic
 • 50% dropout rate over 5 years - why?
 • 286 “dropouts” interviewed – most were sexually abused during childhood and overeating in response

 CDC/Kaiser Permanente ACEs Study – Began in 1995
 Over 17,000 adults
 Asked about ACEs and unhealthy behaviors + chronic dz
 Prevalence and Odds Ratio

 MOSTLY CAUCASIAN
 MIDDLE CLASS
 EDUCATED




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 ACE’s = Poor health outcomes
 I think this man is suffering from memories: Sigmund Freud”

 Understand the link between Adverse Childhood
 Experiences (ACEs) and poor health outcomes
 Resilience, trauma-informed care
 Introduce ways to address ACEs from a primary care perspective; opportunities for engagement

 Most people had ≥1 adverse childhood experiences
 Dose-response relationship:
 More ACEs
 Higher risk of medical, mental,
 Social problems as an adult
 3 ACEs associated with early mortality


 Adverse Childhood Experiences and Adverse Community Experiences
 • Maternal depression • Homelessness
 • Abuse - emotional, sexual • Poverty Racism
 • Substance abuse • Violence
 • Domestic violence • Poor housing: affordability, quality
 • Neglect - physical, emotional • Lack of social/economic opportunity
 • Parental separation • Discrimination
 • Mental illness
 • Incarceration




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 There’s good news. “Resilience”
 The ability (capacity) to adapt (and succeed) in the face of significant adversity
 Resilience transforms potential toxic stress into tolerable stress

 POSITIVE FACTORS
 Strong, stable relationship with caregiver
 Self-regulation skills
 Connection with community, faith

 NEGATIVE FACTORS
 Poverty
 Exposure to violence
 Bullying
 Absence of ≥1 caring adult
 Maltreatment

 4 KEY factors that predispose children to positive outcomes in the face of adversity
 The presence of at least one stable, caring, supportive adult
 Developing strong executive function and self-regulation skills
 Helping to build a sense of mastery over life circumstances (capacity)
 Supportive context of faith and cultural traditions




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Discussion:

Dr. Sonu mentioned doing “Trauma Informed Health Fairs” as a means of connecting with the public.
Counard asked if the Cook County team had ever held this type of event and how was it received? Dr. Sonu
said they had not, but he has heard it’s been done and there would be better ways to market the event.

Dr. Drachler asked about the questionnaire used at Cook County, what is the answer sheet and how is that
interpreted? Dr. Sonu responded most questions if answered no it’s abnormal. But some yes can be a
concern; there is no specific key to the questionnaire. Dr. Williams’s added that you need to have internal
validity and ask double sided questions, as seems to have been done with the questionnaire.

Dr. Williams commented that he used to head up a team in the U.S. Navy using a similar approach to
respond to post-traumatic stress disorder. He would like to collaborate with Dr. Sonu and the Cook County
team, now that he is a civilian.

Dr. Counard asked if NorthShore is doing anything similar to this. Dr. Drachler said he had not heard of the
ACEs approach being used a NorthShore. He would take this concept to the pediatrics department, and see
about having a presentation. Dr. Sonu said he would like to speak to this group about the ACEs Study.

Ms. Jones Thorne asked about those cases where parents are neglectful or in denial - can you ask other
questions to shed some light on any issues? Dr. Sonu said that is great question and concern and has been
discussed at length. The counter argument is that they are still screening. Ms. Jones Thorne mentioned other
screening pathways through other means such as daycares, schools etc. Dr. Sonu said that it could be done
but the main focus is to identify the family’s need for help.

Dr. Topouzian asked about the brain size issue and if the Cook County team is monitoring this concern. Dr.
Sonu explained that they are not specifically doing this but the literature shows the effects and that with
proper treatment for the ACE’s the brain can return to the normal percentile.

Dr. Drachler asked about funding. Dr. Sonu said there needs to be an intersection of primary care and other
central sources that could offer funding. Dr. Williams thought a great resource for screening is the public
school system that could identify potential problems seeing the symptoms and then getting resources to help.

Dr. Drachler thanked Dr. Sonu for coming and it will be interesting to see how these types of social issues
are incorporated into the 2017 Skokie Community Health Plan, and this is a really novel start.


4. Chair’s Report:
 Dr. Drachler reminded the Board that on March 13th the Village is holding the Boards & Commissions
 dinner and that everyone should be receiving an invitation in the mail for the event.

 Dr. Drachler commented on how the 2017 IPLAN process is moving forward and progressing very well
 and that Dr. Counard will be updating the group.


5. Director’s Report: January Monthly Report highlights – a copy is attached:

 Marching with Skokie Board of Health members against racism – Jan. 29 Interfaith rally and
 march at the Morton Grove Mosque.

 Both Dr. Usman and Mr. Abbasi mentioned that the march was very well received. They had a great
 turn out and thanked Dr. Counard for attending.
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 Dr. Usman, Mr. Abbasi and Dr. Counard mentioned on February 19th there is another march taking place
 in Chicago and everyone is welcome to attend.


 “Skokie Welcomes Everyone” campaign
 Health Director Dr. Counard joined Board of Health members, friends and colleagues to kick-off the
 “Skokie Welcomes Everyone” campaign, celebrating Skokie’s remarkable diversity and our ability to
 work together “for the betterment of the entire community” (quoting Village Manager John Lockerby).
 Buttons and signs are available for display through www.skokiecares.org

 Supporting the Affordable Care Act – Letters to Gov. Rauner, Illinois members of Congress
 With the approval of Mayor George Van Dusen and Village Manager John Lockerby, Health Director
 Dr. Counard called and sent follow-up letters to Gov. Bruce Rauner and Illinois members of Congress
 highlighting how the Affordable Care Act (ACA) has benefitted Skokie residents. In the letters Dr.
 Counard asked that Congressional leaders perform due diligence and develop a replacement plan prior to
 repealing ACA. Of note, two weeks later Gov. Rauner's administration sent a letter to House leaders
 urging thoughtful reform of ACA with time for Illinois to adapt.

Numerous Board members had a lengthy and passionate discussion and dialogue about the ACA and various
facets of this issue.


6. Old/New Business

 Dr. Counard gave a quick update on the Environmental Plan and how the Environmental Sustainability
 Commission has been working on a variety of topics. She added that Jenny Grossman, Chair of this
 commission, will give a one year update to the Board at the September meeting.

 Dr. Williams brought up Tobacco 21 and asked if he could write to Mayor Van Dusen about the topic.
 Dr. Counard said that certainly he could write to Mayor Van Dusen.

 Dr. Drachler spoke again about promoting commercial recycling. Dr. Drachler said that he asked the
 staff at Kaufman’s Deli why they do not recycle and was told that the Village does not pick up recycling
 for businesses. Mr. Jones explained that businesses can request one 95 gallon recycling cart once per
 week free of charge; a larger cart or more frequent recycling services would have a cost, but that could
 result in the business’ garbage collection cost being reduced if recyclables are ending up in the trash. Dr.
 Counard said that she and Bruce would follow up with Max Slankard the Director of Public Works about
 business recycling and how this can be improved.


Adjournment: The meeting adjourned at 8:32 p.m.




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