A Matter of Trust
by Cynthia Morrow - Wednesday, April 16th, 2014
A letter by Dr. Cynthia Morrow

By Dr. Cynthia Morrow

On April 1, I resigned from my position as commissioner of health in Onondaga County. When I was asked by the Syracuse New Times to tell my story, in my own words, I hesitated. So much had already been said. However, the ongoing interest in the story and my need to be responsive to our community prompted me to reconsider. These are my parting thoughts as I transition out of public service.

There were many contributing factors that led me to resign, but the most pressing was the county administration’s decision to move maternal and child health programs out of the Onondaga County Health Department in the 2015 budget process. Maternal and child health is a core public health function that should be delivered in a well-established and successful health model of service delivery under the direct supervision of a physician, as it is in Onondaga County at this time.

Because there is a long history of success in and rationale for having maternal and child health programs in the Onondaga County Health Department, I believe that the burden of proof must be on the county administration to justify moving these critical services to an untested model of service delivery. To date, no justification has been provided other than that the departments exist in silos.

I have proposed several no-risk, no-cost strategies that could improve communication and coordination immediately. The county’s proposed strategy simply moves maternal and child health programs from one silo to another and, in doing so, creates a whole new set of risks. My physician training requires that I do no harm, and therefore I could not participate in a process that poses an unnecessary threat to the health of our community.

There are many potentially harmful ramifications to the decision to transition maternal and child health programs from the Health Department to two other departments.

First, because maternal and child health is considered a core public health function, the state and federal infrastructure to support it is in the New York State Health Department and the Department of Health and Human Services. Carving these services out of public health takes programs away from the systems that support them.

Second, program participation is likely to decrease as clients begin to associate services with child protective services and the juvenile justice system. The Onondaga County Health Department has worked diligently to cultivate a safe and nurturing environment for women and babies, rebranding the “Division of Maternal and Child Health” into “Healthy Families” in 2011 response to clients’ and partners’ concerns that is was too closely associated with other governmental services. Referrals to Healthy Families programs increased in 2012. It is risky to underestimate the distrust that community members may have in government.

Third, there are potentially significant legal and fiscal implications to this decision that require discussion with the Health Department’s regulatory and funding agencies, but these agencies were not consulted before the decision was made.

Fourth, public health preparedness relies on a trained staff. Most of the clinical response team is in the Healthy Families programs. Not having these staff members in the Health Department threatens the ability to respond to a public health threat in a timely and effective manner.

And, finally, the Health Department is in the process of becoming accredited but will need to withdraw from the process because of this change. While accreditation is voluntary, it can increase trust in local public health agencies. Furthermore, within a few years, accreditation status will impact local health departments’ ability to receive competitive funding.

While my physician training taught me to focus on risk/benefit analyses, my public health training taught me to look more closely at root causes of problems. In reflecting on my career in county government, especially over the events of the past three months, I realized that the root cause of my resignation was not the decision itself – however strongly I disagree with it – but was the recognition that I could no longer function effectively with the current county administration.

I believe that it is incumbent upon those in public service to earn their community’s trust through transparency, accountability, responsiveness and public engagement. During my tenure, the Onondaga County Health Department consistently sought to build the community’s trust in each of these areas. The Health Department developed a close partnership with the media to ensure the public was informed on public health issues. We dramatically increased data available on our website as the public portal to community health information. We embraced social media, opening Facebook accounts, texting clients and entering the world of Twitter. The Health Department staff strengthened the culture of continuous quality improvement, embarked on a mission to achieve accreditation  and spent more than two years developing a comprehensive strategic plan that will ensure accountability. Our reputation for being responsive to community needs was enhanced by department-wide customer service training. And while there is still much work to be done to increase public engagement, collaboration with partners throughout the community became a priority, as did our efforts to hear directly from community members through focus groups, community meetings  and other opportunities.

I believe that all public servants should work continuously to earn the public’s trust. I feel that the manner in which the decision was made to move maternal and child health programs out of the Health Department was inconsistent with my expectations of public service.

Over the past few days, I have been asked if I regret my decision.

I regret that the county administration and I were not able to work together to address the concerns I had. I regret that there has been so much conflict, especially because it was preventable.

I do not regret my decision to resign. I believe that it triggered a community dialogue not only about the importance of maternal and child health services and how these services should be delivered but also about public service.

This dialogue has provided me with hope. Hope has come from the kind supportive words of legislators as dedicated to transparency as I am. Hope has come from the medical community’s rallying to protect the public’s health and to demand accountability. And hope has come from the overwhelming response from other community members proving that they have a strong voice about this decision. I hope that it is heard.
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THE DIVISION OF HEALTHY FAMILIES

Special Children Services

  • Early Intervention (EI): Provides evaluation, education, therapeutic and transportation services for children through age 2 who have a developmental delay or disability or who have a specific diagnosed condition.

Primary outcomes include: Improved health and educational outcomes for children with developmental delay or diagnosed condition

  • Preschool Special Education: Provides evaluation, education, therapeutic  and transportation services for children ages 3 and 4 who have a developmental delay or disability.

Primary outcomes include: Improved health and educational outcomes for children with developmental delay or diagnosed condition

Home Visitation and Community Outreach:

  • Community Health Nursing: Provides preventive nurse visits for any pregnant woman in Onondaga County, although program focus is on women at highest risk for poor perinatal outcome.

Specific programs include:

  • Nurse Family Partnership; Maternal, Infant, and Early Childhood Home Visiting; EI CARES; Lead Poisoning Case Management; Neonatal Screening

Primary outcomes included but are not limited to: Decreased rates of infant mortality, low birth weight, fewer mental health concerns, decreased tobacco rates, increased breastfeeding rates, lower lead poisoning rates.

  • Syracuse Healthy Start: Provides case management, home visits, community referrals, and health education for pregnant women living in Syracuse, with a focus on those at highest risk for poor perinatal outcome.

Primary outcome:  Reduction in racial and ethnic disparities in perinatal outcomes

  • Maternal and Infant Community Health Collaborative: Provides case management, outreach, and advocacy by paraprofessionals to address medical and social service needs of pregnant women at highest risk for poor perinatal outcomes.
  • Primary outcome: Reduction in poor perinatal outcomes and in racial, ethnic, and economic disparities in these outcomes

Immunization Program:

  • Provides services to ensure that children are up-to-date with all recommended immunizations, that adults are educated about immunizations, and that local physicians have the support needed to participate in the New York State immunization registry

Primary outcome:  Increased immunization rates

The Special Supplemental Nutrition Program for Women, Infants, Children (WIC) and WIC related program:

  • WIC: Provides nutrition education, supplemental foods, and referrals for supportive services for pregnant or breastfeeding women, infants, and children up to age 5.

Primary outcomes: Improved nutrition and increased referrals for other services

  • WIC Vendor Management: Provides training and oversight of WIC vendors to ensure compliance with state and federal regulations governing WIC.

Primary outcome: Increased compliance

A Matter of Trust:

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