Can Polk cut adult health costs by addressing child trauma?

BARTOW – Because the cumulative effect of childhood traumas is linked to an array of health issues and a shorter lifespan, Polk County is seeking a training grant to help community partners' efforts to prevent diseases and promote well-being.

The issue came up Friday morning when the Citizens Oversight Committee met to, among other things, look over the proposed 2018-19 budget that coordinates spending the money raised through Polk County’s voter-approved, half-cent sales tax for indigent health care.

Debbie Zimmerman, a representative of the Polk County Schools who is leading the oversight committee's Prevention and Wellness Subcommittee, reported that county staff has applied for and apparently is in good standing to get a grant that would train community service providers to use the Adverse Childhood Experience questionnaire and relate it to Trauma Informed Care.

The questionnaire, which focuses on childhood abuse, emotional and physical neglect and household dysfunction, could be used by community partners, including United Way, Polk County Schools, free health clinics and other health care providers, to suggest a client or patient seek mental health counseling, Zimmerman said.

Following the meeting, Teri Saunders, representing Heartland for Children on the Citizens Oversight Committee, cited a large-scale epidemiological study that found people who had ACE scores of six or higher had a reduced lifespan of 20 years. That study was published in the American Journal of Preventive Medicine in 2009 using data from the national Centers for Disease Control and Prevention and Kaiser Permanente.

An earlier CDC-Kaiser Permanente study had established that as a person’s ACE score goes up for having adverse childhood experiences, the risk also goes up for developing lung disease, heart disease, liver disease, depression, alcoholism, drug abuse, unintended pregnancies, fetal death, suicide attempts, sexually transmitted diseases and other health-related quality of life issues.

The Prevention and Wellness Subcommittee also has been looking at other issues the county may want to focus on with funds from the sales tax. Zimmerman said ideas being looked at include:

• Whether paramedics could provide some home services that would keep people out of expensive emergency departments.

• Expanding liaisons for churches’ congregational health programs.

• Expanding mammogram services beyond screenings.

• Providing audiology services and hearing aids.

• And providing vision and optical services.

“It is a big county. We have a lot of providers and a lot of needs,” Zimmerman said. The ideas are among those that may be looked at during a January strategic planning retreat of the Citizens Oversight Committee – a volunteer advisory board appointed by the Polk County Commission.

Without making any recommendations for changes, the oversight committee approved the proposed $88 million indigent care fund budget for 2018-19, sending it to the County Commission for final action.

Kelvin Almestica, a health-plan financial analyst with Polk County, said the half-cent sales tax is projected to bring in $44,713,883, which is 6.7 percent more than it raised this year.

The amount the sales tax brings in varies with the county’s economic health but has been steadily rising since the 2010 recession when it dropped to a low of $29.6 million.

The sales tax will fund 50.8 percent of the proposed budget. Most of the rest of the money ($42.3 million or 48.1 percent) is coming from funds saved in previous years when it was not clear whether voters would OK the 2016 proposal to extend the sales tax another 25 years.

Proposed spending in the coming year includes:

• $14,255,280, a 2 percent increase, to pay for the county’s share of state-mandated programs. Those include Medicaid for health services for disabled adults and low-income children, out-of-county hospital services for indigent Polk County residents, specific mental health services for indigent residents and support for certain Department of Health programs.

• $17,735,666, an 18.7 percent increase, to provide health services through the Polk Health Care plan for qualified, indigent Polk County adults who have no insurance or health care coverage. The extra $2.8 million will go toward providing an additional $52 a month in services for each of the 4,500 plan members.

• $17,035,701 for grants and aid to community partners providing health care services, a 0.7 percent increase. The breakdown includes $1.4 million to rehab a building that will house Winter Haven Hospital’s pending medical residency program; nearly $6.6 million for primary care services; $625,000 to provide specialty care; nearly $2.8 million for dental services; $1.3 million in prevention and wellness services and $4.3 million in behavioral health services.

• $2,393,058 for staffing, a 4.2 percent increase

• $2,481,717 for operating expenses, a 0.3 percent decrease.

• $895,870 in other indirect expenses.

The proposed budget sets aside $33,249,042 in various reserve funds, about a 3.7 percent drop from this year.

Marilyn Meyer can be reached at marilyn.meyer@theledger.com or 863-802-7558.