Groundwater—water that comes from the ground via wells—is the water most of us drink every day. People also use water for numerous activities including bathing, cooking, recreating, cooling, manufacturing, food production, and medical use.

Approximately 95% of Idaho’s drinking water comes from ground water sources, with the remaining 5% supplied through surface water sources like lakes and rivers. This is one of the key reasons protecting groundwater is an important priority, and everyone’s responsibility. If you have a well, you should test it at least annually for contaminants and conduct routine inspections to ensure it is operating properly to protect your family. 

Most of the time you can assume groundwater is safe, but sometimes it can become contaminated with bacteria, viruses, parasites, and chemicals, such as fertilizers and pesticides. In addition, there are many natural germs and harmful chemicals that can get in groundwater from the environment, such as arsenic, nitrate, and radon.

Contamination is commonly caused from the incorrect use of fertilizers and pesticides; poorly situated, built, or maintained septic systems; improper removal of storage wastes; mining and construction; and chemical spills.

All of these contamination situations can result in illness among many people..

National Groundwater Awareness Week runs March 6 - 12 and is a great time to learn where your drinking water comes from and how to protect it.

Please visit the Idaho Department of Health and Welfare’s Environmental Health webpage or contact the department at 800-445-8647 for more information on how you can protect your groundwater, including testing and maintenance.

Brigitta Gruenberg is the Environmental Health Program manager in the Division of Public Health.  

The Idaho Department of Health and Welfare is dedicated to strengthening Idahoans' health, safety, and independence. Learn more at healthandwelfare.idaho.gov.

Four new youth crisis centers in Idaho will make it easier and faster for young Idahoans to get help when they’re experiencing a behavioral health crisis.

In December, the Department of Health and Welfare and the Idaho Department of Juvenile Corrections finished awarding grant funding to four applicants to operate four youth behavioral health community crisis centers. Locations will be Caldwell, Boise, Twin Falls, and Idaho Falls and should open later this year.

They will operate every day all year to provide evaluation, intervention, and referrals for youth experiencing a crisis due to serious mental illness or substance use disorder. We expect the centers will reduce the rate of youth hospitalization and incarceration in Idaho.

Youth can stay at one of the centers for up to 23 hours and 59 minutes. They will receive a place to rest, food, and services from mental health professionals to stabilize the crisis, develop a plan of care, and have access to:

• 24-hour crisis hotline
• Medical screening
• Assessment
• Crisis intervention services
• Community-based referrals

The initiative to establish youth community crisis centers was a recommendation from the Idaho Behavioral Health Council (IBHC), which was created by the Governor, the Legislature and the Idaho Supreme Court.

Idaho Gov. Brad Little adopted the IBHC’s recommendation as part of his Leading Idaho plan, which expanded behavioral health resources by $50 million. In 2022, the Legislature allocated a one-time general fund appropriation of $4.42 million to support development of the youth community crisis centers.

While this is an accomplishment for elected and appointed officials, the real winners will be Idaho’s youth in crisis. By giving young people places to go for help, we hope to see a better outcomes for youth experiencing a behavioral health crisis.

Have a safe and healthy weekend.

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.  

Gastrointestinal illness caused by norovirus has been making news the past week, with well-publicized outbreaks in the United Kingdom and New York City, but Idaho is not experiencing more cases than we would expect. We typically see increases in illness due to norovirus during the winter months.

The number of norovirus cases reported during December 2022 through January 2023 is about what we would expect based on the number of cases reported in previous years. Idaho had 48 cases reported during December 2022 through January 2023. By comparison, case counts during December and January in previous winters ranged from a low of 26 to a high of 77.

With or without high case rates, however, norovirus causes a nasty illness that’s best avoided, if possible.

How common is norovirus?

Norovirus tends to be thought of as a cruise ship illness because outbreaks on ships sound like a terrible vacation – and that’s when the media tends to cover it most. But for most of us, there’s a better chance of becoming infected in common public places such as restaurants or big events and in places where people gather and share bathrooms, such as nursing homes, day cares, schools, and camps.  It’s so highly contagious – a very small amount of the virus can make you sick. Norovirus is the most common cause of gastroenteritis in the United States, and the leading cause of foodborne illness. The Centers for Disease Control and Prevention estimates that 19 to 21 million cases of acute gastroenteritis are caused by norovirus each year.

What does norovirus do to us?

It’s not pleasant. Norovirus causes inflammation of the stomach and intestines. That leads to stomach cramping, nausea, vomiting, and diarrhea. The virus is found in the vomit and stool of infected people. Other symptoms include stomach pain, fever, headache, and body aches. Some people call it the “stomach flu,” but it is not related to influenza virus.

Who is at risk?

Everyone is at risk, but the very young and old and those with chronic conditions are more likely to get sick. It’s estimated that on average,  a person will get norovirus five times in their life.

Most people recover in about three days, but the virus causes up to 70,000 hospitalizations and up to 800 deaths a year in the United States.

How does a person become infected?

Norovirus is very infectious and easily spread. You can become infected  through contaminated drinks and foods, touching contaminated surfaces, and through direct contact with infected people. Food and drinks become contaminated by infected food handlers, placing food on contaminated surfaces, or food being grown in or harvested with contaminated water. Any shared surface such as door handles, shopping carts, and light switches can become contaminated when an infected person doesn’t thoroughly wash their hands after using the bathroom. Having direct contact with or caring for someone who is infected is also a way the virus is spread.

How long are people contagious?

People are most contagious from when they start to feel sick until at least three days after they recover. Some people are contagious for even longer. That’s why it’s so important to stay home when you feel sick and always wash your hands after using the bathroom. If you think you have norovirus, see your doctor, but also make sure to drink plenty of fluids to avoid dehydration, which can set in quickly.

So how can we protect ourselves?

There is no vaccine to prevent norovirus or any medication to treat it. The best way to protect yourself is to wash your hands often, but especially after using the toilet or changing a diaper, and always before eating or preparing food.

Other ways to reduce the risk of infection include thoroughly washing fruits and vegetables, and cooking oysters and other shellfish thoroughly before eating them. Also, don’t prepare food for others while you are sick and for at least three days after you recover.

Potentially contaminated surfaces should be cleaned with a bleach-based cleaner or other disinfectant labelled as EPA-registered against norovirus. Any contaminated clothing or blankets also should be washed and dried.

• CDC norovirus website: www.cdc.gov/norovirus
• CDC National Outbreak Reporting System dashboard: https://wwwn.cdc.gov/norsdashboard/

Dr. Katheryn Turner is deputy state epidemiologist in the Division of Public Health. 

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov. 

The Department of Health and Welfare (DHW) has begun the re-evaluation process for Medicaid coverage.  

The department issued around 30,000 notices on Feb. 1 to Idahoans who may no longer be eligible but have remained enrolled in Medicaid because of Medicaid Protection. That allowed people to stay on Medicaid during the pandemic, unless they died, moved out of state, or asked to be disenrolled. Around 150,000 Idahoans are on Medicaid Protection with an unknown status.  

States were allowed by the Centers for Medicare and Medicaid Services to start re-evaluations for people on Medicaid Protection on Feb. 1. States are not allowed to terminate coverage after the re-evaluation until April 1. 

DHW will send around 30,000 new re-evaluation notices each month through July. Participants will have 60 days to respond. They will receive three notices and a text message during that 60-day period.  

Medicaid Re-evaluation Timeline 

Those who are determined to be over-income will be transitioned to Your Health Idaho, the state-based marketplace where they can compare and shop for health insurance.  

It’s important to me to make sure people have health insurance and that they don’t lose appropriate coverage because they failed to respond to one of our notices. It’s also important to me that people who are not eligible for Medicaid understand that there are budget-friendly options at Your Health Idaho. Even if you don’t qualify for Medicaid, you may qualify for a tax credit that will help pay for health insurance coverage.  

But you must respond to the notices.  

If you receive Medicaid, please take action to make sure you receive notices about your benefits and re-evaluations. Report any changes in your household information, including your phone number and address. 

If your contact information has changed, or you want to confirm your current information, call DHW at 877-456-1233 or email MyBenefits@dhw.idaho.gov. You can also report changes by visiting idalink.idaho.gov 

Learn more about Medicaid Protection. 

I hope you have a safe and healthy weekend. 

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.  

When children are not safe in their own homes, they are often placed with a foster family. Some of those children require more care and can’t be placed in a typical foster home. Based on their needs, they require placement with a treatment foster family.  

Idaho doesn’t have nearly enough treatment foster homes for the children who need that critical support. Some youths are being cared for in short-term rentals because a treatment foster family is not available. Youth are also being placed in residential treatment facilities when they are better served in that setting. The number of youths in short-term rentals varies on any given day, but on average there are 10 children waiting for placement, many of whom would qualify for treatment foster care. 

The department works with agencies in local communities to recruit and train treatment foster families. Agencies have been recruiting families for the past year and have not been successful in licensing any treatment foster care families in southern Idaho, specifically. At least 30 families are needed in southern Idaho to meet the needs of these children.  

Children in treatment foster care, generally ages 10-17, have been assessed as having a serious emotional  disturbance, which means they have a diagnosable mental, behavioral, or emotional disorder that limits the child’s ability to function in family, school, or community activities. They may have challenging behaviors and need additional supervision and participation in community services, but they also need a stable and loving family who can support them as they learn positive behaviors.  

These children typically have feelings of neglect or abandonment; have experienced multiple foster care placements, or have bounced from group homes to residential treatment facilities and back to foster homes with parents who lack the knowledge and training and support team to provide care and services to meet their high level of needs.  

Although the work is challenging, treatment foster families can develop a lifelong relationship with the child and their family. Treatment foster families are instrumental in helping youths learn to manage their behaviors and helping parents support their children who have a traumatic history and/or mental health needs.  

If you are an experienced foster parent or have experience with mental healthcare, behavior management, or treatment planning, and have room in your heart and your home for a child that needs a little more, please consider becoming a qualified treatment foster home.  

The department works with two agencies to recruit, train, and support treatment foster families. Please contact them if you are in southern Idaho and can help.  

Pathways of Idaho 

• Email: TFCIdaho@pathways.com
• Website: https://pathwaysofidaho.com/tfc/
• Phone: 208-391-3304 

Rise, Inc. 

• Email: tfcidaho@riseservicesinc.org
• Website: https://riseservicesincid.org/family-services/treatment-foster-care/
• Phone: 208-252-6117 

I hope you have a safe and healthy weekend. As a reminder, our offices will be closed on Monday in honor of President’s Day.    

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.  

Idaho emergency response and mental health professionals gathered last week for a conference focusing on managing crisis in school settings.

Hosted by DHW’s Division of Behavioral Health Feb. 8 and 9 in Garden City, the Idaho Crisis Con featured keynote presentations about calming aggressive and emotionally disturbed individuals, and preventing school shootings.

“That our conference was held just days before the tragic shootings at Michigan State this week underscores the need to talk about and get ahead of this type of tragedy,” said Statewide Crisis Program Manager Belinda Dalrymple, who works in the Division of Behavioral Health. “Our hearts go out to the people of East Lansing and the 67 other communities where mass shootings have also already taken place this year.”

The Idaho Crisis Con brought together professional counselors, administrators, and public servants with emergency first responders including police, fire, EMS, and corrections. Those in attendance represented the entire spectrum of professionals involved with identifying a potential situation before it escalates, and responding to a situation if it does.

“The 260 people who attended Idaho Crisis Con are professionals who someday may be in a situation where they need to use these techniques to protect students, and themselves,” Dalrymple said.

Crises of varying degrees occur every day in schools across Idaho. Students, parents, teachers, and staff may experience stress and anxiety, and crises can arise. The challenge for counselors, police, and school administrators is figuring out how to help a student in crisis and de-escalate a situation before it gets out of control or becomes violent.

“For administrators, it is essential that they know how to respond to warning signs before there is an attack, so they can intervene and perform an effective threat assessment to hopefully avoid having an attack” said keynote speaker Peter Langman, a sought-after expert on the psychology of school shooters and other perpetrators of mass violence.

Threat assessments can help show a pattern of behavior common among school shooters or would-be school shooters, but only if they are thoroughly investigated and shared with appropriate people. Langman cited situations where administrators, police, parents, and children all withheld information, lied, or underestimated the seriousness of a behavioral pattern.

Langman said there are three types of school shooters: psychopathic (no empathy and/or desire power), psychotic (delusions, hallucinations, and/or want to harm others), and traumatized (chaotic/abusive home life, parental substance abuse, or depression). For each profile, violence may manifest in different ways.

In some cases, a heated situation can be quelled before it escalates.

“De-escalation is a specific strategy which is used to try to help people who are in states of agitation or anger,” said keynote speaker Ellis Amdur, a prominent de-escalation trainer in the Pacific Northwest. “We need to clearly delineate what that strategy is and put it in its proper place for professionals to use. If your kid is in a bad mood and you distract your kid, that is a de-escalation strategy.”

Once a person becomes angry, however, verbal de-escalation becomes challenging.

“You can’t problem-solve with an angry person,” Amdur said. “You cannot de-escalate a violent person.”

Amdur said identifying whether a person is calm, angry, or enraged is necessary to determine how to engage them. If they’re calm, discussion may work. If they’re angry, de-escalation techniques may work. If they’re enraged, first responders should exert control to create space.

De-escalation techniques also may vary. The point is to separate a person from their anger, and that may involve giving compliments, asking questions, or talking about food.

While the Idaho Crisis Con covered a wide range of scenarios and responses, the predominant theme was safety: the safety of students, staff, teachers, and first responders. While crisis situations will no-doubt vary, the ways to prevent or de-escalate include advanced communication among all parties, performing proper threat assessments, and training to use de-escalation techniques that may limit or negate violent acts.

• Learn more about Peter Langman: https://schoolshooters.info/about-dr-langman
• Learn more about Ellis Amdur: https://www.edgework.info/ellis-amdur/

The Idaho Crisis Con is envisioned as an annual event that will bring together first responders and mental health professionals to identify and implement solutions for pressing behavioral health issues.

Dustin Lapray has been with the Division of Behavioral Health for two years. He accepted the role of public involvement officer earlier this month.

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.  

The Department of Health and Welfare (DHW) is doing a number of things to ensure affordable, available healthcare that works. We’re addressing three main areas: healthcare workforce shortages, improving health outcomes and cost-efficient care, and limiting Medicaid spending growth.  

Healthcare workforce shortages 

• The Division of Public Health is working to increase the number of National Health Service Corps (NHSC) clinic sites, which improves access to healthcare for Idahoans. A clinic with the NHSC designation offers a sliding fee scale for patients and loan repayment for providers. Idaho has 299 approved NHSC sites in the state. On July 1, 2022, there were 257 sites in the state.  
• The Division of Behavioral Health is working with the Idaho Behavioral Health Council to implement a comprehensive behavioral health workforce plan. A new plan has been published at: https://behavioralhealthcouncil.idaho.gov/. It contains five goals: promotion, education, credentialing, employment, and retention that all address challenges with the behavioral health workforce in Idaho.  
• The Division of Medicaid is working with stakeholders to address challenges in direct care work force retention and recruitment. Initiatives include a marketing campaign that will increase interest in direct care as a job or career, and a project to improve free training opportunities for direct care workers in Idaho.  

Improved health outcomes and cost-efficient care 

• The Division of Medicaid is gathering data for a preliminary report on the cost-efficiency and quality performance metrics for the statewide, value-based payment program. The report will be complete by Dec. 31, 2023. 
• The division has added the Medicaid Expansion population to the Healthy Connections-Value Care Program. That program is a managed fee-for-service arrangement, using a network of primary care physicians and healthcare providers to serve as the “medical home” for Medicaid participants. The program will help transform Idaho’s healthcare system from one that pays for volume to one that pays for value (healthy patients).  
• The division is also working with stakeholders to establish quality metrics for value-based, managed care, and fee-for-service programs in Medicaid. The metrics will be established by September.  

Limit Medicaid spending growth  

• The division is reviewing recommendations for short-term spending reductions from a recent interim report from the consulting firm Sellers Dorsey. A final report with longer-term recommendations is expected in early April.  

You can read more about all of these initiatives in our Strategic Plan, under Goal 1.  

I hope you have a safe and healthy weekend. 

The Idaho Department of Health and Welfare is dedicated to strengthening the health, safety, and independence of Idahoans. Learn more at healthandwelfare.idaho.gov.  

Although tooth decay is largely preventable, it remains the most common chronic childhood disease in the United States. The Idaho Oral Health Program strives to support prevention services, including oral health education aimed at reducing children’s decay rates in Idaho.

As soon as teeth appear, decay can occur. One of the risk factors for early childhood cavities (sometimes called baby bottle tooth decay or nursing mouth syndrome) is frequent and prolonged exposure of a baby’s teeth to liquids, such as fruit juice, milk, or formula, which all contain sugar.

Tooth decay can also occur when a baby is put to bed with a bottle. Infants should finish their naptime or bedtime bottle before going to bed. Because decay can destroy the teeth of an infant or young child, you should encourage your children to drink from a cup by their first birthday.

Training cup tips to help prevent tooth decay in children

For sipping success, carefully choose and use a training cup. It is best to choose a training cup that does not have a no-spill valve. The valve requires a child to suck—similar to a bottle—and does not allow the child to learn to sip. As your child’s first birthday approaches, encourage them to drink from a cup. As this changeover from baby bottle to training cup takes place, consider:

• What kind of training cup you choose
• What goes into the cup (serve milk at mealtime and water between meals)
• How frequently your child sips from it

Talk with your dentist for more information, and if your child has not yet had a dental examination, schedule a well-baby checkup for his or her teeth. The American Dental Association recommends a first dental visit before a child’s first birthday.

The link between sugar and tooth decay

Consuming too much sugar can dramatically affect dental health, as well as overall health. Sugar on teeth provides food for bacteria, which produce acid. The acid can eat away tooth enamel.

Almost all foods have some type of sugar that cannot and should not be eliminated from our children’s diets. Many of these foods contain important nutrients and add enjoyment to eating. But there is a risk for tooth decay from a diet high in sugars and starches. Starches can be found in everything from bread to pretzels to salad dressing, so read labels and plan carefully for a balanced, nutritious diet for you and your kids.

Reduce your children’s risk of tooth decay by following some of the following tips:

• Sugary foods and drinks should be consumed with meals. Saliva production increases during meals and helps neutralize acid production and rinse food particles from the mouth.
• Limit between-meal snacks. If kids crave a snack, offer them nutritious foods.
• If your kids chew gum, make it sugarless – Chewing sugarless gum after eating can increase saliva flow and help wash out food and decay-producing acid.
• Monitor beverage consumption – Children should make healthy beverage choices such water and low-fat milk.
• Help your children develop good brushing and flossing habits.
• Schedule regular dental visits.

Brushing and flossing your child’s teeth

It’s important to develop routine dental habits for your child even before teeth come in. Before the first tooth, you can wipe your baby’s gums with a clean washcloth or gauze after feeding.

Once teeth begin to come in, transition to a soft-bristled toothbrush, brushing twice a day, after breakfast and before bed. Using a small amount of fluoridated toothpaste (the size of a grain of rice), will help protect teeth from decay. A pea sized amount of fluoridated toothpaste can be used at age 3, or once the child learns how to spit out the toothpaste.

Begin flossing your child’s teeth once a day when the teeth touch each other. Children usually need assistance with brushing and flossing until age 7 or 8.

Tips for making good oral health habits routine:

• Start habits early, even before the first tooth
• Brush your child’s teeth twice a day
• Use the recommended amount of fluoridated toothpaste
• Model good brushing and flossing habits for your child
• Make brushing fun by using sticker charts or listening to a favorite song while brushing

Where can parents and caregivers go for more information or to locate resources?

• Idaho Oral Health Program: https://healthandwelfare.idaho.gov/health-wellness/healthy-infants-children/oral-health
• American Dental Association: https://www.mouthhealthy.org/
• Centers for Disease Control and Prevention: https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html
• American Academy of Pediatric Dentistry: https://www.aapd.org/resources/parent/

Kelli Broyles has worked as the oral health program specialist with the Division of Public Health for three years. She has been a registered dental hygienist for more than 25 years and prior to joining the oral health program, delivered dental care in both public health and private dental settings.

The Idaho Department of Health and Welfare is dedicated to strengthening Idahoans' health, safety, and independence. Learn more at healthandwelfare.idaho.gov.