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    Division for Regional and Local Health Services

    1100 West 49th Street, Room M149, MC 1908
    Austin, TX 78756

    Phone: (512) 776-7770
    Fax: (512) 776-7590

Regional and Local Health Services hold state’s public health system together


Regional and Local Health Services hold state’s public health system together

In our statewide public health system, the DSHS Division for Regional and Local Health Services holds together a network that provides essential public health services for Texans in every county.

In Texas, local governments are permitted but not required to perform public health functions. If they opt out of this role, DSHS steps in to cover any service gaps. With only about one-fourth of our state’s 254 counties having a local health department or public health district, there are many gaps to fill.

DSHS regional offices are the sole providers of public health services to residents in three-quarters of Texas counties, shaded in gray above. (Click on image for larger map.)

Some areas of Texas have public hospital districts that provide public health services. Also, a few counties and cities are able to provide very limited public health services, such as restaurant inspections or septic-tank inspections, through local code-enforcement departments or environmental-services departments.

Cathy Dickerson, a registered nurse in public health at Region 2/3 in Vernon, presents a program about rabies to a group of preschoolers.

“DSHS does not duplicate services that a local government chooses to perform,” says Dr. James Morgan, assistant commissioner of DSHS Regional and Local Health Services. “We work with established local health departments and public health districts to fill in gaps in services and to help them out when they’re overwhelmed by public health emergencies or disasters.”

Throughout the state, local governments are encouraged to appoint “local health authorities” – physicians with various roles and responsibilities related to protecting the public health by administering state and local laws. There are 182 individuals serving as local health authorities in Texas. Regional and Local Health Services is responsible for keeping track of these appointments and providing orientation and training to the appointees, along with ongoing technical and professional support.

To effectively provide services across the entire state, DSHS divides Texas into eight geographical regions, a system that’s been in place for more than 25 years. It’s an administrative tool that’s also employed by other state agencies, such as the highway, education, and wildlife departments.

High school science students create a community garden in Liberty for residents and the local school district. Region 5/6 South employees in three regional programs helped to plan and build it. Begun in August 2010, the garden is still going strong.

Gym equipment is cemented into the ground at a ‘fitness zone’ that DSHS Region 5/6 South helped to establish in Aldine. The outdoor gym, installed in a local park in September 2009, is free for anyone to use.

In the 1970s, the former Texas Department of Health had divided the state into 12 regions whose borders were later redrawn into eight regions. The numbering for these eight regions was then changed to match up with the numbering of the state’s 11 regions for health and human services – that’s why one of our eight is named Region 11 and why four of them have somewhat oddly constructed names, such as Region 2/3, Region 4/5 North, Region 6/5 South, and Region 9/10.

Each of our eight regions is headed by a regional medical director who’s a physician. This person officially serves as the local health authority for each county in the region that doesn’t already have a local health authority. Sometimes, the regional medical director also provides backup to local health authorities in cities and counties that do have them.

Each region also has a deputy regional director, a staff that’s budgeted for between 96 and 216 employees, and an area of responsibility that ranges from 16 counties for Region 6/5 South, headquartered in Houston, to 49 counties for Region 2/3, headquartered in Arlington.

In counties without local health departments, the DSHS region fills the role of a local health department. Even in counties with local health departments, the DSHS region may still provide some services that the local health department doesn’t.

The regional directors report directly to Assistant Commissioner Morgan, and they all meet together four times a year to interact and share best practices. In addition, every two weeks, Morgan and his central-office staff conduct a conference call with the regional directors and deputy directors to deal with operational issues and to get important feedback on regional issues.

The essential public health services that regional employees and contractors provide are preventive, protective, regulatory, and preparedness functions. To prevent disease, each region promotes good health behaviors and conducts health education and health promotion with individuals and groups. To protect the public from the spread of communicable diseases, the regions provide immunizations, tuberculosis control and treatment, rabies eradication, and services for those with HIV and sexually transmitted diseases. Medical services are provided in local clinics, regional field offices, one-day temporary clinics, and even in mobile clinics that are driven out to where the need is greatest.

Each region handles family health services in addition to specialized health services, such as case management for clients with special needs and eligibility determination for the Children with Special Health Care Needs program. Environmental-health specialists in the regions protect the public’s health by inspecting retail food outlets, schools, summer camps, day-care centers, and a variety of other institutions, businesses, and facilities. Regional staff also work on preparedness planning and exercises to be ready to act in the event of man-made or natural emergencies or catastrophes.

The regions assess disparities in health status among different populations and work to reduce or eliminate them and to overcome barriers to health-care services. They work with communities and local officials to strengthen and maintain the local public health infrastructure, and they evaluate public health outcomes.

Region 2/3 staffers hold an H1N1 flu clinic in the Anson school in January 2010. Immunization specialist Ronda Meyer, second from left, gives a shot to a resident while Denise White, second from right, a registered nurse certified in public health, speaks with the man standing at far right, whom she has just vaccinated. ‘He was 102 years old, and I think he was doing better than most of us,’ she says. ‘He says it’s because I give him his flu shots each year to take good care of him.’

Public health nurse Denise White of Region 2/3 teaches kids at a school health fair about why immunizations are needed.

“Regional priorities are an extension of the priorities of the agency as a whole,” says Morgan. “DSHS leadership and program staff in the various divisions in Austin establish strategic priorities and program policies, and then staff in the regions carry out program activities in line with them. The tactics used in different parts of the state may differ somewhat due to epidemiological, cultural, or geographic factors, but the goal is for the overall strategy to remain consistent statewide.”

The Regional and Local Health Services office in Austin houses 11 staffers who provide administrative and programmatic support to the regions. The office serves as a primary point of contact for local health departments and public health districts across the state.

“Our job is to make sure that the activities of the regions and local health departments are in line with DSHS program priorities and that DSHS programs understand the issues that regions and locals face in carrying out their programs’ priorities,” says Morgan. “We try to provide clear direction and clarification of program goals and objectives to regions and locals while also providing needed feedback to programs on the effectiveness of their strategies.”

In all, the regions are staffed by 1,053 full-time employees who fill most of the nearly 1,200 full-time positions assigned to the regions. They work in the eight regional headquarters and in 86 field offices throughout the state. With six field offices, Region 1 in the Panhandle has the fewest, while Region 7 in Central Texas, with 24, has the most.

Though the 11 state hospitals are each physically located in a region, the thousands of DSHS employees who work in them are not considered regional employees. “To accomplish shared goals,” says Morgan, “the staff in regions do collaborate with DSHS hospitals as well as with other HHS facilities and regional components of other state agencies.”

Emergency Response Team nurse Linda Williams of Region 2/3 opens a DSHS response van and prepares to administer vaccinations against tetanus, diphtheria, and pertussis to people affected by wildfires in Montague County in July 2009.

It’s been nearly five years since Regional and Local Health Services was elevated to the division level, headed by one of the five DSHS assistant commissioners.

“Our division was launched on September 1, 2006,” says Morgan, who’s directed it since February 2009. “We’re charged with representing and supporting diverse RLHS functions and ongoing operations that cross division lines. We work strategically to improve the design and delivery of coordinated program services at the local and regional levels. Overall, we reflect our agency’s commitment to work in partnership at the local level with public health agencies and communities. Together, we work to build and maintain capacity to provide essential public health services that are responsive to local needs.”


Last updated April 27, 2011