Wake County Human Services and Environmental
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1 of 3 www.wakegov.com Wake County Human Services and Environmental Services Board March 22, 2012 AGENDA Human Services Ctr. - 220 Swinburne St. 2nd Fl., Rm. 2132 Standing Time: 7:30AM – 10:00AM Dianne Dunning, Chair Pablo Escobar, Vice Chair Purpose: Advocacy, Policy, Advisory, Accountability 7:30 am Meeting Called to Order Invocation Approval of Minutes: February 23, 2012 Next Board Meeting: April 26, 2012 220 Swinburne St., 2nd Fl., Rm. 2132 Regular Agenda 7:35 am Board Discussion on WCHS Department Proposed FY 2013 County Budget 7:50 am Regional Networks Development Committee: Mr. Frank Eagles, Chair • Summary Report of Western Region Assessment - Mr. Bill Scanlon, Community Services, and Ms. Rosena West, Southern Regional Center 8:05 am 8:10 am 8:20 am 8:35 am Social Services Committee: Dr. Paul Norman, Chair • Update on Planning of Summit - April 23, 2012 - Mr. Julian Smith • Approve Child Care Subsidy Local Policy Changes - Ms. Giang Le • Update on Child Welfare and Federal Child & Family Services Review (CFSR) - Ms. Lisa Cauley Executive Committee: Dr. Dianne Dunning, Chair • Recognition of Departing Board Member: --Reverend Alexander Herring: November 5, 2007 - February 23, 2012 • Update on the 2011 Smoking Ban Violation Appeal: County Attorney Scott Warren 2 of 3 8:45 am Board Advocacy Workgroup: Dr. Sharon Foster, Chair • Updates on the Board's Priorities Agenda and Advocacy 8:55 am Public Health Committee: Mr. Benny Ridout, Chair • Review/Discuss Public Health Quarterly Report (#2.4) • Review/Discuss State of the County's Health (SOTCH) Report (#39.4a) 9:10 am City of Raleigh Affordable Housing Task Force Report - Mr. Shawn McNamara, City Strategic Planning Division 9:25 am Managed Care Organization (MCO) Update - Mr. Joe Durham, Ms. Denise Foreman, Mr. Ramon Rojano, Dr. Carlyle Johnson 9:30 am Overview on the Continued Management of the Wake LME - Mr. Paul Gross 9:40 am HS&ES Directors' Q & A 9:55 am Chair's Report 10:00 am Adjournment Information Packet Items Human Services Mission Statement Wake County Human Services in partnership with the community will anticipate and respond to the public health, behavioral health and the economic and social needs of Wake County residents. We will coordinate and sustain efforts that assure safety, equity, access and well-being for all. - December 2006 _____________________________________________________________________________ Environmental Services Mission Statement To protect and improve the quality of Wake County’s environmental and ensure a healthy future for its citizens through cooperation, education, management and enforcement. Environmental Services combines: • water quality • air quality • solid waste (recycling, landfills, etc.) • environmental health and safety (sanitation inspections, pest management, swimming pool regulations, animal control) ________________________________________________________________ 3 of 3 FY 2011 Board’s Top Six Priorities: #1 #2 #3 #4 #5 #6 Prevent Child Abuse and Support Families Housing for Vulnerable Populations Obesity Prevention and Nutrition Access to Mental and Physical Health Services Protect Wake County’s Water Resources Human Capital Development (added 10/28/10) Human Services and Environmental Services Board Quarterly Meeting Schedule April 2012 Sun Monday Tuesday Wednesday Thursday Friday Sat 1 2 BOC 2pm---- 3 4 5 6 (County Holiday) 9am-10:30am Social Services, Rm. 5032 (Canceled) 7 8 9 10 11 12 8am – 10am Bd. Executive Cmte. Rm. 5032 13 11:30am – 1:30pm Environmental Services – Library Admin., 4020 Carya Dr. 14 15 16 BOC 2pm---- 17 Noon – 2pm - LME Advisory, 401 E. Whitaker Mill Rd., Rm. 210 18 Board Packet Distribution 19 3:30pm – 5:15pm - Housing & Cmty. Revitalization, Rm. 5032 20 11:30am – 1pm LME Human Rights, HS Millbrook Ctr., 2809 E. Millbrook Rd. 21 24 25 22 23 8:30am – Noon Child Abuse Prevention & Strengthening Families Summit – J.C. Raulston Arboretum, 4415 Beryl Rd. __________ Noon – 2pm Public Health, Rex Women Ctr., Rm. 100C* 26 7:30am – 10am HS & ES Board Mtg. Rm. 2132 28 27 __________ 29 12:45pm – 2pm HRC – Rm. 5032 30 May 2012 Sun 6 Monday 7 BOC 2pm---- Tuesday Wednesday Thursday Friday Sat 1 2 3 4 9am-10:30am Social Services, Rm. 5032 5 8 9 10 8am – 10am Bd. Executive Cmte. Rm. 5032 11 11:30am – 1:30pm Environmental Services – Library Admin., 4020 Carya Dr. 12 18 Noon – 2pm Public Health, Rex Women Ctr., Rm. 100B 19 25 26 __________ 10am – 11am Regional Networks Cmte., Rm. 5040 17 3:30pm – 5:15pm - Housing & Cmty. Revitalization, Rm. 5032 13 14 15 Noon – 2pm - LME Advisory, 401 E. Whitaker Mill Rd., Rm. 210 16 Board Packet Distribution 20 21 BOC 2pm---- 22 23 24 7:30am – 10am HS & ES Board Mtg. Rm. 2132 27 28 (County Holiday) 12:45pm – 2pm HRC – Rm. 5032 29 30 31 June 2012 Sun Monday Tuesday Wednesday Thursday Friday Sat 1 9am-10:30am Social Services, Rm. 5032 2 3 4 BOC 2pm---- 5 6 7 8 11:30am – 1:30pm Environmental Services – Library Admin., 4020 Carya Dr. 9 10 11 12 13 14 8am – 10am Bd. Executive Cmte. Rm. 5032 15 11:30am – 1pm LME Human Rights, HS Millbrook Ctr., 2809 E. Millbrook Rd. 16 __________ 17 18 BOC 2pm---___________ 24 11:30am – 1:30pm Wake County Links Annual Graduation & Promotion Ceremony (2012 Graduating Class) – Commons Bldg. 25 12:45pm – 2pm HRC – Rm. 5032 19 Noon – 2pm - LME Advisory, 401 E. Whitaker Mill Rd., Rm. 210 20 21 3:30pm – 5:15pm - Housing & Cmty. Revitalization, Rm. 5032 26 27 28 7:30am – 10am HS & ES Board Mtg. Rm. 2132 Noon – 2pm Public Health, Rex Women Ctr., Rm. 100B 22 23 29 30 Assignments to Committees Executive Committee 2nd Thursday 8am – 10am Rm. 5032 Dianne Dunning Pablo Escobar Frank Eagles Leila Goodwin Melissa Jemison Paul Norman Benny Ridout Stephanie Treadway Staff: Regina Petteway Joe Durham Ramon Rojano Bob Sorrels Affordable Housing & Community Revitalization 3rd Thursday 3:30pm – 5pm, Rm. 5032 Community and Public Health 3rd Friday, noon Rex Women Ctr. Benny Ridout Alexander Herring Burton Horwitz Sharon Foster Staff: Michelle Ricci Sue Lynn Ledford Brent Myers, EMS Peter Morris Regina Petteway Andre Pierce Yvonne Torres Community: Laura Aiken Kevin Cain Barbara A. Hughes Anne McLaurin Leena Mehta Ann Rollins Heidi Swygard Penny Washington nd 2 Fri., 11:30am, Library Admin. Carya Dr. Leila Goodwin Dianne Dunning Frank Eagles Benny Ridout Melissa Jemison Jeff Smith Staff: Sue Lynn Ledford Deborah Peterson Andre Pierce Matt Roylance Community: Rodney Dickerson Les Hall Glenn Harris Suzanne Harris Don Haydon Bryan Hicks Lana Hygh Buck Kennedy Jacob Reynolds Bob Rubin Henk Schuitemaker John Sowter Paula Thomas Liz Turpin Kenny Waldroup Julie Wilkins Phillip White John Whitson Regional Networks Development Qtrly, Rm. 5040 Melissa Jemison Dianne Dunning Frank Eagles Benny Ridout Staff: Annemarie Maiorano Bob Sorrels Staff: Darryl Blevins Rosena West Ross Yeager Regina Petteway Community: Emmett Curl Steven Hess Michele Grant Teresa Piner José M Serrano Mark Shelburne Trace Stone-Dino Yolanda Winstead Environmental Services Staff: Matt Burton Sharon Brown Andre Pierce Bob Sorrels Community: Arsenio Carlos, ERC Rev. Lenwood Long, NRC Eugenia Pleasant, NRC Lunette Vaughan, SRC Community: Laura Goddard Phillis Ross John Sowter Don Wiseman 3rd Tues., Noon, 401 E. Whitaker Mill Rd. Rm. 210 Staff: Katherine Williams Giang Le Liz Scott Natasha Adwaters Martha Crowley Vielka Gabriel Warren Ludwig Jenny Wheeler Community: Lisa Bireline David Cottengim Pam Dowdy Lisa Draper Dudley Flood Glenn Harsh Marjorie Menestres Rick Miller John Parker Bob Robinson Georgia Steele Lynn Templeton Cherie Thierrault Brandon Trainer Tracy Turner Angie Welsh April Womack Marc Zarate 4th Mon., 12:45-2pm Rm. 5032 Staff: Brian Gunter Leticia Mendez Fabiola Sherman LME Advisory 1st Friday 9am – 10:30am Rm. 5032 Paul Norman Jim Edgerton Burton Horwitz Julian Smith Human Rights/ Consumer Affairs Pablo Escobar Kent Earnhardt Osama Said Social Services LME Human Rights Subcommittee Bi-monthly, 3rd Friday, Varying Times HS Millbrook Ctr. Rich Greb Laura Goddard Bruce Benedict Martha Brock Kent Earnhardt Marc Jacques Martha Pitts Staff: Glenda Reed Stephanie Treadway Pablo Escobar George Corvin Kent Earnhardt Jim Edgerton Melissa Jemison Staff: Carlyle Johnson Ann Wood Community: Ann Akland James Hartye, WakeMed Marc Jacques Rhonda Spence WCHS Matrix Update Summary Revised January 13, 2012 WAKE COUNTY HUMAN SERVICES 2012 MATRIX UPDATE The Wake County Human Services Matrix and the Prioritized List of Services were updated January 17, 2012. The list of services was updated to better reflect the new WCHS budget structure, and a few services were un-bundled to allow for better analysis and prioritization. The Senior Management Team (SMT) Questionnaire, administered through Survey Monkey, assessed and defined Wake County Human Services’ core services. For the Prioritized List of Services, each member of the Human Services Senior Management Team was asked to review the information compiled and to rate each service based on the following (6) WCHS Operating Principles. 1. Accomplishes one or more components of the Human Services and County Mission and Goals, and contributes to the completion of the Human Services and County Work Plans. 2. Attains positive outcomes, helping improve the lives and conditions of individuals, families and communities. Meets service demand for populations with critical needs and closes service gaps. 3. Ensures the current and future financial viability by preserving the capacity to collect revenue and maximizing County dollars. 4. Complies with laws, regulations, and contractual obligations. 5. Responds, or enables the Agency/County/Community to respond to emerging needs or system changes. 6. Ensures the maintenance of a solid programmatic/administrative infrastructure. Final SMT scores were tabulated (0-10 points for each criterion, maximum score was 60 points per service). The Services in the Matrix were then re-ordered from highest score to lowest score based on the cumulative ratings by the SMT, averaged and ranked. Program ranking is not a reflection of program quality. The Matrix update was conducted in the context of a global economic recession that has forced Wake County Human Services to try to meet increased demand for services with diminished resources. The recession has impacted our communities and resulted in a surge in clientele. In addition, the State is in the middle of implementing major changes to the Public Health, Social Services and MHDDSA systems which may considerably affect our delivery of services. These factors, along with others, result in a need to reprioritize services, and strategically plan how to deliver services with existing resources. Wake County Human Services Service Prioritization Program Current Ranking Services Average Score (out of 60) Prior Ranking (out of 52) Economic Self Sufficiency Child Welfare 1 Children Medicaid 48.33 2 2 48.05 1 Child Welfare 3 CW Core Services- CPS Assessment & Investigations CW Core Services- Foster Care 47.29 3 Child Welfare 4 CW Core Services- In Home Treatment 46.33 4 Economic Self Sufficiency Economic Self Sufficiency Health Clinics 5 46.33 5 6 Medicaid,Food Stamps,and Special Assistance for Older Adults Adult Protective Services 46.24 7 7 Communicable Disease Clinics- HIV/STD 46.24 12 Public Health 8 Communicable Disease Control- CD Investigation 46.24 8 Public Health 9 46.19 13 Public Health 10 Communicable Disease Control- Tuberculosis Surveillance PH Preparedness 45.81 18 Health Clinics 11 Communicable Disease Clinics- Immunizations 45.67 9 Children Youth and Family Economic Self Sufficiency Economic Self Sufficiency Economic Self Sufficiency Health Clinics 12 WIC 45.67 11 13 Food & Nutrition 44.90 6 14 Older Adults- Adult Care Homes 44.52 14 15 Child Support 43.76 30 16 Child Health Clinic 43.33 24 Public Health 17 AIDS/HIV Outreach 43.00 12 Admin/Operations 18 Transportation 42.71 28 Economic Self Sufficiency Economic Self Sufficiency Health Clinics 19 Adult Guardianship 42.62 10 20 Work First 42.48 17 21 Maternal Health Clinics- Prenatal 41.86 20 Revised January 17, 2012 1 of 3 Program Current Ranking Services Average Score (out of 60) Prior Ranking (out of 52) Children Youth and Family Behavioral Health 22 Perinatal Substance Abuse 41.48 35 23 Crisis Services (Crisis and Assessment) 41.38 16 Economic Self Sufficiency Child Welfare 24 Older Adults- Suport Services 41.14 31 25 40.52 21 Health Clinics 26 Foster Care Assistance- Emergency Placements (Wake House) Women's Health Clinic 40.48 23 Children Youth and Family Behavioral Health 27 40.29 43 28 Healthy Child Development and Care Coordination for Children Inpatient (Recovery Center) 39.57 26 Child Welfare 29 Child MH Services to Child Welfare Children 39.29 32 Children Youth and Family Children Youth and Family Public Health 30 Maternal Health- Pregnancy Care Management 38.90 41 31 Child Care Subsidy 38.81 27 32 Immunization Outreach 38.10 9 Admin/Operations 33 Housing- SWSC 38.00 25 Admin/Operations 34 Cornerstone/Supported Housing 37.95 38 Child Welfare 35 Adoption Assistance 37.86 22 Economic Self Sufficiency Children Youth and Family Health Clinics 36 Job Link 37.81 39 37 Family Support 37.71 40 38 Pharmacy Services 37.71 37 Behavioral Health 39 Adult MH- Deaf Services 37.43 29 Admin/Operations 40 Housing Supports- Voucher Program 37.05 36 Behavioral Health 41 Adult MH- Workfirst Initiative 36.48 29 Economic Self Sufficiency Health Clinics 42 Energy Assistance 36.24 34 43 Dental Clinic 36.14 33 Children Youth and Family 44 Youth Services- OJJ/DJJDP Program 36.00 50 Program Current Ranking Services Average Score (out of 60) Prior Ranking (out of 52) Economic Self Sufficiency Public Health 45 Employment 35.71 39 46 Child Fatality Prevention 35.62 13 Behavioral Health 47 Child Mental Health 35.19 48 Behavioral Health 48 Developmental Disability Services 35.19 16 Public Health 49 Health Promotion Education 35.19 51 Public Health 50 School Nursing- School Dental 35.05 49 Behavioral Health 51 Adult MH- MHSA Integrated Services 34.90 29 Public Health 52 Vital Records 34.86 13 Behavioral Health 53 Adult MH- Drop In Center 34.81 29 Health Clinics 54 Lab Services 34.43 45 Children Youth and Family Behavioral Health 55 Youth Services- School MH 34.14 47 56 Adult MH- Adult Treatment Teams 33.57 29 Children Youth and Family Behavioral Health 57 Youth Services- Community Youth Development 32.95 52 58 Adult MH- Substance Abuse Team 32.33 29 Admin/Operations 59 Juvenile Detention Center 30.43 42 Economic Self Sufficiency 60 Daily Grind 28.67 39 Revised January 17, 2012 3 of 3 WCHS FY 2013 Budget Reduction Options Reduction Share= $1,481,322 Department Budget Request Code 46 - Human Services 7335 46 - Human Services 46 - Human Services 7325 46 - Human Services 7324 46 - Human Services 7320 46 - Human Services 7330 January 31, 2012 Budget Request Name Impact Code 46911H_LME Network MINIMUM Administration 46928H_DD POS 46101H_ESS Administration 46711H_Juvenile Detention Center 46155H_Daily Grind 46356H_East Wake Youth Initiative MINIMUM MINIMUM MINIMUM MINIMUM MODERATE Ranking Type Code Brief Description REDUCTIONS Reduce the County funds utilized to support the LME Administration and Contract Agencies. REDUCTIONS Partially reduce contract funds with the City of Raleigh- Parks and Recreation, Special Populations Department. REDUCTIONS Reduce the supply budget for Food and Nutrition Services and Medicaid due to the implementation of DSS Document Imaging and NC FAST applications. REDUCTIONS Reduce budget to projected funding level. The Juvenile Detention Ctr is a state-owned facility, administered by the state. By statute, counties must pay 50% of the per diem cost for youth housed in the detention center from each respective county. REDUCTIONS Reduce The Daily Grind (TDG) I and II vendor cost and staffing overlap, improve overall business practices REDUCTIONS Eliminates remaining county dollars to Poe Center to provide health education to youth and adults in Zebulon. Department Request Dept Dept Reduction FTEs Expenditures Priority Impact Statements 1 The impending merger agreement provided opportunity to identify -386,613 potential cost savings, utilized to support LME staff and network provider benefits. 2 Cutting the budget would result in fewer weeks of camp designed for -38,202 children with intellectual and developmental disabilites. 3 4 5 6 Contingent upon the implementation of a Document Management System by the end of -27,500 fiscal year 2012 to ensure cost savings. Any county placing a juvenile in a detention facility shall pay fifty percent of the total cost of caring for the juvenile to the Department. Cost savings are based on FY12 -100,000 projections assuming current rates of detention commitments. Renegotiate contracts with vendors reducing amount of products being ordered; stagger consumer hours -8,000 to avoid overlap- no negative impact to sales, or customers. Diminished capacity to achieve desired outcomes of increased physical activity and healthy -10,000 decision-making among underserved youth population in Eastern Wake County. 3 of 5 Department Budget Request Code Budget Request Name Impact Code REDUCTIONS Reduce the county dollars to NCSU Contract for Cooperative Extension in Human Services. MODERATE REDUCTIONS Reduce County funds by eliminating 1FTE vacant position # 01132, and reduce temporary salaries. MODERATE REDUCTIONS Reduce the County funds utilized to support WIC Client Services. 10 REDUCTIONS Consumer Records- Eliminate .50FTE Admin Asst due to DSS Document Imaging/ Electronic Medical Records implementation. Reduce SC Data Contract and overtime amounts. 11 SIGNIFICANT REDUCTIONS Reduce TANF-EA funds used to assist families with utility and/or rent expenses, whose household income is 150% or less of the Federal Poverty Level. SIGNIFICANT REDUCTIONS Eliminate vacant .50FTE; HS Program Specialist. Position was reduced during current fiscal year at request of the employee with Dept Head approval. 46 - Human Services 7327 46353H_4H Youth MODERATE Development Contract 46 - Human Services 7318 46330H_Child Daycare Administration 46 - Human Services 7323 46314H_WIC Client Services 46 - Human Services 7319 46 - Human Services 7328 January 31, 2012 46130H_TANF (EA) Emergency Assistance 46353H_4H Youth Development MODERATE Impact Statements This reduction equals a 5.5% cut in the Housing Services Contracts Budget. REDUCTIONS 46721H_Housing and MODERATE Support Services 46707H_Consumer Records Brief Description The proposed reduction is a decrease in the funds used to contract with agencies to assist clients experiencing homeless in obtaining permanent housing. Eighteen (18) fewer clients will be placed into permanent housing. 46 - Human Services 7321 46 - Human Services 7331 Ranking Type Code Department Request Dept Dept Reduction FTEs Expenditures Priority 7 -45,900 8 Diminished capacity to respond to consumers seeking educational -37,166 programs for children and families and opportunities for volunteerism. 9 -1.00 -0.50 The WIC program operates by -40,255 using predominantly State funds until depleted, and then The impact is questionable regarding this program. The implementation of the (2) systems will provide efficiencies; however the Medical Records component of -39,780 the new PH Practice Care Management System will be implemented late in fy2013 or fy2014. Program may need to utilize temps to operate effectively. This is a direct service to families with children and would have a significant impact on the lives of -120,957 these families through eviction or loss of utilility services, eg water, electric, gas, oil,etc. 12 13 Contingent upon the implementation of SEEK/NC Fast -100,000 and the State assumes child care subsidy payments at approx 35m. -0.50 Approx 148 fewer youth in Wake County will participate in positive youth development opportunities -43,404 afforded through 4-H. 4 of 5 Department Budget Request Code 46 - Human Services 7326 46 - Human Services 7315 46 - Human Services 7317 Budget Request Name 46637H_Adult Treatment Team Supports 46630H_Psychiatric Services 46634H_Substance Abuse Team Impact Code Ranking Type Code Brief Description SIGNIFICANT REDUCTIONS Adult Treatment Team SupportsEliminate 1.30FTEs; HS Senior Case Manager Positions SIGNIFICANT REDUCTIONS Reduce the Salaries/Temp line of the Psychiatry Budget. The funds are used expressly for the management of emergencies when a locum tenens physician is needed to provide medical care to current clients. SIGNIFICANT REDUCTIONS Elimininate vacant 1FTE HS Clinician position. The intent was to redirect it toward Latino Substance Abuse services, as that was a community need gap identified and agreed to by both the LME and WCHS. Department Request Dept Dept Reduction FTEs Expenditures Priority 14 -1.30 Available case support will be reduced by 50% for over 400 clients, impacting their ability to -55,540 receive services that at time can be critical to maintaining their wellbeing in the community. Diminish capacity to provide psychiatry services in the event of an emergency situation; these events are unforeseeable and -29,853 usually offer little time for planning 15 16 -1.00 Position will be redeployed to addres a gap in service delivery, and become more competitive in our clinical and business practices -63,408 by addressing a need not currently being met in the community. Human Services -4.30 (1,146,578) Grand Total -4.30 -1,146,578 Increase Revenues (reflected in base budget) Total Reductions January 31, 2012 Impact Statements 334,744 -1,481,322 5 of 5 January 25, 2012 WCHS FY2013 Expansion Request Department Request Dept Dept Expenditures Expansion FTEs (excluding Priority vehicle) Department Request Title Brief Description Budget Impact 46 - Human Services 7396 - HS Data Support_1FTE Info Tech Specialist Position Information Technology Specialist (1FTE) supporting the new Practice Management System and Electronic Health Records in the Health Clinics. SIGNIFICANT 1 46 - Human Services 7435 - HS Data Support Group_PCMS Annual Maintenance Annual software maintenance and support costs for the PH Practice Care Mgmt System w/ Electronic Medical Records. SIGNIFICANT 2 157,688 46 - Human Services 7476 - HS Administration and Ops -Millbrook Expansion_Facility Cost Projected lease amount of the Millbrook facility, 2nd floor, area 3; currently occupied by the Wake County Local Management Entity. SIGNIFICANT 3 70,100 1.00 96,792 7479 - Child Support Civil Filing Fees 7416 - HS AMH POS Holly Hill Contract Child Support increased civil filing fees SIGNIFICANT 4 61,491 Increase funding for inpatient psychiatric care at Holly Hill Hospital SIGNIFICANT 5 2,101,550 46 - Human Services 7417 - HS AMH POS Daymark Annualize FY12 funding to support operation of a 16SIGNIFICANT bed crisis/detox unit that will be operated by Daymark. 6 50,082 46 - Human Services 7477 - HS Admin. and Ops Increase lease amount for the facility occupied by Western Wake_Cornerstone WCHS located at 150 Cornerstone Road. Facility Cost MODERATE 7 53,381 46 - Human Services 7406 - HS Administration and Operations - Program Integrity MODERATE 8 46 - Human Services 46 - Human Services Program Integrity- 1FTE Program Auditor to conduct front end investigations 1.00 51,310 46 - Human Services 2.00 2,642,394 Grand Total 2.00 2,642,394 Human Services 2013 Capital Improvement Projects Project Description Amount Swinburne First Floor Transformation Project Swinburne First Floor Transformation to implement NCFAST (North Carolina Families Accessing Services through Technology $ JobLink Millbrook Improvements Replacement of all client chairs in the JobLink at Millbrook (100D), shared office spaces (100A;100C) and Reception area (100) Fulfill contractual obligations with the state to screen all persons with suspected or active TB and pers with new positive skin tests Modify interior to enhance security. awaiting an estimate from GSA Public Health X-Ray Machine Removed from CIP- HS will purchase fy2012 Cornerstone Interior Renovations 3/13/2012 $ 130,392.00 43,107.00 awaiting an estimate from GSA WESTERN REGION ASSESSMENT TEAM 9/19/2011 T H I S D O C U M E N T I S A F I N A L R E P O R T D E L I V E R E D B Y T H E W AK E C O U NT Y W E ST E R N R E G I O N A SSE S SM E NT T E AM . I T P R O V I D E S A D E T A I L E D A C C O U N T O F T H E P R O C E S S AN D O U T C O M E O F T H AT T E A M ’ S A S SE SS M E NT O F T H E V I AB L E S E R V I C E D E L I V E R Y O P T I O N S I N T H AT R E G I O N. ii INTRODUCTION WAKE COUNTY BACKGROUND Wake County is consistently rated as one of the best places to live and work in America. It is the center of the state government of North Carolina and is part of the Research Triangle metropolitan region, which encompasses the cities of Raleigh, Durham, Cary and Chapel Hill and their surrounding suburban areas. Wake County is one of the fastest growing counties in the United States. It is currently the second-most populous County in North Carolina. The County consists of 12 municipalities and includes Raleigh, the county seat and state capital. A unique mix of urban and rural small towns distinguishes Wake County from other counties and provides something for every lifestyle. The County encompasses 860 sq. miles and has a population of more than 900,000 residents. Rapid growth is not a new trend, as the County population has more than doubled since the 1990 census. Wake County Government is governed by a seven-member Board of Commissioners, elected at large to serve four-year terms. Under their direction, the County Manager oversees the daily provision of services to citizens ranging from health programs and other human services to parks and recreational opportunities, land use planning and zoning responsibilities, law enforcement and public safety, solid waste disposal, recycling, and libraries. Wake County’s stated Mission is to improve the economic, education, social well-being, and physical quality of the community and is committed to collaboration, service excellence and embracing new approaches to more effectively meet the ever-changing needs of its citizens. ASSESSMENT BACKGROUND Wake County has been a leader in developing strategic processes to implement seamless governmental services. Over the past few decades public sector organizations have been challenged to reengineer themselves to be more consumer focused, quality driven, good stewards of available resources and conduct business in a transparent manner. In response to this challenge, in 1988, the Wake County Board of Commissioners (BOC) developed a regional network concept for service delivery. The Regional Network philosophy is a strengths–based approach and speaks to the collective role of communities and government in determining their future. At the core of the regional philosophy is developing networks, community and agency, that result in better coordinated service delivery systems. Regional service delivery aims to bring both county and community services closer to local residents through implementing regional service delivery centers that provide an array of services through collaborative partnerships. These centers offer a base to operate an array of county, community and private services and resources that are targeted to address local community concerns. The model emphasizes local access and seamless service delivery for all citizens, community ownership, collaborative partnerships and community development. REGIONAL NETWORK PHILOSOPHY The regional service delivery concept is a comprehensive plan designed to offer a wide range of services that enhances a community’s capacity to respond to local needs. Regional service delivery poses numerous advantages for Wake County communities. These opportunities include: Collaborative Partnerships Regional service delivery targets local community needs and shares in the development of positive alliances among community partners. Community partnering maximizes public and private resources with a goal that service delivery will operate optimally. Effective partnering incorporates (a) exploring and identifying new resources needed to meet community needs and (b) leveraging existing and/or untapped resources or assets. iii Community Ownership Regional service delivery acknowledges that each community is different with respect to its needs and availability of goods and resources to meet such needs. Local community input around decisions that impact community well-being is progressive and merely “sensible planning”. Partnering with local communities to address local concerns fosters community ownership and enhances the community’s capacity to sustain successes gained from collaborative initiatives. Capacity Building and Community Development Regional service delivery aligns the provider and consumer of services in close proximity making utilization efficient and responsive to community needs. Regionalization promotes service delivery that enhances the interconnectedness of county services and the integration of services within the local community. The Regional Network plan included the development of four regional governmental centers and was initiated with the opening of Southern Regional Center in 1996 and continued with the Eastern Regional Center in 2002 and Northern Regional Center in 2008. Regional Government centers have been a regional service delivery platform for multiple county departmental services, state and community organizations since that initial center. The following assessment considers the optimal service delivery model for the final region, the Western Region, given current challenges and goals. The implementation of the regional network philosophy and regional governmental centers was placed under the Human Services and Environmental Services Board (HS/ES Board) and the Human Services department. The HS/ES Board is a policy and advocacy board, charged with representing the broad interests of the community through specific issue-oriented committees. A particular committee of the HS/ES Board, the Regional Networks Committee of the Board, has oversight for development of Regional Networks. The Board‘s work is additionally supported by Regional Community Advisory Committees (CAC) which are operated by key community stakeholders who have an investment and insight into development of the community. The committees consists of local community leaders who advocate on behalf of the Regional Center; assist in marketing the goods and services of the center to the local community; and help build strategic partnerships within their respective regions. As the Regional Networks Board Committee continues to address larger regional network planning and implementation concerns the Regional Community Advisory Committees work with the Regional Director and the community to maintain the local efforts established by the regional networks committee. The Regional Network Committee’s work plan includes development of a comprehensive assessment of the western environment. An earlier review of the western region, 2005-2006, identified service hot spots. An overlay of 2007-2008 and 2009 - 2010 data for the area indicated that new hot spots have emerged. Other factors impacting planning for the west that also required further study included: A possible Apex location was identified to be jointly developed with the town of Apex. This site is no longer a viable site for a Regional Center due to site limitations; Questions about overlap in the service area between the proposed regional site in Apex and the existing Southern Regional Center in Fuquay-Varina; In the past ten years the Western Region of the county has experienced a dramatic population increase with changing social characteristics. The Western Region is comprised of well-resourced communities which may present additional opportunities for service provision and partnership development. iv ASSESSMENT PURPOSE The purpose of this assessment was to identify opportunities for meeting residents’ needs through an array of service strategies and enhanced partnerships within the Western Region, prioritize and make data based conclusions regarding the relative value of specific opportunities in collaboration with our partners and identify necessary next steps to pursuing high value opportunities. The study area consisted of the towns of Cary, Morrisville, Apex, their planning jurisdictions and the unincorporated portions of the County determined to be within the study area. Through a comprehensive planning process, the assessment reflects months of collective discussions, public input, an examination of past and future trends, input from the towns and benchmarked county governments. This process was vital to determine if there is a need for a capital project and, if there is a need, to establish the foundation for this project. Capital projects are among the most expensive and most time-consuming, yet are some of the more important and enduring of any projects that the County undertakes. Therefore, careful planning is the key to this most critical responsibility of local government. And, like all businesses, the County must address its capital needs on a long-term basis to make well thought out plans in regard to spending public funds. Through the County’s Capital projects, the agency is able to plan and support growth through cost-effective use of existing and new facilities. It is important to recognize that the Regional Network goes beyond facilities and co-location of employees. It is an organizational concept that is rooted in the community and serves to provide a definition of community on a broader scale than a neighborhood or organization but also on a more narrow scale than the whole County. This perspective allows the County to assess how best to deliver services within this specifically defined area. In this vein, this report addresses not only the Western Region of Wake County as the fourth proposed service center to be developed but also the Western Region as a distinct regional community within the Regional Network plan. READING THIS REPORT This report is broken into two primary sections – the Executive Summary and the Full Report. You will find in the Executive Summary the basic information necessary to understand the assessment, our recommendation, and, generally, how we came to that recommendation. The Full Report contains detailed information on our methodology, findings, and conclusions, with an effort being made to detail the entire scope of the effort. This entails a lot of information and is geared to provide support to the Executive Summary while also standing alone. Due to this, you will find that there is some amount of repetition between the Full Report and the Executive Summary. Finally the Appendix contains specifics on certain items that either benefited from a larger view, such as tables and maps, or were elements that we felt might be helpful for context but not necessary for understanding the recommendation. Given the amount of information contained in the Appendix, a separate Appendix document was created and is available. For Wake County employees, that information can be found at the following location: P:\Western Region Review\Final Report\Appendix For external partners, contact Bill Scanlon (856-6064) or Rosena West (557-1002) for that information. v ACKNOWLEDGEMENTS This effort could not have been undertaken and completed without the guidance, support and effort of many people. In an effort to recognize in some small way the participation of these important individuals, we thank the following individuals and organizations for their participation: WESTERN REGION PLANNING TEAM Andrew Meyer Wake County Human Services 4-H Youth Development Becky White Human Services Health Clinic Ben Hitchings, Planning Director Town of Morrisville C.J. Harper Wake County Human Services Research and Evaluation Carolina Alford University of North Carolina Intern Cindy Rice Wake County Human Services Southern Regional Center Consuelo Gardner North Carolina State University Intern David MacLachlan Western Regional Center Deborah Norton Public Health Dianne Khin, Planning Director Town of Apex Don Willis Wake County Human Services Transportation Elizabeth Scott Adult Services Emi Wyble Wake County Human Services Project Management Emily Fischbein Wake County Human Services Housing Gail Kenyon, PhD Kenyon Community Building Gail Holden Senior Services Ginny Satterfield Wake County Human Services Office of Community Affairs Gloria Cook Wake County Human Services Children, Youth & Families Ida Dawson Clinic Director Jackie Brady Information Services James Robertson Wake Tech Western Campus Jane Sterner WorkForce Development John Tanner Child Welfare Karen Morant Wake County Human Services Office of Community Affairs Kizzy Thomas North Carolina State University Intern Lisa Sago Wake County Community Services GIS Mapping Lisa Sellers Wake County Human Services Child Welfare Michelle Vendito Wake County Finance Paula Cothren North Carolina State University Intern Rodney Wadkins, Senior Planner/GIS Town of Morrisville Sharon Peterson Wake County Community Services PDI Therese Scott Wake County Human Services Southern Regional Center Timothy Maloney Wake County Community Services PDI Tracy Stone-Dino, Senior Planner Town of Cary Tulia Pascht North Carolina State University Intern Virginia Tysinger Mental Health vi CONSULTANTS/REFERENCES Dr. Gail Kenyon, Kenyon Community Building Ted Abernathy, Executive Director, Southern Growth Policies Board , Southern Consortium of University Public Service Organizations Ronald Ledford, Community Volunteer - Editing COUNTY MANAGERS OFFICE David Cooke, Wake County Manager; Joe Durham, Wake County Deputy Manager; Johnna Rogers, Wake County Deputy Manager DEPARTMENTAL LEADERSHIP Ramon Rojano, Wake County Human Services Director; Frank Cope, Wake County Community Services Director; Phil Stout, Wake County Facilities Design &Construction Director, Tommy Esqueda, Environmental Services Director PROJECT SPONSOR: WAKE COUNTY HS/ES BOARD REGIONAL NETWORK COMMITTEE James Mebane, Chair; Benny Ridout, R. Ph,; Carlos Arsenio, Eastern Regional Center Representative; Mayor Frank Eagles, Northern Regional Center Representative; Eugenia Pleasant, Northern Regional Center Representative; Lunette Vaughan, Southern Regional Center Representative; Ross Yeager Wake County Northern Regional Center; Darryl Blevins Wake County Eastern Regional Center; Andre Pierce, Wake County Environmental Services; Kris Ramsundar, Wake County Human Services Millbrook Center LEARNING CONVERSATIONS Apex Chamber of Commerce; Cedar Rock Missionary Baptist Church; Dorcas Ministries@ Cary Presbyterian Church, Luther Green Community Center, Morrisville; Luz del Pueblo (White Plains United Methodist Latino Church); Western Regional Library; White Oak Missionary Baptist Church; Ramakrishna Vendata Society of N.C.; Cary Teen Counsel @ Cary Senior Center BENCHMARK COUNTIES Fairfax County, VA Montgomery County, MD Monroe County, NY DONATION OF MEETING SPACE Town of Apex Town of Cary Town of Morrisville Western Wake Technical Community College White Plains United Methodist Church, Cary PROJECT LEADERSHIP Bill Scanlon; Wake County Community Services; Rosena West, Wake County Human Services; Mark Forestieri, Wake County Facilities Design & Construction; vii TABLE OF CONTENTS Introduction ........................................................................................................................................................................... iii Executive Summary ................................................................................................................................................................. 1 Full Report ............................................................................................................................................................................. 14 Introduction ...................................................................................................................................................................... 14 Assessment Principles ....................................................................................................................................................... 14 Assessment Parameters .................................................................................................................................................... 15 Methodology ......................................................................................................................................................................... 17 Team Composition ............................................................................................................................................................ 17 Data Collection Process..................................................................................................................................................... 19 Asset Mapping Process ..................................................................................................................................................... 25 Data Validation & Analysis ................................................................................................................................................ 28 Support Workgroups ......................................................................................................................................................... 29 Assessment Timeline......................................................................................................................................................... 30 Findings ................................................................................................................................................................................. 31 Data Collection Findings.................................................................................................................................................... 31 Asset Mapping Findings .................................................................................................................................................... 34 Data Validation & Analysis Findings .................................................................................................................................. 36 Recommendation.................................................................................................................................................................. 46 Next Steps ......................................................................................................................................................................... 47 viii EXECUTIVE SUMMARY INTRODUCTION The goal of this assessment was to look at service delivery in the Western Region of the County and determine if there are ways to approach the County’s work in that area which would benefit the residents through improved service delivery and improved cost effectiveness of County operations. To that end, we defined our deliverable as follows: 1. Identify opportunities for meeting residents’ needs through an array of service strategies and enhanced partnerships within the Western Region; 2. Prioritize and make data based conclusions regarding the relative value of specific opportunities in collaboration with our partners; 3. Identify necessary next steps to pursuing high value opportunities. We recognize that this assessment was done with a view specifically to the Western Region and is not a full analysis of all of the County priorities. We anticipate that future groups will determine how the priority of our recommendations fall relative to the priority of other County initiatives, as that was not our role. What we have attempted to do in this assessment report is to make the case for a service delivery mechanism that we believe will best serve our residents and the County in the foreseeable future. ASSESSMENT PRINCIPLE S To be successful in this assessment we emphasized three critical elements in our methodology – data driven decisions, service delivery based on community assets and an inclusive, broad perspective for service delivery. In order to ensure data driven decisions, we started the assessment with no specific outcome in mind. This required setting aside preconceptions and interests to allow for a final outcome that was based purely on what we observed in the data and discovered in interviews. In addition, we used existing data sets and mined them for information particular to this region and synthesized that data into a structure that allowed for conclusions based on the existing data. We attempted to make sure that all data sets contained the most recent updates to allow for the best possible results and most accurate interpretations. In order to ensure that we are looking at service delivery based on community assets, we used a very specific model for information collection within a community. This model, known as Asset Based Community Development (ABCD), provided a mechanism for understanding what service capabilities currently exist in the community (within the County, Towns and other service providers) and how they can be best used to meet the needs of the citizens. We conducted community learning sessions to collect information without any specific outcome for service delivery in order to focus the participants on what they had in place already rather than what they might need. More on this particular model can be found in the Appendix document. In order to ensure an inclusive, broad perspective we included team members from multiple County departments, all of the municipalities in the Western Region and various experts from outside of government. This team was divided into multiple workgroups focused on different elements but able to participate in all areas. This allowed us to better understand the data, test that the conclusions we drew were accurate from a number of perspectives and that there was a broad consensus on the final report. At the same time, this structure allowed us to ensure that the workgroups were appropriately sized to be effective in the detailed discussions and complex decisions that were required. 1 ASSESSMENT PARAMETERS For any effective study, the parameters of the study must be defined. While this allows for an effective study, this also results in an outcome that is heavily dependent on those parameters. We are including those parameters up front so that readers can understand the context. STUDY AREA The study area is the geographical parameter for the study. In this case, it provided a boundary for the demographic data and for the service data that was leveraged. Our study area included Apex, Cary, Morrisville and the surrounding unincorporated area. EXISTING DATA The team decided to use data from established sources that reflected current demographics, current services and strategic information that already existed rather than creating new sources. This included data from the 2010 Census, 2005-09 American Community Survey, County GIS system, 2010 HS Feasibility Study, and 2010 Community Health Assessment. PROJECT TEAM The project team was assembled to allow for a broad perspective with individuals that had a range of experience at this work. It included individuals from each of the towns in the study area, as well as individuals from multiple County departments. The team also had active participation from an expert in Community Development, a number of graduate student interns, and representation from Wake Tech. While this provided a benefit in perspective, it also was a limitation in that there may have been many other people that could have been added or might have a different perspective or different information. However, we decided that this provided a broad enough perspective to ensure that we were covering all of the critical elements and that there would be a time for others to be added during the review of our findings. This limitation allowed us to design the team in a way which balanced diversity with effectiveness. COMMUNITY INTERACTION While the project team recognized that community interaction was important to the project, we also recognized that it was important to recognize the strengths of the community and the existing assets in the study area. We also knew that community has multiple layers, facets and definitions. For the purpose of this assessment, we defined the community as the individuals and organizations within the Study Area. We decided to leverage a model for community interaction that emphasized community assets and did not reference a Regional Center. We believed that any other method would skew the result in favor of a specific service delivery mechanism and reduce the neutrality of the assessment. 2 ASSESSMENT FINDINGS DATA ANALYSIS The group responsible for analyzing the data and developing a final recommendation spent a significant amount of time reviewing, discussing and interpreting data. After completing this review of the data, they then developed a set of discrete options that were relevant, feasible, met our organizational goals and would be valid for the foreseeable future. For a complete list of the data that was reviewed and the process used for the data analysis, please see the full report. In the review of the data, the following observations were made that were critical to the final recommendation of the team: 1. Population Growth There has been a significant population growth in this area over the past 20 – 30 years and the study area has a much higher population than other areas in the County. This growth in population appears likely to continue and therefore there will be ever increasing demands on our facilities and employees, particularly for services that are population driven rather than demographically driven. While in relative terms it may appear that the growth is slowing, the population of the region is already significantly larger than any other region outside of Raleigh and therefore even small percentage growth will have larger impacts in absolute terms. 3 2. Existing Services There are a number of existing services that are currently delivered by County departments. We found that there are some services that require onsite delivery; some at the consumer’s location and some are delivered remotely. This is a critical element of understanding the value of certain service delivery options. Also, while some of the County services are impacted by municipal incorporation, there are many others that are not. The chart below highlights a list of certain services that are provided in the Western Region as well as the impact of incorporation on those services. This is important to this assessment as this study area has a much higher percentage of incorporation or extra-territorial jurisdiction than any other region. Our analysis also made it clear that there are a comparative number of current Human Services consumers living in this region as in other regions and, given the population in the study area, a much larger likelihood of potential consumers. Part of the data we reviewed included a number of maps that reflected the distribution of Human Services programs. The map below reflects the distribution of current consumers of Child Protective Services who live in the County and the study area. This particular service is found to be largely driven by population and requires both visits to consumers’ homes and onsite visits at a County facility. Each dot on the map represents a home where this service is provided (for privacy purposes, the dot does not reflect the precise location of the consumers home). The map highlights the study area with the red boundary: 4 The map reveals that services are being delivered to individuals that are within the study area. We reviewed a number of similar maps for other programs. This information can be found in the Appendix document. 5 3. Government Facilities As part of our analysis, we reviewed a number of maps that reflect the location of various County and municipal facilities, including parks, libraries, town halls, EMS facilities, Fire stations, schools and others. We found while there are a number of existing County facilities in the area, many of them serve a very specific purpose and are designed specifically for that service. Examples of this situation are parks and libraries, which have specific functions and purposes that are attached to their facilities. However, there are few multipurpose or sites that can be used to provide multiple services. We also found that Human Services currently uses two facilities in the study area. A small mental health office is located on High House Road serving adults with chronic mental illness, many of whom are on Medicaid. In addition to limited space, other limitations in this office include having no medical records on site and Medicaid applications can only be made at other sites in the County. Three miles west of this site, Child Protective Services has a suite in a real estate office where three Child Protective Services teams (18-20 staff) and one Family Support staff member have offices. Space in this site is also limited. It benefits the County to look at facilities that can serve multiple services, such as Regional Centers, and maximize them. Our service mix can determine how they are used and the existence of these facilities provides the County with future flexibility as service delivery changes. An example of this is a list of programs that are currently offered at our Regional Centers can be found in the Appendix document. 6 4. Community Based Assets There are many active and beneficial community groups which are engaged in this area. We found that many of these groups were willing to participate in our assessment and provided information to us. While these community assets exist, we also found that they often do not provide the same services as the County. In other words, they do not compete with our services as much as fill in the service gaps that they have identified between the community needs and the County service delivery. For many of these organizations, County departments are already engaged and are interacting with regularly, although often without any formal interaction from County leadership. In addition, while there is a diverse community with many assets, they are not currently organized in a way that can be used for a sustained level of service delivery and in many ways are already at capacity based on the consumers the County sends to them. A broader, more detailed list of associations can be found in the Appendix document. 7 5. Benchmarking A benchmarking process was undertaken to explore similar counties in the United States. The process compared Wake County’s demographics with other U.S. counties, as well as how other county governments interface with its citizens. To help prepare for this process, the team developed an organizational assessment outline to utilize when researching each county. When comparing county governments the outline addresses areas that include: the organizational overview, environment, organizational capacity, organizational network, and organizational performance. 8 Capital Planning Capital Plans were initiated in three of the counties to increase regional service accessibility. Fairfax, VA is divided into four regions with co-located Human Services Departments (System management, Administration, Health Department, Family Services, Community and Recreation Services, MH/MR/AD Services, Housing and Community Development) and Juvenile and Domestic Relations Court Services having a presence at the regional facilities. Fulton, GA renovated their North Fulton Service Center to include a new integrated regional health care facility including primary care, public health, behavioral health, dental services, housing, workforce development, and a child care area for clients. Four modular units house Cooperative Extension, Voter Registration/Elections Office, Solicitor General Office, Probate Court, County Marshal, Superior Court Clerk, Magistrate Court, Tax Assessor’s Office and Fulton County Career Center. Montgomery, MD has five regional service centers, opening the first one in 1978. The types of services are fluid based on demand: Health and Human Services, a Welcome Center for the immigrant population, Regional Recreation Department, Senior Olympics, Foreclosure Prevention State Office, Public Schools Organizational Office and a Child Care Center are a few of the occupants of the regional facility. Leveraging Partnerships Leveraging partnerships is a critical service strategy and some counties have designated departments/offices responsible for developing partnerships that can maximize resources. Monroe, NY leverages partnerships through the County’s Office of Faith-Based and Community Initiatives. Their mission is to strengthen the role of faith-based and community-based organizations in addressing social needs. Montgomery, MD has plans in place to create the Office of Community Engagement by consolidating staffing of the Regional Services Center, the Office of Community Partnerships, the Gilchrest Center for Cultural Diversity, the Office of Human Rights and the Commission for Women. Fulton, GA‘s Office of Grants and Community Development assists in the coordination of and development of resources and partnerships. Fairfax, VA’s Neighborhood and Community Services (NCS) engages, connects and collaborates with individuals, organizations, neighborhoods, and communities to strategically plan and provide responsive services, and build capacity to support community and neighborhood solutions. Future Challenges The benchmarked Counties’ future plans are to increase capacity where there are gaps centered on growing and underserved populations. Fairfax, VA is experiencing an increase in the elderly population and a need for adult day health care, community health care network and senior assisted living. Montgomery, MD shifted from an agricultural community to more suburban with a drastic increase in culturally diverse populations and opened the Gilchrist Center for Cultural Diversity. Citizen Advisory Groups were engaged to provide input about service decisions, and planning to address gaps in Monroe, Montgomery, Fairfax and Fulton Counties. 9 ASSESSMENT EVALUATION The group responsible for developing options highlighted four viable options in the spectrum of available options. In reviewing all possible options, a number of possibilities were discussed and discarded to get to these four final options. CRITERIA USED TO RATE OPTIONS At the beginning of the data analysis team process, the group developed criteria that they agreed should be used to evaluate service delivery options – critical drivers that would influence the recommendation for a service delivery model to meet the needs of the region. The criteria chosen include that the option: Increases accessibility Available on transit or other transportation Service level capacity is available to meet service demand Removes barriers to entry Maximizes efficiency and effectiveness Provides opportunities to leverage additional resources Operationally it is an effective way of providing services Leverages Partnership Opportunities Maximizes partnerships and collaborations thereby reducing service duplication Increase service delivery efficiencies, increases expertise and ultimately the capacity to serve through these partnerships Optimizes Service Delivery Capacity Increases capacity where there are gaps in service delivery – where current capacity is not meeting customer need/demand or anticipated future demand FINAL EVALUATED OPTIONS The final four options for service delivery the group considered to address the needs of the study area include: 1. One community based site similar to the Millbrook Human Services Center – smaller and focused on limited geographic area 2. Multiple community based sites located across the region 3. Regional Center similar to existing Regional Centers 4. Regional Center Campus with multiple county, municipal and community services located in campus-like setting 10 DISCARDED OPTIONS One of these discarded options was to do nothing – essentially keeping the service level as it exists now in the study area. Through discussion, this option was considered impractical in the long term for the following reasons: Data shows consistent growth in the area that is projected to continue. The data shows existing demand for human services in the area, consistent with other regions. Providing alternative service locations can improve accessibility to service options, specifically related to transportation access. Over time we will have diminishing capacity to handle increased consumer demand at existing sites. While this does not address staff issues, we recognized that space issues exist and will continue to grow as population grows. Another of the discarded options was to leverage the existing assets in the region to allow for service delivery through community assets rather than government assets. While a viable alternative in the long run, this option was considered impractical at this time for the following reasons: Community development opportunities based on assets in the region exist but are not organized in a way to deliver a sustainable model. Willingness within the community would have to exist to take on this role. The service infrastructure in both the community and the County would need to be developed over a significant period of time to ensure success. The community services that currently exist are often provided in conjunction with existing County services and not as duplicative services. These services often capture consumers that our current services do not or cannot. There are certain services that have demand in this area that are federally and state mandated services and must be provided by the County and not by another party. This means that while some service delivery can be moved to the community if the infrastructure were properly developed, there are still many services that the County is required to deliver in this region. 11 PRIMARY RECOMMENDATION After reviewing the data, discussing on a range of options, and evaluating the four options using the selected criteria, the recommendation from the Western Region Assessment team is as follows: A Regional Center is the best model for service delivery in the Western Region. This model should be utilized by the County going forward. At the same time, a Regional Community Action Committee (CAC) should be developed in order to provide community input into the County's work in this region. The Regional Networks philosophy supports bringing services closer to consumers for all departments and is a valid structure for the entire County to leverage. Continuing this philosophy into this region is sensible and appropriate given our current successes and the benefit of community interaction. There are a number of residents that live in the region that currently consume services that are delivered at one of our facilities. Data supports demand for services from residents in the study area and the likely growth of that demand. The services are often federally funded and are available for any resident who meets the eligibility requirements. There are already expenses for the operation of County facilities in the Western Region so there would be an anticipated reduction in those expenses to offset some of the increased operational costs. These services would benefit from colocation and increased collaboration. Accessibility and efficiency were the major drivers in this recommendation, with the Regional Center able to present more efficiencies than the other models while also offering service options to consumers that remove a major barrier to service receipt – ease of access because of transportation limitations and transportation costs. A Regional CAC would allow us to have community input and ideas in future work in this area. This would enhance the quality of our decisions and our service delivery. SECONDARY RECOMMENDATIONS The team also recommends consideration of the following: Begin an active community development program in this region using Asset Based Community Development (ABCD) model and using the foundation of the Learning Conversation participants: o The first step in this community development would be a full asset mapping effort of the Western Region along with the mechanisms to maintain that information. Partnership inventories have been done in the past with minimal success due to a lack of a consistent mechanism to manage the information. This would require a significant allocation of internal resources and would need to be fully defined up front to understand the effort. It would also require a specific knowledge of the ABCD model as Dr. Gail Kenyon provided for this initiative. It is likely that we will need to contract for this assistance. o ABCD could mobilize the resources already in the region to fully develop a comprehensive network of care, which directly impacts service delivery and how County government, the towns, faith organizations and local associations conduct business together. The location of additional services should be placed towards the central or eastern side of the region in order to widen the potential range of consumer interest and meet the needs of known consumers. The location of additional services should be in close proximity to supporting services such as shopping, banking, libraries, town services and other human service partners so that consumers might maximize their trips to access services and is a way to foster economic development to an area when consumers utilize the Center. Services that are to be offered should be based on the region’s needs and may be very different than services offered in other Regional Centers. This is normal for regional networks and is true today through our existing Regional Centers. The CAC could participate and provide input to the location of a center and beneficial services to provide. 12 Increase County departmental awareness of Regional Centers and discuss new ways to leverage this resource by departments who currently may not use them. NEXT STEPS Wake County Acceptance Regional Acceptance County Management Implementation Human Services Board Town Managers Regional Network Town Councils Committee Learning Conversation Program analysis Board of Commissioners Site Analysis participants Staffing analysis Land Acquisition Facility planning Regional CAC development 13 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: March 22, 2012 Committee/Item: Update for Child Care Subsidy Local Policy Specific Action Requested: Information Item Summary: • Changes in state policy regarding expenditures of child care subsidy funding: 1). Reduces use for post-secondary skills training from 24 months to 20 months 2). Eliminates payments for any registration fees • Additionally, to streamline services to clients, Work First Staff will take child care applications and approve child care for clients receiving services thru the Work First Program. Purpose for Action (Proposed Solutions/Accomplishments): Accept and approve the report. Board Chair signature for updated Local Policy Next Steps: Attachments: Updated Local Policy to reflect changes Opportunities for Advocacy, Policy or Advisory: Raising community awareness and advocacy relating to cost of living in Wake County, cost of child care, who receive child care subsidy benefits, impact on childcare business and on local employers. Connections to Other Committees: Social Services Committee HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: March 22, 2012 Committee/Item: Social Services Committee/Child Welfare Update Specific Action Requested: Receive report Item Summary: North Carolina and Wake County are scheduled for a federal Child and Family Services Review (CFSR) later this year. This report will give a snap shot of Child Welfare activity in 2011, briefly describe the CFSR process, and describe Wake County’s program improvement efforts. Purpose for Action (Proposed Solutions/Accomplishments): To inform the board and begin the process of preparing board members for possible participation in the review. Next Steps: This is the first of two planed presentations to position the board for advisory and /or advocacy roles. Attachments: Opportunities for Advocacy, Policy or Advisory: A board member is needed for participation on Wake County’s joint Child Fatality Prevention Team/Community Child Protection Team. Connections to Other Committees: Child Welfare Update March 2012 1. Child Welfare Snap Shot and Data Trends 2. Child and Family Services Review (CFSR) 3. Program Improvement Plan 4. New Initiative--Family Finding 5. Future topics 2011 Child Welfare Snapshot 228 Employees and $22 million budget Core Functions Screen and assess reports of child maltreatment 6741 reports screened 5019 accepted for assessment or assists Provide CPS In-Home Services to keep maltreated children safely with their families 811 families referred for In Home Services 1440 families served during the year Provide foster care and adoption services 322 children entered Human Services custody 828 children served during the year Child Welfare Data Trends • New reports slightly down • In Home cases slightly down • Foster care entries up since June 2010 due to an increase in cases of serious abuse and dangerous neglect • Foster care exits increased in CY 2011 CFSR Round III • Children’s Bureau intends to start Round III of the CFSR in 2012 • North Carolina is scheduled to be the second state reviewed • Wake County expects to be one of the counties reviewed • Reviewers are likely to talk with community leaders including WCHS Board members CFSR Process • Congressionally mandated strategy to assure a process of continuous quality improvement by all states • The Federal Children’s Bureau conducts on-site reviews and requires states to submit Program Improvement Plans (PIPs) for all outcomes not passed at a 95% rate • The Children’s Bureau can withhold funds to states failing to implement PIP and show improvement. CFSR Process • In Round II, federal reviewers used an 85-page instrument to intensively review a small number of cases • Case reviews included interviews with clients, staff, and others • Reviewers also looked at system performance indicators • Round III is expected to be similar but to include significant changes. The Round II review instrument has not been released. CFSR Outcomes SAFETY Children are first and foremost protected from abuse and neglect and maintained safely in their own homes. PERMANENCY Children have permanent and stable homes. Continuity of family relationships WELL-BEING Families have enhanced capacity to provide for their children’s needs. Educational, physical and mental health needs of children are met through appropriate services. Percentage of applicable cases across States substantially achieving each of the seven outcome areas. Child and Family Services Reviews Aggregate Report: Findings for Round 2, FYs 2007–2010 Round II Federal aggregate data across States Versus Wake County Aggregate of 6 reviews, December 2008 to August 2010 100 90 80 70 60 50 Round II Wake 40 30 20 10 0 Safety 1 Safety 2 Perm 1 Perm 2 WB 1 WB 2 WB 3 Program Improvement Plan Major Strategies Division discontinued quarterly reviews Peer Reviews and designated review team Improve knowledge of review instrument expectations Structured supervision and tracking Assuring all required contacts are made and documented throughout the case Try to make required monthly contacts in first 3 weeks Continued engagement of court system and efforts to expedite steps to achieve reunification or adoption Program Improvement Plan Major Strategies Targeted strategies for specific outcomes Staff work groups including one on timely initiation of Friday and other special reports Assure documented follow up when families do not follow through with services Family Engagement Focus on locating and engaging parents especially absent and incarcerated fathers Implementation of Family Finding Program to create relative supports for children and their families Family Finding—A Major Initiative • Developed by Kevin Campbell to find and engage relatives of children lingering in foster care. • State grant from FY 09 to FY 11 • Casey Family Programs invited Wake to submit a proposal in support of Casey’s Vision 20/20 (Safely reduce foster care by half nationally by 2020) • Proposed to adapt Family Finding for use as children enter foster care. Family Finding • Began planning a front end Family Finding intervention with CW and CYS internal staff • Children’s Home Society (CHS) received a Clark Foundation grant for Family Finding • This fall learned that CHS had unmatched grant money and that a CHS supervisor had supervised a front end Family Finding project in San Francisco Family Finding Proposed to CHS and Casey that we combine the two efforts. Wake County will: Have 2 Family Finding workers focused on older youth Have a team of 5 Family Finding workers and a supervisor focused on children entering foster care Have additional funds for supportive services for identified relatives Family Finding Goals • Decrease length of stay in foster care through reunification and relative placements • Safely divert children from foster care • Provide foster youth with family connections and support • Improve CFSR performance in areas of engaging relatives and achieving permanence • Improve compliance with Federal Fostering Connections law Future Topics Increase in serious cases and foster care entries Budget issues Anticipated loss of federal funding Possible opportunity of federal IV-E Waiver CFSR system outcome data HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: Executive Committee: March 8, 2012 HS & ES Board: March 22, 2012 Committee/Item: Public Health Committee/Public Health Quarterly Report October – December 2011 Specific Action Requested: Receive Public Health Quarterly Report Item Summary: The Public Health Quarterly Report is published by WCHS Public Health Division and highlights program data such as disease trends, program participation and outcomes. This quarterly report includes data from the 4th quarter of calendar year 2011. Purpose for Action (Proposed Solutions/Accomplishments): Public Health Accreditation requires that “The local health department shall analyze and note reportable events occurring within the community and shall report atypical incidence, if any, to the Division and the local board of health” (Benchmark 2 Activity 2.4). Next Steps: Accept quarterly report and use as needed to inform discussions, decisions and advocacy efforts related to public health. Attachments: Public Health Quarterly Report October – December 2011 Opportunities for Advocacy, Policy or Advisory: (see next steps) Connections to Other Committees: Environmental Services Public Health Prevent · Promote · Protect WAKE COUNT Y HUMAN SERVICES P U B L I C H E A LT H R E P O R T FOURTH QUARTER 2011 OCTOBER—DECEMBER, 2011 Wake County Human Services Public Health Division 10 Sunnybrook Road P.O. Box 14049 Raleigh, NC 27620-4049 www.wakegov.com February 17, 2012 Ramon Rojano, Human Services Director Sue Lynn Ledford, Public Health Division Director Editor-in chief: Edie Alfano–Sobsey, Public Health Epidemiologist Editorial Staff: Roxanne Deter, Public Health Nurse and Carla Piedrahita, Public Health Educator Design and Layout: Michelle Ricci, Public Health Educator Table of Contents Topic Page Introduction 3 Tobacco Use Tobacco Use in Adults and Youth 4 Secondhand Smoke Exposure 4 Complaints and Violations of the North Carolina Smoke-Free Restaurants and Bars Law 5 Use of the Quitline 5&6 Physical Activity and Nutrition Overweight and Obesity 7 WIC Participation 8 School Health School Nurse Referrals 9 School Principal Survey 9 & 10 School Nurse to Student Ratio 10 Sexually Transmitted Diseases Chlamydia and Gonorrhea 11 Integration of Services 12 & 13 HIV Viral Load and Disease Transmission 13 Infectious Disease and Foodborne Illness Seasonal Flu Vaccines Given 14 Reportable General Communicable Disease Investigations 15 Cases of Tuberculosis (TB) in Wake County 15 & 16 Critical Violations in Restaurants and Food Stands 16 & 17 Communicable Disease Events 17 Chronic Diseases Cardiovascular, Breast and Cervical Cancer Screening and Counseling 18 Injury and Violence Wake County Child Maltreatment Surveillance Project 18 Emergency Preparedness CDC Public Health Preparedness Capabilities Assessment 19 Disaster Preparedness Program Monitoring 20 Healthy North Carolina 2020 Objectives 21 & 22 Acknowledgements 23 2 Introduction On December 16, 2011 Wake County Human Services achieved Public Health Accreditation status! North Carolina’s Local Health Department Accreditation focuses on the capacity of local health departments to perform the three core functions of assessment, policy development and assurance and the 10 public health essential services (See Figure 1) at a basic, prescribed level of quality. This report helps fulfill public health essential services: • Number 1: Monitor health status to identify community health problems and • Number 3: Inform, educate, and empower people about health issues. It provides data on a quarterly basis to inform residents, providers, policy makers and community partners about the health and safety of Wake County residents. Figure 1 = The report is organized to align with selected Healthy North Carolina 2020 Focus Areas and Objectives (see http://publichealth.nc.gov/hnc2020/docs/HNC2020-FINAL-March-revised.pdf). The information presented monitors the current state of health indicators in Wake County and presents some of the strategies used by Wake County Public Health programs and services to improve health outcomes. The content of this report may change to include data for analysis of health indicators identified in the Wake County Community Health Assessment, through the Human Services and Environmental Services Board or elsewhere as needed. For additional information not included in this report, point of contact information is provided for each area. We wish to thank all staff who contributed to this report and for their daily efforts toward improving the health and safety of the citizens of Wake County. Sue Lynn Ledford, Public Health Division Director Edie Alfano-Sobsey, Public Health Epidemiologist 3 To b a c c o U s e TOBACCO USE IN ADULTS AND YOUTH There has been a 25% increase in the percentage of adult smokers in Wake County since 2008. In 2010 only 16% of all adults in Wake county smoked as compared to 20% of adults in NC (see Figure 2). Figure 2 Percent of Adult Smokers in Wake County Compared to NC from 2006-2010 25 22.1 2 2.9 20.9 20.3 19.8 20 15 17.5 Percent 10 15.7 16.2 NC 12 .0 12.5 Wake County 5 0 2006 2007 2008 2009 2010 Year Source: Behavioral Risk Factor Surveillance System (BRFSS) Survey, NC Center for Health Statistics According to the North Carolina 2009 Youth Tobacco Survey (YTS), which includes Wake County Youth: • 24.6% of students used any tobacco product (Male = 29.1%, Female = 19.5%) • 16.0% smoked cigarettes (White = 19.4%, Black = 10.8%, Hispanic = 11.3%) • 7.7% used smokeless tobacco (Male = 12.7%, Female = 2.2%) SECONDHAND SMOKE EXPOSURE From 2008-2010, the percent of people reporting no exposure to secondhand smoke in the workplace has increased from 93% to 96% in Wake County and from 84% to 91% in NC (see Figure 3). Figure 3 Percent of People Exposed to Secondhand Smoke in Wake County Compared to NC 2008 2010 1-6 days all 7 days No days 1-6 days all 7 days No days NC 5% 11% 84% 4% 5% 91% Wake 3% 4% 93% 3% 2% 96% Source: BRFSS Survey, NC Center for Health Statistics 4 To b a c c o U s e COMPLAINTS AND VIOLATIONS OF THE NORTH CAROLINA SMOKE-FREE RESTAURANT AND BARS LAW As of January 2, 2010, restaurants and bars and many lodging establishments in North Carolina were required to be smoke-free by enforcement of SL2009-27 (G.S. 130A-496) known as the North Carolina Smoke-Free Restaurants and Bars Law. In 2010, as a result of public attention to this new law through media and educational campaigns, 242 complaints about violations of this law were filed involving 81 establishments. In 2011, the number of complaints declined. In 2010 and 2011, 13 violations of this law were issued by WCHS involving some repeat offenders. Figure 4 Number of Complaints and Violations of the North Carolina SmokeFree Restaurants and Bars Law in Wake County Businesses during 2010 and 2011 300 250 242 200 Number 150 100 # complaints #businesses 81 #violations 30 50 13 27 13 0 2010 2011 Year Source: NC State Careline Reports and Wake County Human Services Site Visits and Violation Letters USE OF THE NC QUITLINE The NC Quitline started in November 2005. The purpose of the Quitline is to provide NC citizens a FREE resource to aid in quitting tobacco use. The Quitline offers four counseling sessions either by phone, and/or online. As of February 2, 2012, the Quitline is available 24 hours a day. Healthcare providers can refer someone to the Quitline by fax and a quit coach will call them. Additionally, even though supplies are limited, callers who enroll and qualify are offered FREE nicotine replacement therapy (NRT) medication in the form of patches, gum or lozenges. The Quitline number is 1-800-QUITNOW (1-800-784-8669). During February and March 2010, enrollment in the Quitline increased (see Figure 5) because of media coverage about the new North Carolina Smoke-Free Restaurants and Bars Law and other promotional activities through Wake County Human Services (WCHS) Project ASSIST (American Stop Smoking Intervention Study). Radio advertisements and health professionals were most effective in informing people about the Quitline (see Figure 6). 5 To b a c c o U s e Figure 5 Number of Wake County Residents Registered in Quitline in 2010 & 2011 250 200 150 Number 2010 100 2011 50 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Month Source: NC Quitline Monthly Data Reports for Jan.—Dec. 2010 and Jan.—Dec. 2011 Figure 6 Percent of Wake County Respondents Answering the Quitline Question " How did you hear about the Quitline?" in 2010 compared to 2011. N= 496 Website Tv Radio Outdoor ad 2011 Newspaper 2010 Health Professional Health Dept Family/Friend Employe r/worksite 0% 5% 10% 15% 20% 25% 3 0% Source: NC Quitline Monthly Data Reports for Jan.—Dec. 2010 and Jan.—Dec. 2011 Contact: Sonya Reid, Health Promotion Chronic Disease Prevention Section 919-250-4553 sreid@wakegov.com 6 Physical Activity and Nutrition OVERWEIGHT AND OBESITY Figure 7 Overweight or Obese % BRFSS Respondents Who Have a Body Mass Index (BMI) > 25 70 60.1 63.1 62.9 64.6 65.4 66.5 60 50 58.1 61.8 61.9 55.8 61.1 59.9 40 BMI 30 Underweight: BMI <18.5 Recommended Range: BMI 18.5 to 24.9 Overweight: BMI 25.0-29.9 Obese: BMI >30 20 NC 10 Wake 0 2003 2004 2006 2007 2009 2010 Year A measure of body mass index (BMI) is often used to identify possible weight problems. Adults with BMI of 25-29.9 are considered overweight and adults with a BMI of 30 or above are considered obese. During 2010 in North Carolina, 66.5 % of adult respondents were overweight or obese compared with 60% of Wake County respondents (see Figure 7). Wake County Human Services’ (WCHS) top priority is to reduce obesity among preschool, school age and adult populations by 2% through nutrition and physical activity by 2014*. Services provided in WCHS programs, such as Health Promotion and Disease Prevention** and the Special Supplemental Nutrition Program for Women and Children (WIC), routinely address this issue as well as partnerships with the Wake County Public School System that focus on reducing obesity in children. This is consistent with Healthy North Carolina 2020 Objectives for Physical Activity and Nutrition (see Healthy North Carolina 2020 Objectives: Physical Activity and Nutrition page 21). * Wake County State of the County’s Report, 2011 (http://www.wakegov.com/humanservices/communityhealth/default.htm) ** Health Promotion and Disease Prevention Annual FY 11 Report Contact: Sonya Reid, Health Promotion Chronic Disease Prevention Section 919-250-4553 sreid@wakegov.com 7 Physical Activity and Nutrition WIC PARTICIPATION The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides nutrition education, breastfeeding promotion and support, referrals to healthcare, and food vouchers for pregnant women, mothers of infants, and children under five years of age who have nutrition-related health problems and income at or below 185% of poverty. WIC is a federally-funded program administered by NC Department of Health and Human Services (DHHS). Additional County funds (5% of total budget) support WIC services in Wake County. Figure 8 Active WIC Participation 2009 - September 2011 19,400 19,200 19,000 18,800 C a s e l o a d 18,600 18,400 18,200 18,000 17,800 17,600 17,400 • • • The temporary fall in WIC participation during August to December 2009 is attributed to high staff vacancy rates causing a decreased ability to serve current and new participants during that time. The creation of six new direct client services positions and staff hiring for eighteen vacant positions resulted in improved client to staff ratios with program growth since January 2010. The caseloads continued to decline through April 2011 (also observed in the North Carolina WIC Program statewide) but participation in Wake County has shown a rebound as of May and June 2011 (most recent data available). Contact: Sharon Dawkins, Women, Infants and Children Section 919-250-4728 Sharon.Dawkins@wakegov.com 8 School Health SCHOOL NURSE REFERRALS In the first quarter of 2011-2012, there was a 13% increase in the number of students referred to the school nurse compared to 2010-2011 (see Figure 9). When comparing the second quarter of 2010-2011 to the second quarter of 2011-2012, there was a 20% increase. School nurses are receiving more referrals each year. Figure 9 Unduplicated* Number of Students Referred to the School Nurse Comparison of 2010-2011 and 2011-2012 School Year 1st Quarter (July-September) and 2nd Quarter (October-December) 8000 6302 5578 5017 4178 6000 Number 4000 2010-2011 School Year 2000 2011-2012 School Year 0 1st Quarter 2nd Quarter Quarter *Each student a school nurse has contact with throughout the school year is counted once to get the unduplicated number of students referred to the nurse. Students who are screened for vision and those participating in group presentations are not included in this number. SCHOOL PRINCIPALS SURVEY Figure 10 Categorized Open Ended Responses to Survey Question: "How Can the School Heath Program Help You?" 28 of 41 survey participants responding to this question wrote in references to increase nursing time 2010-2011 School Year Principals of Wake County Public Schools (WCPSS) respond to a yearly survey given by WCHS School Health Nursing Program. More time 5 days a week Survey results indicate that principals want nurses to spend more time and provide more health services to the students in their schools (see Figure 10). More services Increasing More days Numrsing Time More than 1 day Responses More Nurses More hours 2 days 0 2 4 6 8 Number of Responses Source: Principal Survey 2010-2011, WCHS School Based Nursing Service, June 2011 10 9 School Health Figure 11 Catagorized Open Ended Responses of WCPSS Principals to Survey Question: "What are the most important challenges facing your school?" 50 out of 77 respondents answered this question 2010-2011 School Year Limited Nurse Resources Limited School Staff Resources Quantity and Quality of Health Concerns Chronic Life Threatening illnesses Diabetic & special programs Physical Health and Behavorial Health Concerns Parent Concerns Access to health care Responses Communication Poor Living Conditions Absenteeism 0 5 10 15 Number of responses for each category *Some respondents gave multiple answers to the question. Source: Principal Survey 2010-2011, WCHS School Based Nursing Service, June 2011 Principals are responsible for the education, health and welfare of children in their schools. They listed challenges facing their schools in a survey. The emergency and daily care of students with chronic and complex health conditions such as diabetes, severe allergies, feeding tubes and catheterizations are provided by non-medical school staff trained by school nurses. As nurses split their time between three schools, the limited nursing resources are a challenge for principals (see Figure 11). SCHOOL NURSE TO STUDENT RATIO Figure 12 The school nurse to student ratio is a measure used across the state of North Carolina and the United States. The recommended ratio of nurses to students helps assure students are healthy and able to participate in school. The school nurse to student ratio is significantly higher in Wake County compared to the recommended standard and other North Carolina Counties. The standard ratio is one nurse for 750 students. In 2010-2011, the ratio in Wake County was one nurse for 2,715 students. In NC the ratio was one nurse for 1,201 students. Contact: Roxanne Deter, Public Health Division 919-250-4637 rdeter@wakegov.com 10 Sexually Transmitted Diseases CHLAMYDIA AND GONORRHEA Preliminary data from the Communicable Disease Branch, NC Division of Public Health from 2008-2011 indicates that the case rates per 100,000 population for chlamydia (400.1 to 527.0) and gonorrhea (112.6 to 150.4) continue to increase (see Figure 13). Figure 13 C hlamydia and Gonorrhea Case Rate (per 100,000 population) in Wake County from 2009 -2011 600 502.8 500 527.0 400.1 400 Chlamydia 300 Gonorrhea 200 100 112.6 138.6 150.4 0 2009 2010 2011 Source: Communicable Disease Branch NC Division of Public Health Several strategies have been implemented to address the high rates of gonorrhea and chlamydia in Wake County. These include: • Expedited Partner Therapy (EPT). Partners of those who are diagnosed with chlamydia or gonorrhea are offered treatment without having to be seen first by a health care provider. This helps treat these diseases faster. Wake County Human Services (WCHS) clinics began offering EPT last quarter. • Field Delivered Therapy (FDT). Beginning November 29, 2011, FDT to treat clients for chlamydia and/ or gonorrhea infections was implemented by Disease Intervention Specialists (DIS) and the Disease Intervention Nurse. As of February 7, 2012, infected clients with positive laboratory results for either disease ranging from 1/1/11 to 10/28/11 and who were lost to follow up for treatment, were identified and enrolled in this program. Medications were delivered to 32 clients with chlamydia, 6 with gonorrhea and 1 with both gonorrhea and chlamydia infections. In the near future, WCHS HIV/STD Counselors will also assist in FDT. • Comprehensive Risk Counseling and Services (CRCS) are being provided by WCHS HIV/STD Health Educators to STD clients referred by the clinics. CRCS is a best practice strategy that provides intensive, individualized counseling for adopting and maintaining HIV risk reduction behaviors. Individuals who enroll in CRCS receive free one-on-one risk-reduction counseling and support and work with their counselor to develop personalized goals for behavior change. • Consultation and support for community partners. Since December 2011, HIV/STD Health Educators provide consultation to 4-H staff providing education for youth ages 12-18 yrs. old. The HIV/STD Community Outreach Program has been working with area colleges and universities using HIV/STD peer educators (a best practice strategy). These efforts provide prevention education to those who are at the highest risk. Strengthening the Black Family, Inc. is also incorporating prevention messages and training to young people participating in its youth leadership program 11 Sexually Transmitted Diseases • Parents Matter. Parents Matter is an evidence-based program that is provided by HIV/STD Health Educators to help parents of preteens become better health teachers for their children and protect them from the negative outcomes of unhealthy sexual behaviors. The five sessions (2.5 hours each) build parents’ knowledge and skills so they can better communicate their personal values about sex to their children. This program also provides current STD information that can be shared with family members and helps parents develop strategies to help children understand sexual messages in the media. The program is intended for parents with children 9–12 years old and is available in English and Spanish. INTEGRATION OF SERVICES To increase detection of and treatment for all STDs in high risk populations, testing services for HIV, syphilis, chlamydia, gonorrhea, hepatitis C and TB are integrated by offering them at the same time to clients at community as well as clinical testing sites. Enhanced testing is made possible through the CDC Program Collaboration and Service Integration (PCSI) and other grant funding. Figure 14 shows the number of tests performed at community sites and the positivity test rates for HIV, syphilis, gonorrhea, chlamydia and hepatitis C from October to December 2011. From March 2011 to December 2011, 198 at risk clients were also tested for TB at non-traditional testing sites (Wake County Human Services data). Figure 14 Number of Tests and Test Positivity Rate (%) at Non-Traditional Testing Sites in Wake County from October to December 2011 39 (12.8%) 500 (9.6 %) 680 (0.4%) HIV Syphilis 500 (1.4%) 682 (0.1%) Gonorrhea Non-traditional testing sites are community locations where HIV/STD counseling and testing services would not customarily be provided (churches, shelters, colleges and universities, etc.) Chlamydia Hepatitis C Source: Wake County Human Services Figure 15 Note: Totals in Figures 14, 15, and 16 show the number of tests administered followed by the percentage of tests with positive results. Number of Tests and Test Positivity Rate (%) at Substance Abuse Centers in Wake County from October to December 2011 76 (15.8%) 90 (0 %) Syphilis 61(0%) 91(0%) 61 (0%) HIV Gonorrhea Chlamydia Hepatitis C Source: Wake County Human Services 12 Sexually Transmitted Diseases Figure 16 Number of Tests and Test Positivity Rate (%) at Expanded Testing Sites in Wake County from October to December 2011 Hepatitis C testing is not offered at Expanded Testing Sites (jail, detention). 406 (6.9%) 406 (2.5%) 398 (0%) HIV Syphilis 407 (2%) Gonorrhea Chlamydia Source: Wake County Human Services (WCHS) HIV VIRAL LOAD AND DISEASE TRANSMISSION Figure 17 Average Viral Load Among Clients at Wake County Human Services from 2007-2011 Average All 45000 40000 35000 30000 25000 Copies/ml 20000 15000 10000 5000 0 Average All on ART Average All Not on ART Linear (Average All) Linear (Average All on ART) 20072008200920102011 Source: WCHS CAREWare YEAR Linear (Average All Not on ART) Viral load is a measure of the amount of HIV viral nucleic acid in the blood of a person infected with HIV. This measure is used to monitor the status of HIV infection in a newly diagnosed patient, to guide recommendations for therapy, and to predict the future course of the infection. A low viral load indicates that HIV is not actively reproducing and that the risk of disease progression is low. Wake County Human Services monitors the viral load counts annually among clients who have been in the system for at least six months during the year of analysis. Since 2007 the overall average viral load and average viral load among clients on antiretroviral therapy (ART) has generally decreased although it increased again during 2011 (see Figure 17). However, the median for those on ART has decreased from 48 in 2007 to 20 copies /ml in 2011 indicating that clients now have lower viral loads. Of note, a recently published study (Cohen et al., 2011) demonstrated that early treatment of HIV infection by ART before the disease progresses and while the immune system is healthy is an important public health measure to prevent transmission of this disease to others. Contact: Yvonne Torres, HIV/STD Community Section 919-250-4479 ytorres@wakegov.com or Edie Alfano-Sobsey, Epidemiologist Public Health Division 919-212-9674 Edie.AlfanoSobsey@wakegov.com 13 Infectious Diseases and Foodborne Illness SEASONAL FLU VACCINES GIVEN Figure 18 Figure 18 represents the number of seasonal influenza (flu) vaccine doses administered to children and adults at Wake County Human Services (WCHS) clinics and outreach activities. The totals do not include the H1N1 influenza doses administered during the 2009/2010 pandemic response. * During the 2009/2010 flu season, WCHS conducted an American Recovery and Reinvestment Act (ARRA) funded, school-located seasonal flu initiative in addition to traditional flu clinic operations. The project provided flu vaccine to nearly 6300 children. Source: NC Immunization Registry (NCIR) and WCHS Weekly Flu Tally Reporting – Clinic E Figure 19 State-supplied doses of flu vaccine are provided to Vaccines for Children (VFC) program eligible children and pregnant women. Private purchased doses are provided to Medicare and Medicaid patients, self-paying clients and Wake County staff. Figure 19 shows sources of flu vaccine provided for the last 5 flu season years. Seasonal flu vaccine is traditionally offered at WCHS between October and April. The flu season of 2009/2010 included a school-located American Recovery and Reinvestment Act (ARRA) funded seasonal flu initiative that administered 6300 doses to children at 21 public, private and charter school sites in Wake County. Source: NC Immunization Registry (NCIR) and WCHS Weekly Flu Tally Reporting – Clinic E 6/2011 Contact: JoAnn Douglas, Immunization Outreach 919-250-4518 jdouglas@wakegov.com 14 Infectious Diseases and Foodborne Illness REPORTABLE GENERAL COMMUNICABLE DISEASE INVESTIGATIONS Figure 20 Reportable Communicable Disease Investigations January - December 2011**** 167 180 160 140 120 100 Investigations 80 60 40 20 0 127 Foodborne Illness* Tickborne Illness** Hepatitis B*** 111 70 53 46 30 18 Jan - Mar 41 51 28 7 Apr - Jun Jul - Sep Oct - Dec *Foodborne Illness includes Campylobacter, E. coli shiga toxin producing , Hepatitis A, Salmonella and Shigella **Tickborne Illness includes Rocky Mountain Spotted Fever, Lyme Disease and Ehrlichiosis ***Hepatitis B includes new infections, long term infections and those acquired through pregnancy/ Birth ****Number reported by NC Electronic Disease Surveillance System (NCEDSS) as of February 10,2012. Figure 20 shows the investigations of food and tickborne illnesses and hepatitis B. The increase shown in tickborne illness investigations during October through December is likely due to diagnoses reported late in the summer and early fall months and to delayed reporting due to other outbreak investigations (see Communicable Disease Events page 17). TUBERCULOSIS (TB) CASES Wake County Human Services has the legal responsibility and authority to coordinate all TB control efforts in Wake County. This includes reducing the number of people who become infected, providing preventive treatment to those who are infected and ensuring that people with TB disease get appropriate treatment. Figure 21 shows the number of active TB cases WCHS TB control reported to the North Carolina Division of Public Health and the Centers for Disease Control and Prevention (CDC). Figure 21 Number of Active TB Cases Reported to Centers for Disease Control and Prevention (CDC) Wake County Human Services TB Control 2005-2011 60 50 40 Number of 30 Active Cases 20 Total Number Cases reported to CDC 10 0 2005 2 006 2 007 2 008 20 09 20 10 2011 Source: Wake County Human Services Tuberculosis Control Annual Report 15 Infectious Diseases and Foodborne Illness Figure 22 Percent of Active TB Cases by Race WCHS TB Control 2010 and 2011 100% 19% 41% 43% Asian White Black 14% 50% 45% 38% 0% 2010 (N=37) 2011 (N=29) Sour ce: Wake County Human Services Tuberculosis Control Annual Report Figure 22 shows the percentage of active TB cases by race. Figure 23 shows the percentage of active TB cases who were born outside of the US. Figure 23 Percent of WCHS Active TB Cases Foreign Born Compared to Those Born in the United States 2005-2011 80% 70% 60% 50% Percent 40% 30% 20% 10% 0% 63% 65% 68% 60% 54% 66% 50% 37% 35% 40% 46% 32% Percent cases were foreign born 34% Percent cases were were USborn 2005 2006 2007 2008 2009 2010 2011 Source: Wake County Human Services Tuberculosis Control Annual Report CRITICAL VIOLATIONS IN RESTAURANTS AND FOOD STANDS "Critical Violation Risk Factors” are those that increase the chance of developing food-borne illness and are categorized by CDC as poor personal hygiene (1-5), food from unsafe source (6-9), cross contamination/ contaminated equipment (10-12), inadequate final cook temperature (13), improper holding/time-temperatures (14-18). Figure 24 on page 17 shows that most of the critical violations involved cross contamination of foods and contaminated equipment. 16 Infectious Diseases and Foodborne Illness Figure 24 Number of Critical Violations Associated with CDC Risk Factors* at Wake County Restaurants/Food Stands October-December 2011 300 250 Oct-11 200 Nov-11 150 Dec-11 100 50 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Risk Factors Risk Factor* Items 1-5: Poor Personal Hygiene Item 13: Final Cook Temperature Items 6-9: Food from Unsafe Source Items 14-18: Holding/Time-Temperature Items 10-12: Cross Contamination/ Contaminated Equipment Contact: Andre Pierce Wake County Environmental Services 919-865-7440 apierce@wakegov.com COMMUNICABLE DISEASE EVENTS Rabies Exposure Investigation During September 2011, a kitten named Silverbelle that was adopted from the Wake County Animal Shelter tested positive for rabies. This began an extensive investigation to trace human and animal exposure to the kitten involving multiple partners in several counties. Twenty two people were evaluated for possible rabies exposure. Of these, 17 were exposed and referred for post exposure treatment. No other human exposures to Silverbelle were identified after media alerts were issued to the public. The total cost of this investigation including Wake County Human Services staff time, Wake County Animal Control staff time, quarantine fees and treatment for post-exposure prophylaxis is estimated at over $100,000. E. coli O157:H7 Outbreak On October 25, 2011, Wake County Human Services and Environmental Services staff, partnering with the NC Division of Public Health, began an investigation of an enteric illness outbreak caused by infection with E. coli O157:H7 bacteria. More than 50 calls were received by Wake County Communicable Disease Section staff about the outbreak. A total 25 cases of illness were identified in residents from Wake (13), Sampson (6), Wilson (2), Cleveland (1), Durham (1), Johnston (1), and Orange (1) counties. Eight (32%) were hospitalized and 4 (16%) experienced a severe complication of the disease, hemolytic uremic syndrome. The NC Division of Public Health conducted a case-control study interviewing all 25 cases as well as 77 individuals who attended the fair, but did not get sick. The results of the study determined that visiting the Kelley Building at the North Carolina State Fair, a structure where sheep, goats, and pigs were housed and competed in livestock shows during the fair, was a likely source of exposure for this illness. The investigation was written up in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. To view the report, visit http://www.cdc.gov/mmwr/PDF/wk/mm6051.pdf (p. 1745). Contact: Ruth Lassiter, Epidemiology and Surveillance Section, 919-212-7344 ruth.lassiter@wakegov.com 17 Chronic Diseases CARDIOVASCULAR, BREAST AND CERVICAL CANCER SCREENING AND COUNSELING Cardiovascular ( July 1, 2010 to June 30, 2011) Provided 1,111 blood pressure checks; detected 71 individuals with hypertension stage 2 and secured care for 43 of them lacking a medical home. According to the NC Heart Disease and Stroke Prevention Branch, the average lifetime cost of a stroke in the US is estimated at $103,576 per stroke event. Health Promotion staff assisted in securing medical care for those 43 individuals resulting in a potential cost savings of $4.3 million dollars. Left untreated, those individuals run the risk of stroke and the huge medical costs associated with the event. • Provided 923 body mass index measures; detected 33% were overweight and 50% obese • Provided 627 cholesterol checks; detected 50% with high cholesterol • Provided one-on-one counseling for 100% of people who had a blood pressure check, a cholesterol check or a body mass index measure Breast & Cervical Cancer Screening ( July 1, 2010 to June 30, 2011) • Provided 335 mammograms; detected 10 breast cancers. • Provided 78 cervical screenings via WCHS’ Breast and Cervical Cancer Control (BCCCP) Clinic. These screenings were provided for women who are ineligible to receive family planning services but need access to women's preventive cancer screenings. Source: Wake County Human Services Health Promotion Chronic Disease Prevention Section, FY '11 Annual Report • Contact: Sonya Reid, Health Promotion Chronic Disease Prevention Section 919-250-4553 sreid@wakegov.com I n j u r y a n d Vi o l e n c e WAKE COUNTY CHILD MALTREATMENT SURVEILLANCE PROJECT The John Rex Endowment has recently awarded funding to address improvements to child maltreatment systems in Wake County. The purpose of the Wake County Child Maltreatment Surveillance (CMS) project is to partner with Wake County agencies working on child maltreatment to assess current data, identify data gaps, and implement changes that could become the basis for a comprehensive CMS system. Wake County will benefit from an improved understanding of the problem of child maltreatment which can help inform and guide decisions around child maltreatment prevention. The CMS system hopes to add to the current child maltreatment work done in Wake County by addressing the following objectives: • Develop standard and agreed upon data definitions for child maltreatment. • Monitor the prevalence of child maltreatment, including maltreatment perpetrated by family caregivers and non-family caregivers. • Use multiple sources of data to provide a broader picture of child maltreatment. • Identify science-based measures for collecting indicators of, and risk and protective factors associated with child maltreatment. • Collect summarizing and reporting data on a yearly basis to measure trends over time. • Provide more information about child maltreatment, specifically enhancing data around cases that do not involve Child Protective Services or result in a fatality. Source: Megan Shanahan, Wake County Child Maltreatment Surveillance Coordinator Contact: Edie Alfano-Sobsey, Epidemiologist Public Health Division 919-212-9674 Edie.AlfanoSobsey@wakegov.com 18 Emergency Preparedness CDC PUBLIC HEALTH PREPAREDNESS CAPABILITIES ASSESSMENT Today, in addition to responding to emergencies that affect the health and safety of citizens, public health systems and their respective preparedness programs face many challenges. Federal funds for preparedness have been declining, causing state and local planners to express concern over their ability to sustain the real and measurable advances made in public health preparedness. State and local planners likely will need to make difficult choices about how to prioritize and ensure that available resources are directed to priority areas within their jurisdictions. The Centers for Disease Control and Prevention (CDC) implemented a systematic process for defining a set of public health preparedness capabilities to assist state and local health departments with their strategic planning. The first step in the strategic planning process is to conduct a “Public Health Capabilities Assessment” utilizing the CDC defined review process. The Public Health Preparedness Capabilities are organized into 15 categories and then additionally a number of functions for each category: • Community Preparedness (4 functions) • Community Recovery (3 functions) • Emergency Operations Coordination (5 functions) • Emergency Public Information and Warning (5 functions) • Fatality Management (5 functions) • Information Sharing (3 functions) • Mass Care (4 functions) • Medical Countermeasure Dispensing (5 functions) • Medical Material Management and Distribution (6 functions) • Medical Surge (4 functions) • Non-Pharmaceutical Interventions (4 functions) • Public Health Laboratory Testing (5 functions) • Public Health Surveillance and Epidemiological Investigation (4 functions) • Responder Safety an d Health (4 functions) • Volunteer Management (4 functions) Additionally under each “function”, there are several assessment areas for priorities, skills, training and equipment required by the CDC assessment tool. This assessment process is to be completed by March 2012, as directed by NC Public Health Preparedness & Response section. Since September 2011, this comprehensive assessment for Wake County has occupied the majority of time for the Preparedness Coordinator and has involved a time commitment from other staff in WCHS and other Wake County agencies. 19 Emergency Preparedness DISASTER PREPAREDNESS PROGRAM MONITORING OM 2011. WCHS Disaster Preparedness Program staff responded to 8 situations in Wake County. Figure 25 shows the number of public health situations by quarter responded to in 2011 by Wake County Human Services, Wake County Environmental Services and partners. Figure 25 WCHS Disaster Preparedness Program Monitoring (As of January 18, 2012) No. of Public Healt h Situations* in Wake County 3.5 No. of Public Healt h Situations* responded to by WCHS/WCES 3 2.5 No. of Public Healt h Situations Responded to with Partners** 2 Number of Situations 1.5 1 0.5 0 (Jan-Feb-Mar) (Apr-May-Jun) (Jul-Aug-Sep) (Oct-Nov-Dec) * A Situation can be an incident, an event, or any observable or predictable occurrence. It is a generic term referring to occurrences of any scale that may require some form of Emergency Response and Management, and that requires tracking and information exchange. ** Partners = Any agency or groups outside of WCHS/WCES Contact: Brian McFeaters, Public Health Emergency Preparedness Section 919-212-9394 bmcfeaters@wakegov.com 20 Healthy North Carolina 2020 Objectives Every ten years since 1990, the state of North Carolina sets objectives aimed at improving the health of North Carolinians. Below are the objectives that are set for the year 2020 organized by focus area. The Wake County Human Services Public Health Report is organized to align with selected Healthy North Carolina 2020 Focus Areas and Objectives For more information about North Carolina’s health objectives and how they are decided, visit the North Carolina Division of Public Health web page at http://publichealth.nc.gov/ hnc2020/objectives.htm. Tobacco Use Current 2020 Target 1. Decrease the percentage of adults who are current smokers 20.3% (2009) 13.0% 2. Decrease the percentage of high school students reporting current use of any tobacco product 25.8% (2009) 15.0% 3. Decrease the percentage of people exposed to secondhand smoke in the workplace in the past seven days 14.6% (2008) 0% Physical Activity and Nutrition Current 2020 Target 1. Increase the percentage of high school students who are neither overweight nor obese 72.0% (2009) 79.2% 2. Increase the percentage of adults getting the recommended amount of physical activity 46.4% (2009) 60.6% 3. Increase the percentage of adults who consume five or more servings of fruits and vegetables per day 20.6% (2009) 29.3% Current 2020 Target 1. Reduce the unintentional poisoning mortality rate (per 100,000) population 11.0 (2008) 9.9 2. Reduce the unintentional falls mortality rate (per 100,000) population 8.1 (2008) 5.3 3. Reduce the homicide rate (per 100,00) population 7.5 (2008) 6.7 Current 2020 Target 1. Reduce the infant mortality racial disparity between whites and African Americans 2.45 (2008) 1.92 2. Reduce the infant mortality rate (per 1,000 live births) 8.2 (2008) 6.3 3. Reduce the percentage of women who smoke during pregnancy 10.4% (2008) 6.8% Injury and Violence Maternal and Infant Health Sexually Transmitted Diseases and Unintended Pregnancy Current 2020 Target 1. Decrease the percentage of pregnancies that are unintended 39.8% (2007) 30.9% 2. Reduce the percentage of positive results among individuals aged 15 to 24 tested for chlamydia 9.7% (2009) 3. Reduce the rate of new HIV infection diagnoses (per 100,000) population 24.7% (2008) 22.2 Substance Abuse Current 8.7% 2020 Target 1. Reduce the percentage of high school students who had alcohol on one or more of the past 30 days 35.0% (2009) 26.4% 2. Reduce the percentage of traffic crashes that are alcohol-related 5.7% (2008) 4.7% 3. Reduce the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days. 7.8% (2007-2008) 6.6% 21 Current 2020 Target 1. Reduce the suicide rate (per 100,000 population) 12.4 (2008) 8.3 2. Decrease the average number of poor mental health days among adults in the past 30 days 3.4 (2008) 2.8 3. Reduce the rate of mental health related visits to emergency departments (per 100,000) population 92.0 (2008) 82.8 Current 2020 Target Mental Health Oral Health 1. Increase the percentage of children aged 1-5 years enrolled in Medicaid who receive any dental service during the previous 12 months 46.9% (2008) 56.4% 2. Decrease the average number of decayed, missing or filled teeth among kindergartners 1.5 (2008-09) 1.1 3. Decrease the percentage of adults who have had permanent teeth removed due to tooth decay or gum disease 47.8% (2008) 38.4% Environmental Health Current 2020 Target 1. Increase the percentage of air monitor sites meeting the current ozone standard of 0.075 ppm 62.5% (2007-09) 100.0% 2. Increase the percentage of the population being served by community water systems (CWS) with no maximum contaminant level violations (among persons on CWS) 92.2% (2009) 95.0% 3. Reduce the mortality rate from work-related injuries (per 100,000 equivalent full time workers ) 3.9 (2008) 3.5 Current 2020 Target Infectious Disease and Foodborne Illness 1. Increase the percentage of children aged 19-35 months who receive the recommended vaccines. 77.3% (2007) 91.3% 2. Reduce the pneumonia and influenza mortality rate (per 100,000 population) 19.5% (2008) 13.5% 3. Decrease the average number of critical violations per restaurant/food stand 6.1 (2009) 5.5 Current 2020 Target Social Determinants of Health 1. Decrease the percentage of individuals living in poverty 16.9% (2009) 12.5% 2. Increase the four year high school graduation rate 71.8% (2008-09) 3. Decrease the percentage of people spending more than 30% of their income on rental housing 41.8% (2008) 36.1% Chronic Disease Current 94.6% 2020 Target 1. Reduce the cardiovascular disease mortality rate (per 100,000 population) 256.6 (2008) 161.5 2. Decrease the percentage of adults with diabetes 9.6% (2009) 8.6% 3. Reduce the colorectal cancer mortality rate (per 100,000 population) 15.7 (2008) 10.1 Current 2020 Target 1. Increase average life expectancy (years) 77.5 (2008) 79.5 2. Increase the percentage of adults reporting good, very good, or excellent health 81.9% (2009) 90.1% 3. Reduce the percentage of non-elderly uninsured individuals (aged less than 65 years) 20.4% (2009) 8.0% 4. Increase the percentage of adults who are neither overweight nor obese 34.6% (2009) 38.1% Cross Cutting 22 Acknowledgements Contributors to this Public Health Quarterly Report are: Edie Alfano-Sobsey Debbie Bissette Sharon Dawkins Roxanne Deter JoAnn Douglas Lydia Loyd Brian McFeaters Michael McNeil Carla Piedrahita Andre Pierce Michelle Ricci Ronda Sanders Megan Shanahan Yvonne Torres February 17, 2012 23 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: Executive Committee: March 8, 2012 HS & ES Board: March 22, 2012 Committee/Item: State of the County Health (SOTCH) Report Specific Action Requested: Receive SOTCH Report Item Summary: Purpose for Action: Receive and accept 2011 SOTCH Report in accordance with Public Health Accreditation Benchmark 1.3 Next Steps: Attachments: SOTCH Report 2011 Opportunities for Advocacy, Policy or Advisory: (see next steps) Connections to Other Committees: Environmental Services State of the County’s Health Report 2011 TABLE OF CONTENTS County Vision and Mission Page 3 Overview: Population and Projected Trends Educational Attainment Page 3 Page 5 Health Indicators Major Morbidity and Mortality Page 6 Page 7 Priority Issues: #1 Overweight and Obesity Physical Activity and Nutrition #2 Access to Healthcare Page 8 Page 8 Page 15 Page 19 Significant Public Health Issues • Disaster Preparedness • Rabies Exposure Investigation • E. Coli Outbreak Page 23 Page 23 Page 23 Page 24 Emerging Issues • Current Economic Climate Challenges for Public Health • Sexually Transmitted Infection Reduction Efforts • Environmental Services Recruitment of New Director Waste Water Management Animal Shelter • Healthcare Reform Page 25 Page 25 Page 25 Page 28 Page 28 Page 28 Page 29 Page 29 Conclusion Page 29 Distribution Plan Page 30 2|Page Vision: Wake County will be a great place to live, work, learn and play. It will be a place where people are self-sufficient, enrich their lives, respect the environment, appreciate their heritage, participate in government, and plan for a better tomorrow. Mission: to improve the economic, education, social well-being, and physical quality of the community, we are committed to collaboration; service excellence and embracing new approaches to more effectively meet the ever-changing needs of our customers. 2011 State of the County’s Health Report Wake County, North Carolina Wake County Human Services is pleased to present the 2011 State of the County’s Health Report. The purpose of this report is to convey current information on the health status of the county. This report illustrates local demographics, leading causes of death, and other priority issues affecting our community. A formal Community Health Assessment is undertaken every four years and was completed during the 2010 cycle. The 2010 report is available for viewing at www.wakegov.com. Overview: Wake County Population and Projected Trends The U. S. Census released its official Census 2010 population. The County's population rose to 900,993 as of April 1, 2010, up from 627,876 on April 1, 2000. This represents a gain of 43.5%, or 273,147 residents. Projections by the North Carolina State Demographer indicate the population of Wake County will exceed 1 million by 2015. In April 2010, Wake County had 76,549 residents over the age of 65, for a total of 8.5% of the population. This is an increase from 46,732 and 7.4% in 2000. In 2010 the poverty rate in Wake County was 12%. The Unemployment Rate was 8.2% in 2010, decreasing to 7.7% in October 2011. Source: Wake County Planning Department. 3|Page According to the United State Census 2010 • Raleigh ranks as the 43rd most populous city in the United States. Population Raleigh 403,892 Wake County 900,993 North Carolina 9,535,483 Age/Gender Median Age 34.4 Male 48.7% Female 51.3% Median Household Income Wake County $61,426 North Carolina $43,326 United States $50,046 Source: 2010 American Community Survey/ Wake County Economic Development, Population Characteristics 4|Page Educational Attainment According the U.S. Census Bureau, for the School Year 2010–11, the enrollment in the Wake County Public School System is 143,289 students. In the Adult Population, 48% possess a B.A. degree or higher level of Education. Source: 2006-2008 American Community Survey Educational Attainment by Race Group for Population 25 Years and Over 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 16.1% 17.8% 19.7% 37.4% 16% 30.9% 35.4% 30.9% 23.2% 29.1% 25.8% 25.9% 18.3% 8.9% 15.9% 5% Total population White 27.9% 13.7% 14.2% 11% 8.7% Black or African American Less than high school diploma High school graduate (includes equivalency) Some college or associate's degree Bachelor's degree Graduate or professional degree 5|Page 6.6% 11.4% 7.3% Asian 42.8% Hispanic or Latino Health Indicators African–Americans suffer from a higher over-all death-rate, higher death rates from all causes of chronic diseases listed in above table and a higher homicide rate compared to whites and other races. • • Whites have higher a suicide rate compared with African–Americans and other races. Males have a higher death rates compared to females for unintentional motor vehicle injuries and all other unintentional injuries (15.3 versus 5.4 and 26.8 versus 14.8, respectively) according to the N.C. Department of Health and Human Services, State Center for Health Statistics. 6|Page Major Morbidity and Mortality Data Infant Deaths, Births, Death Rates- NC and Wake County, 2010 Infant deaths (under 1 year) North Carolina Wake County White Non-Hispanic African American Non-Hispanic Other Non-Hispanic Hispanic Total Infant Live births 362 367 32 93 854 North Carolina 30 27 3 10 70 Wake County White Non-Hispanic 68,496 6,786 African American Non-Hispanic 28,926 2,838 Other Non-Hispanic 6,150 1,018 Hispanic 18,730 2,063 Total births 122,302 12,705 Infant mortality rates (per 1000 live North Carolina Wake County births) White Non-Hispanic 5.3 (5.5)* 4.4 (4.4)* African American Non-Hispanic 12.7 (15.8)* 9.5 (19.3)* Other Non-Hispanic 5.2 (4.7)* 2.9 (0)* Hispanic 5.0 (5.7)* 4.8 (6.2)* Total rate 7.0 (7.9)* 5.5 (7.6)* * 2009 rates Source: NC DHHS State Center for Health Statistics Pregnancy Rate 15-19 Years Of Age 2005-2009 North Carolina and Wake County 70 61.7 63.1 63 58.6 56 39.5 37.6 Rate per 1000 60 50 42.4 43.2 43.6 40 Wake 30 North Carolina 20 10 0 2005 2006 2007 2008 2009 North Carolina State Center for Health Statistics The number of pregnancies and rate for 15-19 years of age continue to decline in Wake County and North Carolina. 7|Page Priority Issues This report includes a review of Current Issues and the Health concerns selected from the 2010 Community Assessment. Wake County identified two (2) major health concerns as priorities. They are: 1. Overweight and Obesity 2. Access to Health Care Priority Issue #1: Overweight and Obesity Objective: Reduce the rate of obesity through nutrition and physical activity by 2% by 2014. The issue of obesity is one that continues to loom over our county and state. Overall, there are a variety of factors that contribute to this chronic condition (i.e. lifestyle, environment, economics, culture, etc.). There is as much a concern for our children’s health as adults. CDC reports this generation of youth is not likely to outlive the lifespan of their parents. With this and other such reports, Wake County has committed itself to addressing this public health threat and therefore has identified obesity as one of its priority areas. Earlier this year, WCHS along with 125 other local stakeholders convened for a health and wellness summit to identify evidence-based and promising practices as it relates to improving health outcomes associated with obesity. The interventions included in the action plan are a result of those discussions. 8|Page Priority Area #1: Overweight and Obesity Objective: Reduce the rate of obesity in adults and children through nutrition and physical activity interventions by 2% by 2014. Interventions/Actions Strategies Progress To-date (Jan – Dec 2011) 1.1 - Establish community protocols to assess the impact of community policy changes and design on health and well-being 1.1 A - Assure adequate staff training for the Health Impact Assessment (HIA) process 1.1 A - Three Wake County Human Services (WCHS) staff were trained (i.e. Public Health Director, Health Promotion Chronic Disease Prevention [HPCDP] Program Manager & Supervisor) – Phase 1 (completed 2011) Additional WCHS staff will complete training – Phase 2 (2012) Contact: Steve Bevington, NCDPH 1.1 B – WCHS’ Health Promotion Staff along with representatives from the New Bern Ave. Stakeholder Advisory Group met August 2011 and reviewed the scoping and screening tools. Plans to implement the tools are in process and expected for implementation early 2012. Contact: Steve Bevington, NCDPH 1.1 C - GIS mapping devices were utilized by 4-H and AHA to evaluate access to healthy food and physical activity for everyone living in Wake County (includes all parks, greenways, sidewalks, grocery stores, community gardens, emergency food shelters, farmer’s markets, etc). Local decision makers (i.e. City of Raleigh Pedestrian Committee, Town of Cary Master Plan Committee, etc.) can now locate food deserts in Wake County. Contact: Laura Aiken, AHA Thomas Ray, Wake Cooperative Extension 1.1 D – WCHS, Wake’s Cooperative Extension and Wake County Public School System’s School Health Advisory Council (SHAC) partnered to advocate for improved healthful food choices and physical activities in schools and childcare centers. Contact: Katherine Williams, Wake County Wake Cooperative Extension 1.2 A – City of Raleigh Parks and Recreation staff maintain approximately 68 miles of paved and unpaved trails. Contact: Scott Payne City of Raleigh Parks and Recreation 1.1 B – Identify & utilize scoping and screening tools for the HIA assessment 1.1 C - Utilize technology tools to assess needs, demands, and community assets 1.1 D - Encourage schools to adopt health and wellness policies 1.2 - Develop a plan to increase the usage of greenway systems in Wake County 9|Page 1.2 A - Provide upkeep (maintenance) of greenways 1.2 B - Distribute materials to promote the use of the greenways 1.2 C – Incorporate technology and social media venues 1.3 - Promote worksite wellness to improve the health and wellbeing of Wake County’s workforce. 1.3 A - Work with partners at the local & state level for the creation of wellness committees 1.3 B - Provide wellness programs & activities for worksites 1.4 - Increase access to and consumption of fresh fruits and vegetables & other healthy food choices 1.4 A - Promote EBT card holder acceptance at approved local farmers’ markets 1.4 B - Provide technical assistance to local farmers’ markets in order to become 21st Century Farmers’ Market sites 10 | P a g e 1.2 B – WCHS’ HPCDP distributed greenway directories to 25 communitybased organizations (including faith partners) during HPCDP outreach events; Wake County Council on Fitness and Health distributed to City of Raleigh & Wake Co. Park Sites & local libraries. Contact: Sarah Plentl, WCHS Beth Collins, WCHS 1.2 C – Created a Quick Response Code (QRC) to be used by Smart Phone users. Contact: Scott Payne, City of Raleigh Parks and Recreation 1.3 A – WCHS’ HPCDP partnered with Sigma Electronics (Garner, NC) to establish a wellness committee. Contact: Kristen McHugh, WCHS 1.3 B1 – WCHS’ HPCDP partnered with Sigma Electronics (Garner, NC) - as a result of the partnership, HPCDP staff provide quarterly Lunch-N-Learn sessions, and mapped out a walking route on the property. Additionally the Sigma wellness coordinator has begun an employee newsletter and prepares an annual employee wellness fair, etc. Contact: Kristen McHugh, WCHS 1.3 B2 – Wake County Wellness Coordinator offers monthly employee wellness activities (i.e. seminars, wellness challenges, healthy vending options, etc.) Contact: Marie Edwards, Wake County Government 1.4 A – WCHS’ HPCDP partnered with Western Wake Farmers’ Market to provide quarterly educational displays and taste testing at the Food & Nutrition Services (FNS) registration site. The Market Match sponsored by Rex Endowment continues for EBT recipients. Contact: Kristen McHugh, WCHS Sharon Gardei, WCHS 1.4 B1 - WCHS’ HPCDP provided technical assistance to two Wake County farmers’ markets who applied for the 21st Century Farmers’ Market Program in order to accept EBT funds (approval pending). Contact: Kristen McHugh, WCHS 1.4 C - Promote and support the development and maintenance of community & teaching gardens 1.4 B2 – Wake’s Cooperative Extension developed a comprehensive web resource for healthy, local food in Wake County to include interactive “Wake Local Food Finder.” Contact: Katherine Williams, Wake County Wake Cooperative Extension 1.4 C1 – 350 Wake County residents participated with the annual “Dig In” event designed to educate about building, maintaining, and sustaining a community garden and strengthening the local food economy. Contact: Laura Aiken, AHA 1.4 C2 – Community gardens have grown from 10 to 33 via the efforts of AHA’s network of partners who provide technical assistance and advocate for fresh, affordable produce. Extra produce is commonly donated to organizations such as the Inter-Faith Food Shuttle. Additionally, AHA provided technical support to Smart Start and helped secure donations to start learning gardens at 16 Wake County daycare centers. Contact: Laura Aiken, AHA 1.4 C3 – A garden tool donation network has been established which collects and distributes new and gently used gardening equipment to needy community gardens. To date, AHA partners has provided approximately $1500 in tools to local community gardens. Contact: Laura Aiken, AHA 1.4 D – Provide nutrition education and trainings in community settings 11 | P a g e 1.4 D1 - Cooperative Extension’s Expanded Food and Nutrition Education Program (EFNEP) reached 653 WIC clients served impacting 2820 people in households; 60% of Cooperative Extension’s Expanded Food and Nutrition Education Program (EFNEP) clients have increased consumption of fruits as a result of program; 52% of Cooperative Extension’s Expanded Food and Nutrition Education Program (EFNEP) clients have increased consumption of vegetables as a result of program. Contact Katherine Williams, Wake County Wake Cooperative Extension 1.4 D2 - Cooperative Extension’s 4-H EFNEP program reached 1176 youth in grades K-12 through 50 community-based sites. Contact: Katherine Williams, Wake County Wake Cooperative Extension 1.4 D3 - Poe Center provided two weeks of Healthy Habits Camp to over 50 children receiving Supplemental Nutrition Assistance Program (SNAP) benefits that focused on nutrition and included gardening education. Contact: Ann Rollins, Alice Aycock Poe Center for Health Education 1.4 D4 – A partnership between the Alice Aycock Poe Center and WCHS’ FNS Program yielded monthly sessions for over 100 SNAP participants. Additional session, in English and Spanish, held at Millbrook Regional Center for more than 50 participants. Contact: Ann Rollins, Alice Aycock Poe Center for Health Education 1.4 D5 – Poe Center Staff provided technical assistance in August 2011 to the Wake County Public School Healthful Living teachers on the new USDA My PLATE Initiative. Contact: Ann Rollins, Alice Aycock Poe Center for Health Education 1.4 E - Connect families and businesses to local farmers 12 | P a g e 1.4 D6 - The Sport Snack Game Plan has now been implemented with the Capital Area Soccer League (CASL) and more than 80 area physicians have signed in support of the Game Plan. Through partnership with CASL over 10,000 children were impacted with healthy snacks. Contact: Laura Aiken, AHA Betsy Tilson, MD, CCWJC 1.4 E1 – The Farm it Forward Pilot Initiative provided 5 Wake County families with free shares of local produce for 8 weeks and families received six free Cooking Matters classes from the InterFaith Food Shuttle (IFFS). 100% of families reported an increase in food produce consumption at the end of the series and farmers sold extra shares of their produce through the program. Contact: Laura Aiken, AHA Jill Bullard, IFFS 1.5 - Promote healthy eating and increased physical activity policies and practices in child care facilities. 1.6 - Promote breastfeeding support policies in child care facilities 1.7 Establish appropriate and accurate obesity baseline measures 13 | P a g e 1.4 F - Continue involvement in the Women’s Infant Children (WIC) Farmers’ Market Nutrition Program for which WIC participants receive coupons to obtain fresh fruits and vegetables at local farmers' markets. 1.5 A - Provide the Nutrition and Physical Activity SelfAssessment in Child Care (NAP SACC) Curriculum 1.5 B - Introduce the “Color Me Healthy” curriculum for providers to educate children on healthy foods and fun physical activity ideas. 1.6 A - Offer the Breastfeeding Friendly Child Care curriculum to educate providers on the health benefits of breastfeeding and the importance of supporting the breastfeeding family. 1.6 B – Serve as technical support to the UNC Breastfeeding Project 1.7 A - Collect baseline data on obesity in three categories: Preschool, school-age and adult populations 1.4 E2 – Convened Wake County stakeholders to begin the process of developing a sustainable local food system. 150 participants representing businesses, farmers, health & wellness professionals, retail and healthcare representatives, land owners and environmentalists, etc. attended the October 2011 event. Contact: Laura Aiken, AHA 1.4 F - 11,850 Farmers’ Market Nutrition Program vouchers were issued to Wake County WIC participants during 2010 equating to a monetary value of $47,400 worth of fruits and vegetables. Contact: Sharon Dawkins, WCHS 1.5 A – Ten child care facilities, serving approximately 700 children will implement the curriculum Contact: Krista Barbour, WCHS 1.5 B – Ten child care facilities, serving approximately 700 children will implement the curriculum Contact: Krista Barbour, WCHS 1.6 A - Five child-care facilities, serving approximately 350 children have been identified to implement the curriculum. Contact: Krista Barbour, WCHS 1.6 B – Project underway led by UNC Breastfeeding Project Director (data forthcoming) Contact: Sharon Dawkins, WCHS 1.7 A - Agreement from partners as a priority need and to work with PH Epidemiologist appropriate and accurate baseline measures Contact: Sue Lynn Ledford, WCHS 1.7 B – Public Health Epidemiologist and HPCDP staff will work with partners to establish program outcome measures 1.7 B – Convened stakeholders meeting on December 1, 2011 to identify gaps in data and establish baseline measures Contact: Edie Alfano-Sobsey, WCHS Sonya Reid, WCHS Overweight and Obesity Abbreviations: AHA – Advocates for Health in Action CASL - Capital Area Soccer League CCWJC – Capital Collaborative of Wake County and Johnston County CBO – Community Base Organization EBT – Electronic Benefits Transfer EFNEP – Expanded Food and Nutrition Education Program FBO – Faith Base Organization FNS – Food and Nutrition Services HIA – Health Impact Assessment HPCDP – Health Promotion Chronic Disease Prevention Program NAP SACC - Nutrition and Physical Activity Self-Assessment in Child Care NCDPH – North Carolina Department of Public Health QRC – Quick Response Code SHAC - School Health Advisory Council SNAP – Supplemental Nutrition Assistance Program WCHS – Wake County Human Services WIC - Women’s Infant Children Program 14 | P a g e Physical Activity and Nutrition 15 | P a g e 16 | P a g e 17 | P a g e 18 | P a g e Priority Issue #2: Access to Healthcare Objective: By 2014, increase access to high quality healthcare by 3% among those enrolled in Medicaid as of December 1, 2011 (11,000 enrollees). Access to affordable, quality healthcare is an issue that affects many Wake County residents. This was an issue identified as a priority through the 2010 Community Health Assessment. Lack of health insurance, accessibility and availability of providers, and lack of transportation are all issues that contribute to access to care. About 18% of Wake County’s adults under age 65 currently lack health insurance. Upcoming Healthcare Reform laws require that most Americans have health insurance by 2014. These laws also expand Medicaid to cover all people under 65, including childless adults, with incomes less than 133% of the Federal Poverty Level. These new laws will require that the healthcare community increase its capacity to provide quality healthcare to more people. The interventions listed below include strategies for: • increasing enrollment in Medicaid • providing early and quality healthcare to first time mothers • improving access to care for pregnant mothers at risk of poor birth outcomes • providing quality healthcare for uninsured adults living in Wake County 19 | P a g e Priority Area #2: Access to Healthcare Objective: By 2014, increase access to high quality healthcare by 3% among those enrolled in Medicaid as of December 1, 2011 (11,000 enrollees) Interventions/Actions Strategies Progress To-date (Jan – Dec 2011) 2.1 - Assure eligible Wake County residents are enrolled in Medicaid and maintain enrollment 2.1 A - Enhance community capacity to enroll eligible Medicaid recipients through a partnership with WakeMed, Community Care of Wake & Johnston 2.1 A - Provided funding for 8 new eligibility positions. Two new case managers are now at WakeMed, one is on site at Rock Quarry Rd Family Medicine. Contact: Liz Scott, WCHS 2.1 B - WCHS clinics to 2.1B - The presumptive eligibility and begin operating Presumptive billing have begun. Eligibility program for Contact: Ida Dawson, WCHS pregnant women 2.2 - Work together to improve birth outcomes and access to quality care for pregnant women at risk for poor birth outcomes, and enrolled in Medicaid, through coordinated, evidenced-based pregnancy care (Pregnancy Medical Home Project Community Care of North Carolina (CCNC), the Division of Medical Assistance (DMA) and the Division of Public Health ( DPH)) 20 | P a g e 2.1 C - Increase Carolina Access enrollment of Medicaid recipients 2.1C - A new position was created to focus on increased Carolina Access enrollment. Contact: Liz Scott, WCHS 2.1 D - Implement business processes that enhance Medicaid access and utilization 2.1D - A recommendation was developed for new business practices to focus on all staff talking with clients about their Medicaid/insurance coverage. Increased focus beginning January 2012. Contact: Liz Scott, WCHS 2.1 E - Increase marketing to community and WCHS about changes in Medicaid eligibility 2.2 A - Increase number of Obstetric practices who are Pregnancy Medical Homes 2.1 E - Increased focus on this beginning January 2012. Contact: Liz Scott, WCHS 2.2 A - As of October 31, 2011, six providers of prenatal care in Wake County have enrolled as PMHs 2.2 B - Complete a standardized risk screening on each pregnant Medicaid patient in the practice 2.2 B - Pregnancy Care Managers engage in care management of identified Medicaid patients from each practice that meet the risk screening criteria. 2.2 C - Coordinate an integrated pregnancy care plan among CCNC, the Pregnancy Care Manager (PCM) and WCHS 2.2 C1 - Identified case management is provided to these patients through their six week post-partum period 2.2 C2 - Coordination and support from the OB team (physician champion and nurse coordinator) from the local network is available to the provider practices and to the pregnancy care managers. 2.2 D- Participate in medical records review to assure quality improvement 2.3 - Provide early engagement of 1 time, at-risk low-income mothers in selected Wake County zip codes. (Nurse-Family Partnership (NFP)) st 2.4 - Improve access to adolescent health services. 2.5 - Provide chronic disease management and primary care services for low-income, uninsured adults living in Wake and neighboring counties. 21 | P a g e 2.3 A - Recruit 75 clients from prenatal education classes and Maternal Health Liaison at WakeMed 2.2 D - All Pregnancy Care Management staff has been trained in the CMIS documentation system which is currently used by all local CCNC staff and pregnancy care managers to document all patient assessments and interventions Contact: Sheila Frye, WCHS 2.3 A - Referral Source - Health care provider/clinic (57%) Enrollment Health care provider/ clinic (51%) 2.3 B - Enroll client in the program early in her pregnancy and provide first home visit by no later than the end of the 28th week of pregnancy 2.3 B - Enrolled by 16 weeks (46%), 28 weeks (98%) 2.3 C - Connect with local college and university health services for referrals 2.3 C - In progress 2.3 D - Enhance marketing of program 2.4 A - Participate in feasibility study with Youth Empowerment Solutions (YES) for a school-based health clinic 2.3 D - In progress Contact: Stephannie Senegal, WCHS 2.4 A - Meetings held with YES, Wake County Public School System and state and local health providers. 2.4 B - Seek additional youth health resources 2.5 A - Provide prescription assistance to eligible patients 2.4 B - In progress Contact: Sue Lynn, WCHS 2.5 A - Free meds dispensed equating to $162,911 cost savings to patients Contact: Leona Doner, Shepherds Care Medical Clinic 2.5 B - Provide healthcare services to eligible patients 2.5 B1 - 950 total patient visits - this has doubled since June 2010 2.5 B2 - Within first three months of 2011, clinic moved from 6-8 clients/week to 16 clients/week 2.5 B3 - One new medical provider (PA) added in March 2011, therefore morning clinic hours were made possible, thus allowing two opportunities for clinic hours 2.5 B4 - Donations received: * Wake Heart and Vascular in Clayton donated a EKG machine 2.6 - Establish appropriate and accurate baseline measures for improving health care access 2.6 A - Collect baseline data on healthcare access Access to Healthcare Abbreviations: CCWJC – Community Collaborative of Wake and Johnston County CCNC - Community Care of North Carolina DMA - Division of Medical Assistance DPH – Division of Public Health NFP - Nurse-Family Partnership PA – Physician Assistant PCM – Pregnancy Care Manager YES - Youth Empowerment Solutions 22 | P a g e 2.5 B5 - Donations received * Henry Schein donated an A1c Analyzer Contact: Leona Doner, Shepherds Care Medical Clinic 2.6 A - In progress Contact: Sue Lynn Ledford, WCHS Edie Alfano-Sobsey, WCHS Significant Public Health Issues Disaster Preparedness Wake County had multiple incidents in 2011 that required leadership from our Disaster Preparedness Team; storms, hurricane support services, bio-hazard events and communicable disease outbreaks to name only a few. However, on April 16, 2011, tornadoes crossed central and eastern North Carolina and one of the tornados crossed Wake County from the southwest portion of the county, to the northeast portion. Several areas along the path of the tornado received major damage. Three (3) congregate care facilities were opened in conjunction with the Triangle Chapter of the American Red Cross, to attend to the victims. Over 600 persons were sheltered the first evening of the event. In the following days, these shelters were consolidated into a single shelter housing approximately 200 residences. For the next two weeks, these persons were cared for and provided basic living essentials by the staff of Wake County Human Services. Through excellent team work with many partners which included NC Baptist Men, American Red Cross, Salvation Army, NC Emergency Management, FEMA and many others Wake County was able to assist every person in relocating to either permanent or temporary housing by May 6, 2011. The Tornado Disaster After-Action Report generated several new strategies to improve delivery of services for Wake County EM Services and PH Preparedness. New plans for a more robust Shelter and Volunteer Coordination team are in process and pre-established Partner Memoranda of Understanding were drafted. These strategies will assure provision of a more robust and trained WCHS and EM staff prepared to respond in time of need. Challenges for Disaster Preparedness include the current economy. Local government budgets been reduced and thus expansion funds are not available to address emergency needs in a comprehensive manner. Also, it is evident that a location for a “long term” sheltering is very limited. An agreement with the Wake County Public School System allows for the opening of any school facility as an emergency shelter. However, there is a need for schools to return to normal function in a brief time. In addition, an alternative location for long term sheltering (1 – 4 weeks) still needs to be identified. Rabies Exposure Investigation During September 2011, a kitten “Silverbelle” that was adopted from the Wake County Animal Shelter tested positive for rabies. This began an extensive investigation to trace human and animal exposure to the kitten involving multiple partners in several counties (refer to “Silverbelle” Rabies Event 09/10/2011 – 10/06/2011 Contact / Impact Chart). Twenty-two people were evaluated for rabies exposure. Of these, seven were referred for full post-exposure prophylaxis against rabies and 10 with pre-exposure vaccinations were given two rabies boosters. No other human exposures to Silverbelle were identified after media messages to the public about the incident. The total cost of this investigation including Wake County Human Services staff time, Wake County Animal Control staff time and quarantine fees, treatment for post-exposure prophylaxis is estimated at $96,111. 23 | P a g e E. coli O157:H7 Outbreak On October 25, 2011, Wake County Human Services and Environmental Services staff, partnering with the NC Division of Public Health, began an investigation of an enteric illness outbreak caused by infection with E. coli O157:H7 bacteria. Wake County Communicable Disease Section staff received more than 50 calls about the outbreak. A total 27 cases were identified in residents from Wake (13), Sampson (6), Cleveland (1), Durham (1), Johnston (1), Lenoir (1), Orange (2) and Wilson (2) counties; five (4 children and 1 adult) of these cases were hospitalized with a severe complication of the disease, hemolytic uremic syndrome. The NC Division of Public Health conducted a case-control study interviewing all 27 cases and another 87 individuals who attended the fair, but did not get sick. The results of the study determined that these infections were most likely transmitted in the Kelley Building at the North Carolina State Fair, a structure where sheep, goats, and pigs were housed and competed in livestock shows during the fair. 24 | P a g e Emerging Issues Current Economic Climate Challenges for Public Health Economy often shapes the complex interface of budget limitations and escalating health needs. Unemployment, reduced income, or losing insurance coverage in economic downturns often result in reduced access to health services. According to studies by the Robert Wood Johnson Foundation current economic uncertainty affects people’s behavior. They avoid spending money on health care and on other commodities or activities that can affect their health and health outcomes. Various reports indicate that the current recession is leading some to forego not just elective surgery and preventive screenings, but also basic care for acute and chronic conditions. This increases the challenge to public health to move the metrics in a positive direction for health outcomes. Rising needs due to unemployment, population growth, and lack of health care coverage, preventive services and a leaner staffing allocation in budgets at the local, state and federal level will continue to have a significant impact on provision of Public Health Essential Services. These issues drive Public Health to be more strategic, do more cross-training and be more collaborative with partners to provide necessary services. In the short-term, these measures may be able to maintain services at a minimal delivery level. However, in the long-term there is reason to be concerned especially as prevention dollars are often the low hanging fruit. Loss of prevention service funds often leads to increased cost for emergent and chronic disease problems. Sexually Transmitted Infection Reduction Efforts • • • • • Chlamydia and gonorrhea are the most commonly reported sexually transmitted diseases in Wake County and the chlamydia case rate per 100,000 population has increased 21% from 2009 to 2010 (WCHS Gonorrhea Culture and Community Health master files for 2009 and 2010). Eighty–one percent of all cases of gonorrhea and 64% of all cases of chlamydia occur among African–Americans. Most cases of chlamydia (85%) and gonorrhea (78%) occur among young adults ages 15-29. From 2006 to 2010, Wake County HIV/Syphilis comorbidity rates (preliminary data) have remained high (over 50% of all syphilis cases are also infected with HIV) and are higher than NC statewide rates. Wake County Human Services (WCHS) strategies to improve the health of these populations include: o Expedited Partner Therapy (EPT) is offered to treat partners of those diagnosed with chlamydia or gonorrhea without first being seen by health care providers to expedite treatment of these diseases. o Through the Program Collaboration and Service Integration (PCSI) grant funding, testing services for HIV, Syphilis, Hepatitis C and TB are integrated by offering them at the same time to clients at testing sites. o Field Delivered Therapy (FDT), a method similar to Directly Observed Therapy (DOT), will be implemented by disease intervention specialists and nursing staff so that treatment is expedited for those infected with gonorrhea and chlamydia that become lost to follow up. o Through FDT protocols, staff from the Communicable Disease and TB programs will work together to investigate, treat and provide prevention educational services to reduce the spread of these communicable diseases. 25 | P a g e WCHS HIV/STD Program will implement the use of social networks as a recruitment strategy for counseling, testing and referral services to target testing among highest risk Men who have sex with Men (MSM) of color (African- American and Latinos) in Wake County who are HIV positive, but unaware of their serostatus. Evidence- based intervention programs will be targeted toward young adults (15-29 years of age) with emphasis on African-Americans in this age o o Wake County Sexually Transmitted Disease Cases 2009 vs. 2010 9.3 Syphilis 12.8 19.2 HIV 20.5 Disease 139.2 Gonorrhea 2010 112.6 2009 504.9 Chlamydia 400.1 0 100 200 300 400 Case Rate (per 100,000 population) 26 | P a g e 500 600 Source: NCDHHS, Communicable Wake County Gonorrhea Cases (%) by Age Group and Race/Ethnicity, 2009-2010 (N= 2152) All 40 35 30 25 Percent 20 15 10 5 0 Black/African American White Other, Hispanic <15 15-19 20-24 25-29 30-34 35-39 Age Group >40 Source: Public Health Division, Wake County Human Services Wake County Chlamydia Cases (%) by Age Group and Race/Ethnicity, 2009-2010 (N=8110) All 40 Black/African American 30 White Percent 20 Other, Hispanic 10 Other, Non-Hispanic 0 <15 15-19 20-24 25-29 30-34 35-39 >40 Age Group 27 | P a g e Source: Public Health Division, Wake County Human Services Wake vs. NC HIV/Syphilis Comorbidity* Cases 2003-2010 80 60 % of Total Syphilis 40 Cases 20 NC Wake 0 2006 2007 2008 2009 2010 * HIV/Syphilis comorbidity is defined as HIV diagnosis before or within 6 months of syphilis diagnosis Source: NCDHHS, Communcable Disease Branch New Strategies for STI Interventions: Test, Teach and Treat Expedited Partner Therapy (EPT): Treating sexual partners of patients diagnosed with sexually transmitted infections (STI) without face-to-face contact and a medical evaluation. Field Delivered Therapy: Treatment of individuals infected with gonorrhea and/or chlamydia is an evidence-based public health measure for controlling STI morbidity. Infected individuals with gonorrhea and/or chlamydia who do not respond to phone calls and/or letters requiring them to return to their providers (or the health department) for treatment, will be contacted by WCHS Disease Intervention Specialists (DIS) and HIV/STD Community Program staff collectively referred to as “Community Health Direct Outreach Therapy staff.” The DIS Staff will deliver prescribed medications for gonorrhea and/or chlamydia-positive clients in conjunction with prevention measures and education during field investigations. Environmental Services A. Recruitment of New Director: As of November 2011, Wake County is in the process of recruitment and interviews for the Environmental Services Director. The previous director resigned in October 2011. B. Waste Water Management: During 2011 Wake County Environmental Health Division and Human Services Board has worked to modify regulations governing Wastewater Treatment and Dispersal Systems in Wake County. The major modifications include: • Rewording for clarification and grammar • Removed water meters • Removed installation of pretreatment devices for repairs • Removed mandatory requirement of maintenance These recommendations have been referred to the County Board of Commissioners. 28 | P a g e C. Animal Shelter Wake County recently restructured the Animal Services Division. The Animal Services Division was formed in the Environmental Services Department on July 1, 2011 with a $2.7 million budget. The Wake County Animal Center is the county's only open admissions shelter, where all animals from the county and other areas are brought for intake. The shelter took in 16,000 animals in FY 2011, and adopted and transferred over 6500 animals the same period. The shelter manages population health to offer healthy and adoptable animals to the public. Healthcare Reform Healthcare Reform requires that by 2014 most people have health insurance. New Healthcare Reform laws expand Medicaid to cover all people under 65, including childless adults, with incomes less than 133% of the Federal Poverty Level. These new requirements, along with new funding for prevention, expansion of health workforce long-term care services, increasing healthcare safety net and improving quality of healthcare services, promises to have a significant impact on the public health needs of the community and services provided. Conclusion During 2012, primary focus will be given to the two priority issues of obesity reduction and improved healthcare access. This decision is based upon the 2010 Community Health Assessment and Wake County Human Services (WCHS) Board priorities. WCHS Public Health will continue to emphasize partnerships with key stakeholders, provide technical support to community and promote utilization of established evidence based interventions. The agency will align its strategies with CDC and State Physical Activity and Nutrition branch efforts. WCHS will also strategically aim to impact the other significant issues listed: Disaster Preparedness, STI Reduction, Communicable Disease and Environmental health issues. Additionally, focus on the health disparities outlined throughout this report will be priority for WCHS Public Health in the coming years. 29 | P a g e Distribution Plan The CHA and SOTCH reports shall be distributed to the public within sixty (60) days of NC DHHS approval. The reports will be distributed via the following methods: • The Public Health Committee of the Human Services and Environmental Services (HS/ES) Board shall receive copies of both reports in the month they are submitted to the State. • The HS/ES Board shall submit a written letter to the Board of Commissioners providing an update on the SOTCH report in the month following submission to the State. • The reports shall be posted on the Wake County website (Wakegov.com) • Community partners linked to the Community Action Planning Process shall receive copies of both reports (i.e. Wake County Board of Education, Wake County Mayors Council, Capital Care Collaborative, etc.) • The Community Assessment Steering Committee shall receive copies of both reports • Other methods identified by staff and community partners Sue Lynn Ledford Wake County Community Health Director 919-250-1474 sue.ledford@wakegov.com 30 | P a g e HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: March 22, 2012 Committee/Item: Housing/City of Raleigh Task Force Report Specific Action Requested: To receive an update on the City of Raleigh Affordable Housing Task Force Item Summary: The Raleigh City Council created the Affordable Housing Task Force in 2008. The Task Force included representatives of for-profit and non-profit builders, lenders, community leaders, housing advocates, and nonprofit service providers. The task force was charged to accomplish the following: • • • • • Review affordable housing needs and issues identified during the Comprehensive Plan Process Review the existing Housing Element and current City of Raleigh Housing programs and resources Review best practices in other jurisdictions. Submit recommendations on potential affordable housing strategies to City Council Review the Draft Comprehensive Plan, including the Community Inventory and the Housing Element. On March 5, 2009, the City of Raleigh Affordable Housing Task Force presented the following recommendations to the City Council on affordable housing policies and strategies for inclusion into the updated Comprehensive Plan. • Mixed Income Communities – Continue the preference given to households at or below 50% of the Area Mean Income (AMI) while recognizing there may be occasions when it is appropriate for the public sector to support the housing needs of households with slightly higher incomes in areas where land costs are prohibitively high such as downtown, in transit-oriented developments or as a part of a mixed-income community. • Creation of New Affordable Housing Tools – These include land banking, establishment of a community land trust, inclusionary housing policies, and creation of a dedicated funding source, such as a housing trust fund, for producing affordable housing. • Make Improvement to the Land Development Process – Modifications to the development process to increase the production of affordable housing and to ensure that providing lower-cost housing through non-financial means is maximized. • Fair Housing, Special Needs Housing and Aging in Place – Elimination of discrimination in the sale or rental of housing and exploration of needed changes to the City’s Fair Housing ordinance to achieve equivalence with Federal Fair Housing Act. Allowing seniors to age in place by providing tax relief mechanisms for them. • Regional Approach to Addressing Low-Income Housing Needs – Work with Wake County, the public housing authorities and other resources to supplement what the City of Raleigh is able to provide in terms of housing. Task Force recommendations were integrated into the housing chapter of Raleigh’s Comprehensive Plan 2030 to signal a commitment to equitable housing opportunities for all income groups. The City of Raleigh has begun or instituted several of the recommendations of the Task Force since it issued its report. The Community Development Department and Planning Department have launched a reworking of the city’s redevelopment approach and are collaborating on several initiatives that will link transit improvements with affordable housing investments. Several sites for possible land banking have been identified along transit corridors and the city continues to sponsor the building of affordable housing in several areas of the city, partnering with nonprofit organizations. Purpose for Action (Proposed Solutions/Accomplishments): Next Steps: Attachments: Opportunities for Advocacy, Policy or Advisory: Connections to Other Committees: Wake County Housing and Community Revitalization partnership efforts with the City of Raleigh Community Development Department Combined request for proposals (RFPs) – Two combined RFPs are distributed each year. The City and the County share in the review process and make joint funding recommendations. Environmental reviews – This is a requirement of the Community Development Block Grant and HOME Grant. The City and County partner in the review process for jointly funded projects. Asset management – All housing developments funded by the County are reviewed annually for compliance with development agreements. All housing related programs that the County funds are also reviewed annually for compliance. The City and County combine the review process for mutually funded projects. Shared review of non-mutually funded projects – Even when funding is not combined County staff participate in City RFP reviews. Provide support - City and County staff maintain ongoing communication. They assist each other with grant and programmatic matters. Fair Housing - Both programs partner to support fair housing events. Housing Committee – The City of Raleigh Community Development Director is on the Human Services Board Housing and Community Revitalization Committee. Support Circles program – The City and County provide complementary services for this program. The County provides funding for the program coordinator and the City provides rental assistance to program participants. ESG – The City of Raleigh uses its Emergency Grant Funds to help support the South Wilmington Street Center. Homeless Prevention and Rapid Rehousing Grant – The City and the County both received this grant. It was part of the American Recovery and Reinvestment Act. Both entities worked together to develop a single program that could be accessed by City and non-City residents. INFORMATION ITEMS • Board Fund Report (Separate) • Feral Cats Ordinance Q&A • Board Advocacy Workgroup: Response Letter from Rep. Neal Hunt • Article: Notes on E coli From 2011 NC St. Fair, JAMA • Committee Reports/Minutes Q&A FROM PUBLIC HEALTH COMMITTEE MEETING 2-17-12 1. What does it mean if a cat has a tipped ear? It identifies them as being part of a managed colony of community cats. 2. Is there a limit to the number of cats in a colony? The ordinance doesn’t impose a limit. However, the ordinance does require a standard of care and the caretaker’s resources may limit the colony size. 3. How often are the colonies checked on? The ordinance requires that caretakers provide food at least once per day. 4. What happens if a caretaker goes on vacation or moves away? The caretaker is responsible for arranging for proper care of the colony if they will be away temporarily. If they are moving they must find an alternate caretaker or contact Wake County Animal Control. 5. Do these colonies become “drop-off centers” for unwanted pet cats? It is possible that could happen, although the problem of abandoning unwanted pets exists regardless of TNR. The practice is illegal currently and will remain so under the revised ordinance. Even if drop-offs do occur, the caretaker will be required to vaccinate and sterilize the cat in order for it to be a part of the colony. 6. Are caretakers required to get approval from the entire neighborhood before establishing a colony of community cats? No, the ordinance only requires approval of the property owner where the colony will be maintained. However, County staff believes neighborhood-wide (or at least adjoining property owners) education and involvement at the beginning of the process will greatly reduce the number of complaint calls that Animal Control Officers will have to respond to. 7. What would the Caretaker do if a cat had a microchip? Make every reasonable effort to return it to its owner. 8. Are caretakers required to microchip the community cats? No. Microchips are of greater benefit on a pet cat since they will stay stationary long enough to be scanned. A person with a microchip scanner can’t get close enough to a feral cat to scan it unless it is trapped. And the metal trap interferes with the microchip scanner. 9. Is revaccination required? Yes, the ordinance requires caretakers to keep the vaccinations current. 10. Will caretakers be required to get rabies vaccinations? No, the ordinance does not require this, but it is recommended practice. 11. Will citizens still be able to request that Animal Control trap the cat, or is TNR the only option? Both options will be available to citizens. 12. When citizens call the County about a feral cat, how will they know that TNR is an option? The County will use three strategies to inform citizens: a. The County will work with cat advocates on a proactive educational campaign to inform citizens of the new option for dealing with feral cats. b. The County will modify its phone system to alert citizens to this additional option. Calls for service go to 212-PETS where they are routed through a touch-tone decision tree. That decision tree will be modified to refer people to a separate TNR information line. c. Animal Control Officers and administrative staff will be trained to respond to questions from citizens. 13. How much will this cost the County? The costs of managing the community cats (food, medical care, etc.) will be borne by the caretakers, not Wake County. The caretakers will also be responsible for the cost of any major educational campaign. Advocates report that there is significant grant funding available to help offset these costs. There will be staff time from County employees dedicated to administering this ordinance, plus administrative costs (such as producing the registration form, etc.). 14. Are there model policies from other communities that take into account public health? There are model ordinances available for review and County staff referred to these ordinances when crafting the County’s ordinance. The ordinance addresses public health concerns by requiring rabies vaccination and sterilization. 15. How will we know if it’s working? Since TNR does not have a long implementation history, there is not a definitive collection of data regarding its effectiveness. One of the reasons to approve this ordinance is to allow staff to collect local data regarding its effectiveness during a pilot testing period. Over a three-year period, staff and caretakers will work together to collect and evaluate data in the following areas: a. Number of animal control calls for feral cats and TNR requests b. Intake numbers for feral cats and all cats at the Wake County Animal Center c. Euthanasia rate for cats at the Wake County Animal Center d. Number of cruelty cases involving feral cats e. Number of rabies cases in Wake County f. Number of spays/neuters and vaccinations provided as part of TNR g. Other factors Notice on Environmental Health and Safety Division Report: EH&S monthly reports will now be sent quarterly. Data will still be reported by month, but will be aggregated over the quarter. The 3rd quarter report (January - March) will be sent on April 12th, the day before the ES Committee meeting. Thank you, Andre C. Pierce, MPA, REHS Wake County Environmental Services Environmental Health and Safety Director apierce@wakegov.com 919-856-7440 - Phone 919-743-4772 - Fax Wake County Human Services Board Social Services Advisory Subcommittee Friday, January 3, 2012 9:00 am – 10:30 am Swinburne Building, Room 5032 Minutes Board Members: Paul Norman Julian Smith Guest: Agenda Item Committee Members: Angie Welsh Anna Troutman Lisa Draper Lynn Templeton Marjorie Menestres Discussion, Conclusions, Recommendations I. Welcome The meeting was called to order at 9:00 p.m. & Introductions II. Review and approval of the minutes Staff: Giang Le Katherine Williams Liz Scott Martha Crowley Nikki Lyons Ramon Rojano Vielka Maria Gabriel Warren Ludwig Action, Follow-up Responsible Due Date Party Paul Norman Minutes were reviewed and were accepted. Vielka Gabriel 1 III. Business Discussion And Updates Advocacy Group: • Wine & Cheese Social was held at the home of Dr. Foster for the Wake County Delegates. The purpose of the event was to get to know the delegates in an informal session. Child Abuse Prevention Summit: • Finance Committee: Created the budget of $5,000 revenue • Program Committee: o Summit will be held on April 23, 2012 – 9:00 am – 12:00 noon - JC Railston Arboretum o Details are being worked on where participants may be eligible for CEU’s for attending the summit. • Marketing Committee: The name and logo has been identified by the committee and the use of a private graphic design firm. The firm also gave the committee a 50% discount for the work. o Theme of the summit Building Foundation – Strengthening Families. o SSA Committee members are asked to please sign up to help with the setup and/or clean up to help reduce the cost of the event. o Invitees Contact Sheet has been sent electronically to members. Please send contact information to Holly Myanker at hmyanker@gmail.com by February 17th. Invitations will be mailed out on February 23rd. (Online webpage invitation/registration will be live on February 22nd. o Event is Free. The budget has included breakfast and a boxed lunch. Julian Anna Child Abuse Summit.pdf 2 III. Business Discussion And Updates continue… WCPSS Kindergarten Registration: Guest Presenter Cris Mulder- WCPSS Chief of Family & Public Engagement. III. Business Discussion And Updates continue… WCHS Budget Overview/Update: (See attached handouts) • $32 million net decrease from FY 2009 Adopted to FY 2012 Adopted • Did not have to lower the Adopted Budget for FY11, and should not have to for FY12 due to revenues stabilizing. • Summary of Department Submitted Reductions: Line item 46- Human Services – Total Expenditures ($1,146,578). o $1.46 million reduction with the elimination of the LME (Handouts) III. Business Discussion And Updates continue… Child Care Subsidy: • Renee Chou with WRAL interviewed a WCHS Child Care Subsidy clients followed by an interview with Gloria Cook, WCHS Child Care Subsidy Program Manager. Interview is scheduled to air this week. (see attached article) (Handout) • (Handouts) Giang Registration is no longer happening at the local schools or Central Services Office. Registration is done online. As of February 2nd 12,081 students are currently enrolled in WCPSS Kindergarten (2011-2012). 67.6% of upcoming kindergarten students have been preregistered for 2012-2013 school year. Heavy concentration has been place on the Eastern Regional, Apex, and South East Raleigh area due to low registration numbers. o Partners in the community are helping to spread the word and assist in the registration process. Depending on skill set and information of the school of choice the process can be done in as little as 20 minutes. However, due to language, skill set, and knowledge of school the process can become very time consuming. o Challenges: There are many challenges preventing or delaying the registration process including missing documentation (certified birth certificates, vaccination records), transportation, accessing resources. 3 III. Business Discussion And Updates continue… Consolidated Wake County Human Services Board: • With the LME being dismantled from WCHS there will be a shift in the WCHS Board. (Draft Handout) o The consolidated human services board shall be composed of 21 members, and reasonably reflect the population makeup of the county and shall included: 1. Eight public health professionals 2. Four social services professionals 3. One member of the board of county commissioners 4. Four persons who are consumers of human services, public advocates, or family members of clients of the consolidated human services agency 5. Four representatives of the general public III. Business Discussion And Updates continue… Announcements: • Saturday, February 4, 2012 from 1:00-3:00 pm SouthEast Raleigh Positive Youth Development Day. Tarboro Road Community Center • March 6, 2012 from 8:30 am -2:00 pm – 8th Annual Youth Summit of Wake & Johnson County. Ages 14-21 – Wake Tech Main Campus Raleigh, NC • The VITA Program generally offers free tax help to people who make $50,000 or less and need assistance in preparing their own tax returns. IRS-certified volunteers provide free basic income tax return preparation to qualified individuals in local communities. They can inform taxpayers about special tax credits for which they may qualify such as Earned Income Tax Credit, Child Tax Credit, and Credit for the Elderly or the Disabled. VITA sites are generally located at community and neighborhood centers, libraries, schools, shopping malls, and other convenient locations. WCHS Swinburne JobLink center is currently offering these services daily. • HCD Presentation at the next BOC Meeting April 13th at 2:00 pm V. Next Meeting March 2, 2012 9- -10:30 am ~ Swinburne Building, Board Room. – Agenda: Child Welfare Presentation 4 VI. Adjournment The meeting adjourned at 10:35 am. 5 Human Services Regional Networks Committee Board - Minutes February 9, 2012 Committee Charge: Create advocacy, awareness, and community and political support for the need and value of regional networks of care. Members Present Frank Eagles Benny Ridout Jun Lee Human Services Staff Present Bob Sorrels Ross Yeager Darryl Blevins Kris Ramsundar Therese Scott Diana McBride RNC Secretary Cindy Rice Agenda Item I. II. III. IV. Call to Order/Welcome by Chair Western Region Update Client Identification Cards Southern Regional Center Update Discussion Conclusions, Recommendations Meeting called to order by Mayor Frank Eagles (Chair). A special welcome was extended to Diana McBride, Executive Secretary at Eastern Regional Center. Bob Sorrels gave the authorization to send the findings from the Western Region assessment to the mayors. In order to track clients, barcoded cards were introduced at the opening of the Northern Regional Center in 2006. NRC has not implemented this feature. E Data Logic is going to play a factor in this. NC Fast, Document Imaging implementation will take precedence due to investment already made in these new programs. The Southern Regional Center, Mayor Frank Eagles, Ramon Rojano & Bob Sorrels hosted the mayors of Cary, & Morrisville on February 1st. This visit included a tour and explanation of the layout and services offered in a regional center environment. The mayors showed great interest in the regional center concept. Water kits for sample analysis of private wells, a service provided by Wake County Environmental Services in conjunction with Wake County Human Services can be obtained at all three regional centers. This service has I. II. III. IV. V. VI. VII. VIII. IX. Agenda Call To Order/Welcome Western Region Update Client Identification Cards Southern Regional Center Update Eastern Regional Center Update Northern Regional Center Update Millbrook Human Services Center Update Good of the Order Adjourn Action, Follow-up Responsible Party Due Date Agenda Item V. Eastern Regional Center Update VI. Northern Regional Center Update VII. Millbrook Human Services Center Update Discussion Conclusions, Recommendations proven to be beneficial for well owners eliminating numerous trips to Raleigh for additional water kits. The Eastern Region Community Advisory Committee is currently working on 5 areas: • Assist in planning the 10 Year Anniversary- ERC would like to involve everyone and is asking for members of the RNC and other members of NRC and SRC CAC members to participate. • Engage businesses in the Job Boost ProgramMore businesses needed to participate. Businesses are not aware of the service. • Establish partnerships with Senior Centers and others who work with seniors to provide health promotion services to seniors including accessing services and the energy program. • Revamp the Faith Partnership • Follow up on strategies identified through the community assessment action plan. The VITA (Volunteer Income Tax Assistance) program has begun. Taxpayer turn out thus far has been excellent. • The Community Advisory Committee has been involved with the obesity initiative. Through advisory member Eugenia Pleasants’ non-profit organization, a list of locations for healthy food and fitness locations were established. • The VITA program has begun at NRC and remaining busy assisting taxpayers. • Tax Revenue collections have increased. • All Advisory members have business cards with NRC information/services that are shared with the community. • As a part of Service Integration, Ross shared an idea generated from a nutrition wheel concept whereas a program wheel was generated. • • Action, Follow-up Submit names for the ERC 10 Year Anniversary Planning Committee to Diana McBride. Responsible Party RNC Committee Due Date ASAP Millbrook Human Services Center will be forming a Community Advisory Committee before the end of February. VITA program has begun 2 Agenda Item Discussion Conclusions, Recommendations Action, Follow-up Responsible Party Due Date Dental services offered once a week On the horizon: LME currently occupies ¼ of the building (upstairs). Crucial conversations needed with division heads concerning future space at Millbrook. Bob Sorrels addressed concerns at 150 Cornerstone & High House Road in Cary including rental agreement issues, safety concerns, repairs needed, space shortage, and the inability to store client records. There is space adjacent (we currently utilize ½ the building) to 150 Cornerstone that could be redesigned to make safer and have enough space to vacate the High House Road location. GSA has agreed that this would be a smart move. Bob suggested to Mayor Eagles and Benny Ridout that advocacy from the Human Services Board may be needed for there to be action taken. • • VIII. IX. Good of the Order Adjourn United Way Overview ERC & NRC tied in the amount of staff participating in the United Way Campaign with 64 participants. SRC had 56 participants and Millbrook had 5. Holding true to his word, Bob Sorrels will honor the regional center with the most participants a hotdog luncheon. Therefore, luncheons will be held at both ERC & NRC. Regional Centers’ contributions totaled 55% of all of the Human Services contributions and 27% of the total county. After hearing no further business, Mayor Eagles adjourned the meeting. The group will next assemble on Thursday, May 10th, Swinburne Room 5040, 10-11am. 3 Public Health Committee Meeting Minutes –17 February, 2012 Committee Members Present: Benny Ridout, Ann Rollins, Sharon Foster, Barbara Ann Hughes, Heidi Swygard, Laura Aiken, Penny Washington Staff Members Present: Ramon Rojano, Joe Durham, Sue Lynn Ledford, Peter Morris, Nelson Pearce, Andre Pierce, Michelle Ricci Guests: Melissa Anderson, Marie Brewer, Kim Parker (NCSU • Welcome Agenda Items • Approval of Minutes • Chair’s Privilege • Public Health Quarterly Report • Trap-Neuter-Return (TNR) • Overweight /Obesity • Human Services Director’s Report • State of the County Health (SOTCH) Report • Public Health Division Director’s Report • Benny welcomed committee members and called the meeting to order. Welcome and Call to Guests Melissa Anderson, Marie Brewer, and Kim Parker representing the Wake Order Voice for Animals Cat Committee were introduced. Benny Ridout Approval of Minutes Benny asked for a motion to approve the minutes. Ann Rollins made a motion that was seconded by Penny Washington. The minutes were unanimously approved. Chair’s Privilege Benny Ridout Wastewater Treatment Committee Committee members who are interested in serving on the Wastewater Treatment Committee should be receiving information soon about proposed meeting times. Members should select their preferred meeting time when responding. Letter Supporting Continued Tobacco Prevention Funding A draft letter from the Human Services and Environmental Services Board (Board) to the North Carolina General Assembly Wake Delegation supporting continued funding for tobacco prevention activities was given to committee members for review. Ann thanked Benny for creating the letter of support on behalf of the Board. Laura made a motion to move the letter to the Board that was seconded by Ann. The committee voted unanimously to move the letter to the Board. The draft letter was shared with the Executive Committee which met prior to the Public Health Committee. The letter is scheduled to be signed after the next Board meeting then sent to the Wake delegates. Standard Operating Procedure for the Public Health Committee The Board will be restructuring to form a Public Health, Social Services and Environmental Services Board as Mental Health moves with the LME to a managed care organization. The new structure of the Board is being considered and Benny would like to hold further discussion on the Public Health Committee’s SOP until the Board structure and any SOP changes related to the new structure are complete. Public Health Quarterly Report Purpose: Public Health Accreditation requires that “The local health department shall analyze and note reportable events occurring within the community and shall report atypical incidence, if any, to the Division and the local board of health” (Benchmark 2 Activity 2.4). Action: Accept quarterly report; recommend report to the Board. Use as needed to Sue Lynn Ledford Benchmark 2 Activity 2.4 Public Health Committee Meeting Page 2 inform discussions, decisions and advocacy efforts related to public health. Sue Lynn presented the Quarterly Public Health Report October-December 2011 to the committee. The report includes tobacco use data not seen in previous reports and describes strategies being used by HIV/STD staff to address the numbers of cases of STDs. Sue Lynn would like have a more detailed discussion of efforts to address STDs at a future meeting because of their impact on many other things like birth outcomes and cervical cancer. Discussion included: • There is some controversy in the HIV field about what community viral load measures in terms of public health effort but it does demonstrate increased success in getting clients into care and on treatment at earlier stages. When people are on treatment medications, it keeps their viral load down and they can be healthier and stay in school /work. Being on medications with viral load below detectable limits means a longer and a better quality of life. • The HIV clinic is in the process of re-enrolling its clients in the AIDS Drug Assistance Program (ADAP). ADAP is a medication resource for people without any payer source and who are at 125% of federal poverty level. At this time there are about 140 people on the waiting list statewide (their application has gone to the State) and another 6,000 have been approved. Work continues to get clients enrolled. This year re-enrollment for ADAP will occur every six months. That has always been the case but this year it is being enforced for the first time. • An effort is underway to ensure that clients with other payer sources use those sources and keep ADAP open for those without other payer sources. • In the past there have been funding issues for ADAP. It is still somewhat of an issue but the ADAP budget is fixed and is set. As people are enrolled into Medicaid and taken off ADAP rolls, those ADAP resources can be used for another person. • Partners in pharmaceutical industry are providing medications without charge to those on the ADAP waiting list. • The importance of sharing the Public Health Quarterly Report with County and community leaders and decision makers. Trap Neuter Return Andre Pierce Purpose: Receive information about trap-neuter-return (TNR) Action: Provide input, make recommendations The Wake County Board of Commissioners will hear proposed changes to the current animal control ordinance to allow TNR of feral cats in Wake County. Andre made a presentation, the goals of which were to: • Present information about TNR • Get committee input • Get committee feedback as a presentation will go before the Commissioners on March 19 • Get a recommendation from the committee Andre highlighted the current iteration of the ordinance and a flow chart outlining proposed options for consumers making calls to report cats at large. At the conclusion of the presentation questions were posed and answered by staff and Voice for Animals representatives concerning ear tipping to identify feral cats, the size of feral cat colonies, pets accidentally trapped as part of a colony, microchipping of cats, revaccination of cats, public education about options regarding at large cats, costs of the TNR option and who bears those costs, pre-exposure rabies vaccination for colony managers, the approval process for TNR volunteers, public Public Health Committee Meeting Page 3 health concerns, jurisdictions the proposed changes apply to and collection of data to determine effectiveness of the proposed changes. The committee could not make a recommendation without answers to the following questions and would like the Board to consider the following questions/concerns: 1. Protect the health of the public. 2. Insufficient information on public health issues and education. (From a public health standpoint of doing the public education—that can be partnering but who is doing it, who is developing it and is it something that needs to be approved by the County? Is there a process for that?) 3. Necessity of and requirements for rabies post-exposure prophylaxis. (This concern was expressed on several occasions.) 4. Public health impacts. (Are there model policies from other communities that take into account public health? What about / is there a limit on the number of cats?) 5. What is the neighborhood consensus and how it is achieved? 6. Are County stakeholders involved (Sheriff and Animal Control) and engaged (informing callers of 2 choices) 7. How will TNR agencies/rescue groups be approved? 8. Are there hidden costs and who will bear those costs? 9. Need collection of data for effectiveness 10. Accountability for managing colony if a care taker leaves. Feedback to the presentation given included: • HSUS (Humane Society of US) now supports TNR as an option • National Association of Animal Control Officers supports TNR. (States it has a place in the community). • Would be helpful to know which organizations listed on the slide are regional, national etc. (List that information beside the organization.) Overweight/Obesity Benny Ridout Purpose: Discussion of committee activities to address Board and Committee priority of Obesity/Overweight. Action: As determined by discussion. This agenda item was moved to the March meeting agenda as there was not adequate time for discussion. Ramon Rojano Healthy People 2020 Ramon provided the committee with a handout “Introducing Healthy People 2020” highlighting the Healthy People 2020 goals for improving the nation’s health over the next 10 years. Ramon invited the committee to visit the Healthy People 2020 website to look at the comprehensive version of the 2020 goals. Due to limited meeting time, Ramon will spend time at the next meeting examining the nation’s health goals and those set by the state and discuss how Human Services, as an integrated agency, works toward those goals. State of the County Health (SOTCH) Report Purpose: Receive and accept the 2011 SOTCH Report in accordance with Public Health Accreditation Benchmark 1, Activity 1.3. Action: Accept and recommend report to Human Services and Environmental Services Board. Human Services Director’s Report Sue Lynn Ledford Lechelle Wardell Benchmark1 Activity 1.3 Sue Lynn described the new format for the SOTCH report and pointed out that some data from the Public Health Quarterly Report can be found in the SOTCH report. The biggest difference in the way the SOTCH report looks is that the priority areas are specifically listed –access to health care and increase in healthy weight. The strategies for addressing priority areas are listed with progress to date. Committee Public Health Committee Meeting Page 4 members will see this report annually until the next Community Health Assessment (CHA) which is slated for 2014. Area hospitals have been very involved in the CHA process and hospitals are now being required to conduct community health assessments every 3 years and health departments are required to conduct community health assessments every 4 years. Other organizations are also required to perform community assessments such as the United Way and Wake Health Services. Consideration is being given to an enhanced collaborative community health assessment and a more comprehensive state of the county health report in the future. Discussion included: • Examination of and alignment with the Healthy People 2020 national health objectives and the Healthy North Carolina 2020 health objectives. Funding trends in health care reform will follow the national health indicators and campaign. • The Health Resources and Services Administration (HRSA) requires federally qualified health centers to gather data that are not currently being gathered by Wake County. It is important to collaborate with community partners to best utilize resources and work with the same metrics. • Data has helped give public health a stronger voice in the community. • Enhanced collaboration on the community health assessment would include coordinating timing of assessment cycles and cost sharing. Public Health Division Director’s Report The Public Health Division Director’s Report was submitted to the committee prior to the meeting and can be found at the conclusion of these minutes. Sue Lynn Ledford Adjournment Benny asked for a motion to adjourn the meeting. Penny made the motion and it was seconded by Ann. The meeting was adjourned Public Health Division Director’s Report Sue Lynn Ledford RN BSN MPA Friday 2/17/12 1. DHHS and DPH changes at State Level (see article at end of my report) : a. New State Health Director, Dr. Laura Gerald started February 1, 2012. She is a pediatrician that has headed the Health and Wellness Trust Fund Tobacco Settlement and Governor’s Eugenics Compensation Task Force. b. She will replace Dr. Jeff Engle who has taken a policy advisory position with the new DHHS Acting Secretary Al Delia. c. Acting Secretary Delia had previously served as the Governor’s senior adviser for policy and will assume the new post in early February. d. Secretary Lanier M. Cansler, who has served in that post since the beginning of the Perdue administration, has taken a different role with health care reform. e. Also, State Environmental Health Director Terry Pierce has retired effective 1/31/12. f. State Environmental Health and Rural Health Departments have now been moved to State Department of Public Health (on Six Forks Road, Raleigh) Public Health Committee Meeting Page 5 2. State Fair Task Force on E. coli outbreak meeting updates: a. Second meeting held January 26, 2012; toured Kelly Building area and assessed various stations. The third meeting was held on February 14, 2012 to hear the various subcommittee evaluations. b. Subcommittees are reviewing the following topics: • Traffic flow between the Kelley Building and Exposition Center • Traffic flow or Jim Graham Building • Hand washing stations 3. Other communicable disease and Epi Team updates: a. Flu geographic spread is still sporadic and incidence is low b. New strain (avian/swine/human) mix H3N2 now has surfaced with 12 cases and is being monitored closely. Still NO NC Cases at this time, closest is WV. c. Communicable Disease Update i. Jay Levine reported that they are currently working with 2 probable TB Cases in felines. Study of isolate is being done. ii. Currently working with 8 facilities that are having Norovirus Outbreaks: 1. 7 Regulated 2. 1 Private 3. First date of onset was 1/9/2012 4. Among the 8 facilities: • 93 residents ill • 19 staff members ill • Last date of onset was 2/09/2012 • Follow up continues. 4. 5. 6. 7. 8. iii. Select Annual #’s for CD 1. Total Animal Exposures 2011 447 2. Communicable Diseases 611 3. Vaccine preventable CD 208 4. Vectorborne diseases: Wake County managed 511. a. The highest number in NC (per Jodi Reber RN state consultant) b. Durham was second highest total with 199 vectorborne diseases. Healthy Weight information: will be on agenda for committee at the 2/17/12 Public Health Committee meeting. SOTCH Report to be heard at 2/17/12 meeting. PH Quarterly Data Report also to be reviewed this month. Continue to work with Environmental Services (ES) Committee and ES Department on issues related to the TNR Ordinance which the Board of Commissioners has requested for the March meeting. Sue Lynn will present PH info related to ordinance at the 2/17/12 meeting. Working with Waste Water Management and ES Department to move the community discussion forward on the Waste Water Ordinance. Britt Stoddard and Edie Alfano-Sobsey have been working with chairs of both Public Health Committee Meeting Page 6 the ES and PH Committees. A proposal for the community discussion design will be presented in the near future. 9. PH Division submitted requested Abstract proposal for the Annual NALBOH Atlanta Conference. I would like our DIS team to present to PH Committee in near future. Presentation Title: "Shoe Leather" Public Health for STI Reduction: Field-Delivered Therapy (FDT) for Chlamydia and Gonorrhea Cases. 10. Changes At The Top Of Department of Health And Human Services JANUARY 24, 2012 by ROSE HOBAN in FEATURED, MEDICAID, STATE HEALTH POLICY with 0 COMMENTS Laura Gerald and Jeff Engel More changes are coming at the top of the state’s Department of Health and Human Services in the wake of the departure of Secretary of Health and Human Services Lanier Cansler. Cansler announced he would be stepping down from his post nearly two weeks ago. Now other leaders in the Department will be switching chairs. Current State Health Director, Dr. Jeff Engel, will move to the Office of the Secretary as a special advisor on health policy to the incoming HHS Secretary Al Delia. Delia is currently Governor Bev Perdue’s chief of public policy and starts his new job in February. Taking Engel’s place at the helm of the Division of Public Health will be pediatrician Dr. Laura Gerald, a former executive director of the Health and Wellness Trust Fund who most recently chaired the Governor’s Eugenics Compensation Task Force. “It was a surprise, but a welcome one,” said Gerald, who was reached on her cell phone outside jury duty. “But I’m ready to hit the ground running.” The Lumberton native said she intends to continue the Division of Public Health’s focus on the current work of prevention and access to care. “From my background and the work I’ve done professionally, I’m particularly oriented to rural communities and underserved populations,” Gerald said. “I hope to be able in this position to improve conditions for those who are in our most needy communities.” Public Health Committee Meeting Page 7 Meg Molloy, head of NC Prevention Partners, said the moves at the top of DHHS are simply moving around talented people into new positions. Both Engel and Gerald serve on the board of the organization, that’s focused on helping reduce tobacco use and obesity in North Carolina. “We’re fortunate as a state to have such good public health servants,” Molloy said. “We’ve made a lot of progress… but there’s a tight economy and we understand the need to consolidate and economize at DHHS.” North Carolina has climbed in the UnitedHealth Foundation state rankings of health indicators from 40th in the nation in 2004 to 32nd last year. Secretary Cansler leaves at a sensitive time for Health and Human Services. For months, Republican legislators in the General Assembly have tussled with Gov. Perdue over the status of a Medicaid budget shortfall now totaling more than $149 million. Cansler has said that if the governor and legislators do not resolve their disagreement over who has the authority move money to cover the shortfall, Medicaid will run out of money sometime in mid-May. Cansler also leaves under a cloud due to his relationship with Computer Services Corp., a DHHS contractor working on information technology projects for the Department that is now years behind schedule and several hundred million dollars over budget. Before assuming the position as Secretary of HHS, Cansler was the lobbyist for the company. A recent audit by state auditor Beth Wood criticized Computer Services Corp. over its performance on the DHHS project and excoriated DHHS leadership for its poor oversight of the project. Cansler called the audit’s criticisms “ill-informed, negative and unfounded.” Wake County Human Services Board LME Advisory Committee Meeting Community Services Center – 401 E. Whitaker Mill Road, Rm. 210 Minutes – February 21, 2012 Members Present: Mr. Pablo Escobar, Committee Vice Chair / HS Board Ms. Ann Akland, Advocate / NAMI Dr. George Corvin, HS Board Mr. Jim Edgerton, HS Board Dr. Jim Hartye, Horizons Healthcare / WakeMed Ms. Melissa Jemison, HS Board Staff Present: Ms. Denise Foreman, Assistant to the County Manager Mr. Paul Gross, HS Finance Officer Dr. Carlyle Johnson, LME Administrator Ms. Beth Nelson, LME/Network Development/CFAC Liaison Mr. Ramon Rojano, HS Director Ms. Ann Wood, Mental Health Project Manager Guests/Community: Mr. Eric Fox, NC DHHS MH/DD/SAS Members Absent: Ms. Stephanie Treadway, Committee Chair / HS Board Dr. Kent Earnhardt, HS Board / HRC Ms. Rhonda Spence, Advocate Agenda Item Discussion, Conclusions, Recommendations, Follow-up Call to Order The LME Advisory Committee meeting, facilitated by Mr. Pablo Escobar and Dr. George Corvin, opened at 12:03 p.m. Approval of Minutes Agenda Items Upon motion by Dr. George Corvin, seconded by Ms. Melissa Jemison, the committee approved the January 24, 2012, committee minutes. Announcements Agenda: •Business/Finance Report •Merger Updates •Local Site Planning •LME Director/Administrator Updates •Good of Order Vice Chair Pablo Escobar announced that Chair Stephanie Treadway would be running late today due to some appointments and that he would need to leave early to chair a 1:00 p.m. meeting in his new position as Administrative Director of the Open Door Clinic at Urban Ministries. Dr. George Corvin agreed to chair the remainder of the committee meeting. Agenda Item Discussion, Conclusions, Recommendations, Follow-up LME Budget/ Finance Report Mr. Paul Gross and Ms. Beth Nelson, presented the LME Monthly Financial Reports as of February 21, 2012. The committee reviewed and discussed the reports. Highlights Summary: Wake LME Purchase of Service (POS) UCR Expenditures: • LME is currently overspending by $756,831. Hope to close the gap through the adjustments in the benefit plans that went into effect in January. Will not begin to realize savings until the end of February or early-to-mid March. To offset the overspending of IPRS dollars (and with approval by the state), Wake is looking at the LME Systems Administration dollars as Plan B.--projected to underspend by $407,875. Also lapse salaries/benefits could add as much as $150,000 additionally to that figure by June 30. Wake is prepared to move forward with the request to the state for approval to move funding to offset. • Ms. Nelson said the request is important because, like services dollars, the Systems Admin. dollars have to be earned, and Wake will not earn these dollars unless the state allows Wake to use it for services dollars. Mr. Gross said the county cannot supplant state budget cuts with county dollars, but Wake can request from the state to move systematic dollars. • Projecting to underspend Holly Hill Hospital (HHH) Inpatient expenditures by $295,008. However, this is affected by occupancy rates and other issues. If Wake does underspend, Wake will ask that these dollars be encumbered and carried forward into next fiscal year to help with the projected deficit in FY’13 base budget. • The FY’13 base budget (based on FY’12 adopted budget, less carry forwards from FY’11) sets the HHH budget back to $5.6 million for FY’13. WCHS has made an expansion budget request for the difference of about $1.5 million to close the gap. • Upon question by the committee, Ms. Nelson answered that the adjustments in the benefits plans were primarily in adult mental health, with minor changes in child mental health and substance abuse areas. • Committee question: With the change to Wake/Durham MCO Merger, how many of these dollars will no longer be a concern to the Wake County Human Services Board? Mr. Gross answered that the decisions have not yet been made where the HHH, DayMark and Wake Behavioral Health Services county dollars will be placed in FY’13. All state dollars will go to the MCO. • The committee asked who makes the final decision for county dollars. Mr. Gross said county management makes recommendation to Wake BOC for approval. • The committee asked if there is an opportunity to weigh in on this and/or is anyone expecting a recommendation or advice from the HS&ES Board? Dr. Carlyle Johnson said he is not aware of anyone expecting a recommendation or advice from the Board, but that there is always opportunity to weigh in on it if you’re interested. Dr. Johnson said there is not yet a scheduled discussion with the MCO on this topic. He said Ms. Holliman, CEO, The Durham Center, was asking about this topic last week, and he believed it would come up fairly soon. He said the MCO Board will be convened soon and will be looking at the budget for next year and hearing about our planning goals. • Mr. Escobar reminded the committee that one of the key roles of the HS&ES Board is to vet issues such as this. He said this is the committee’s opportunity to weigh in on this topic and/or to ask questions or request information of staff that is needed in order to give input regarding the management of those funds. • Mr. Escobar reminded the committee that it was asked to weigh in on the LME governance several months ago, and that this committee recommended to the HS&ES Board that Wake LME be a single county area authority. The HS&ES Board made this recommendation to the Wake BOC. (Cont.) Agenda Item Discussion, Conclusions, Recommendations, Follow-up LME Budget/ Finance Report (Cont.) Wake LME Purchase of Service (POS) UCR Expenditures (Cont.): • The committee asked staff to confirm whether Johnston and Cumberland Counties would be allowed to keep their local funds separate. Dr. Johnson said they are in an interlocal agreement with the MCO, the funds still come through the MCO, and the MCO is still responsible for the overall management, but essentially they will stay local. Mr. Rojano said both Johnston and Cumberland Counties have transferred mental health programs to the public health department. • Mr. Edgerton suggested that Wake hold on to its local funds and mental health related programs until the new MCO Board is formed and things settle down and we see how things will go. • Dr. Johnson said the maintenance of effort (MOE) dollars are going through the MCO. Johnston and Cumberland counties have a local branch. Wake has a different configuration. The discussions mainly focus on how do the dollars leverage other funding in order to put them together to be stewards of all public funds and not fragmenting the system. Ms. Akland said this could be achieved by contracting arrangements. • Mr. Edgerton asked for clarification of whether there was a conflict between Durham and Wake BOCs about the MCO central office. Ms. Denise Foreman said there was not a disagreement between Durham/Wake on the new MCO corporate headquarters; however, the Wake BOC wanted more information about the Triangle Transit Authority’s transaction of the purchase of the facility. • Dr. Hartye agreed with Mr. Edgerton that Wake should keep local funds separate until (1) MCO is up and running, and (2) dynamics of Healthcare Reform (currently 40% of clients being sent to HHH are unfunded). He said the current set up is that we have an advisory committee that is not involved with the LME and county contract, and he believed there needs to be some specific negotiations to that relationship. He believed the MCO already has a lot on its plate in trying to get set up. • Dr. Johnson said he would have concerns about fragmenting the system. If you manage the state and Medicaid dollars without managing the county dollars, you essentially have to set up two parallel LME systems. You lose the care coordination ability, and the fee-for-services contracting basis becomes complicated if you mix the two. You also lose some of the efficiency of a single managed care organization. An example with Daymark: by managing the system by a single manager, you’re able to monitor utilization, divert from crisis, and house LME staff on the campus. If you have two managers, it becomes unclear of how to contract. If you can increase revenue from state sources, you can decrease the county share. • Ms. Denise Foreman said from the MCO perspective, they want to ensure that they have the full continuum of care and being able to fill gaps is a great tool for them. Separating it out means you lose the opportunity to have a more cohesive approach. However, it does not mean that every local dollar needs to go to them or that the decision has been made. • Mr. Escobar said the concern is that the local dollars would not be used to serve Wake County citizens. • Dr. Hartye said he agreed with everything except the HHH contract funds because that is something the MCO has not run before. He said a discussion about HHH might be reasonable six months to a year down the road, but he does not foresee the MCO being able to handle it adequately in the short run with so many other items they have to focus on with the interlocal agreement. (Cont.) Agenda Item Discussion, Conclusions, Recommendations, Follow-up LME Budget/ Finance Report (Cont.) Wake LME Purchase of Service (POS) UCR Expenditures (Cont.): Committee Request: • Mr. Escobar asked that the committee continue this discussion online and have staff address Dr. Hartye’s concerns about the management of the HHH/County contract and report back to the committee. • Dr. Johnson said one of the next steps is developing the Wake/Durham counties contracts with the MCO for the management of county funding. Since this will get into the contract language details, he said stipulations can be included to specify the how and the conditions that local funds go back to each county. He said there is opportunity to weigh in on this part. Consumer Priority Groups FY12 • This report shows the dollar amount and client count for each of the consumer priority groups served year to date in FY12. • This is a “point in time” snapshot. Consumers move from various consumer groups as they progress through treatment. Client Trends by Month and Account • Trends of number of clients (IPRS only) served over the last 18 months. Not much change from last month. Wake LME Expenditures by Service Category • This report shows expenditures by service category for calendar year 2011-2012. Not all of the January billing data is in yet. IPRS UCR Earnings • In the past Wake had all state/federal dollars on this chart. However, this is the first year of single stream funding dollars. Staff noticed that some categories were low earning and found that the dollars were being pulled from the state single stream funds before federal; however, the rule says that federal funds must be pulled first. Wake is submitting an inquiry to the state to find out why and if it can be corrected. • In response to committee question about the overage in substance abuse services at 130%, Ms. Nelson said Wake earns more in this area and it means Wake is doing more services. A lot of this is in ATC, which has some county dollars and ABC Board dollars. Hilltop Home: Dr. Johnson said Hilltop Home (DD facility) switched to ICF MR Facility in September 2011 (change means they now can bill Medicaid). He said staff met with the state two weeks ago, and is awaiting a state allocation letter authorizing Wake to keep the dollars it received since September. This was already taken into account on the POS UCR Expenditures spreadsheet. Final Comments: --Mr. Escobar said he wanted to remind the committee and HS&ES Board of the responsibilities it has to Wake citizens regarding the services provided as an LME until it changes in July. He said we should ask questions and raise concerns about the services that will be provided through June 30. He said he is talking with community providers who are concerned. --Ms. Beth Nelson said a staff committee recently met with Beth Smerko, County Attorney’s Office, and John Stephenson, County Auditor, to discuss financial, legal, and liability tasks that will still belong to Wake County after June 30. Staff pulled together a group this morning to begin looking at these tasks. Agenda Item Discussion, Conclusions, Recommendations, Follow-up MCO Merger Updates MCO Merger Agreement – Dr. Carlyle Johnson: • The MCO Merger Agreement was approved by Wake County Commissioners on February 6, 2012, and approved by Durham County Commissioners on February 13, 2012. • This enables Wake/Durham to begin doing preparatory work effective March 1. Wake LME Closeout Plans and Staffing Updates: • Have to figure out how to close out the Wake LME and simultaneously open the new multicounty LME and prepare for the January 1, 2013 Medicaid Waiver startup. Overlapping timeframes. • Interviewing February 23 and 24 for the next round of MCO supervisory positions for the Wake site. • Current staff on workgroups will be switched out as staff are identified and filled for the MCO. • Dr. Johnson gave a powerpoint overview of an organization tool that tracks by unit (1) vacancies, (2) LME closeout staff who will not move to MCO, (3) staff who have job offers within Wake County, (4) staff applying to MCO and/or Wake and have not yet heard, (5) staff that have been offered jobs with MCO. • Mr. Rojano said as of February 20th, 20 people have been placed in Wake County jobs. Wake County used a team approach where supervisors held vacant positions in order to help place LME staff. Negotiating with Wake supervisors on transition dates. • Some MCO staff will need to begin their new job before June 30. Trying to arrange additional coverage for those duties and asking Wake for longer transition times. Also staff are working more hours to complete processes and not all are eligible for overtime pay. • Crossroads contract for the Access Center has been increased. Crossroads will begin taking calls at 7pm instead of 9pm. • Care Coordination is an area of concern. The hospital liaisons are leaving. One will remain through June 30. This will require new hires, hopefully with staff that have done this in the past such as pre-trained temps. • The DD care coordination function: fine through June 30 - only one departure; however, the challenge is that this staff have tremendous knowledge on med refills and client placements. Need to identify new staff before June 30 to shadow current staff in order to have a seamless transition on Monday, July 2, 2012. • Substance Abuse care coordination: have some vacancies and working on securing seasoned temps to assist. • The highest priority items are client focused tasks that involve risks to Wake County and financial issues. Least critical items or items that can wait until the merger start up will be delayed or not done as frequently. • Working closely with WCHS financial staff to provide overtime and to hire temps as needed. • Trying to identify strategies to ease transition. For example we will be aggressive in getting providers to submit client claims soon after June 30 and not have them extend out for months. • Quality Management: half the unit is leaving. Remaining staff will focus on the highest need issues: incidents, complaints. Routine monitoring of providers will be delayed or lagged until July 1. We may want to merge earlier the MCO Quality Management Team to handle complaints and endorsements. Appeal rights will not be with Wake County after a certain point in the process. Mr. Rojano asked Dr. Johnson to have Miki Jaeger and Jane Tallis meet on Quality Management issues. • Information Management: have one temp.; continue to look for additional temps in this area. (Cont.) Agenda Item Discussion, Conclusions, Recommendations, Follow-up MCO Merger Updates (Cont.) Wake LME Closeout and Staffing (Cont.): • In summary Dr. Johnson said that overall it is challenging for several reasons, such as staff wanting to move on, negotiating to find temps when possible, shifting staff as possible and approving overtime, being aware of the job volume increases in some areas to close out (for example in the records area), and being aware of what we are not doing and what things the MOC can pick up after June 30. Mr. Rojano made the following summary points: • Wake LME feels accountable and responsible to insure an effective and smooth transition. • Met with Mr. Steve Jordan, State Division of Mental Health, to discuss streamlining. • Do not want clients to feel disruption and at the same time building the new MCO. • Thanked staff for close out efforts. Shows commitment of staff. • The major thing was getting Wake and Durham BOC approval. Moving forward week by week. • Asset of having a great relationship with Ellen Holliman, CEO of TDC. • Suggested that Wake may need to keep Rick Zelno a few months after July 1 to help with financial obligations. Committee Response/Recommendation: Dr. Hartye asked if staff would be following specific measurements or critical points to know if there are any disruptions. He believed points in patient care or provider payments could be useful. He said these are useful points to getting back to Mr. Escobar’s request on responsibility. Mr. Rojano said he and Dr. Johnson will meet to set some measurement standards. He also suggested meeting with Ms. Crystal Farrow to request assistance with temporarily back up of the system. MCO Board Appointments: Ms. Foreman said Wake County is accepting online applications for the MCO Board until February 24. She asked that committee members encourage people to apply. The MCO will vet the applications and make recommendations to the Wake BOC. Wake BOC will make final appointments and is not bound by MCO recommendations. The Wake BOC is scheduled to make the board appointments on March 19. She encouraged MCO Board candidates to attend The Durham Center meetings because it is an opportunity to learn and be engaged. The Durham Center Budget Retreat was held February 17 and candidates were welcomed to attend. The next Durham Center meeting is March 1 at 4:00 p.m. Once the board is appointed, there will be many decision making and clarification items to consider. The board will also be considering salary/benefits, policy, procedures. Dr. Johnson said the School of Government pointed out at the budget retreat that the MCO may want to go back to Wake and Durham BOCs to modify language about the budget schedule. Under the current merger agreement, the MCO Board cannot meet until July 2 for budget presentation, then there is a 10-day public comment period, then the Board can reconvene on July 12 to approve the budget. During this time, you cannot encumber or spend any money. Ms. Foreman said we have to go back to BOCs for another approval in May and this could be included. Ms. Foreman said we could also get an opinion from the county attorneys on this language. MCO Name: The name of the new entity will be voted on by the MCO Board. Agenda Item Discussion, Conclusions, Recommendations, Follow-up Local Site Planning: -Overview and Feedback about Community Expectations and Priorities Dr. Johnson said as we prepare for the Wake site, he wanted to start the discussion of “what is” the Wake site and “what is” local presence. He said there will be a Wake site, a Durham site, and a corporate office. He showed/described the org. chart. for sites. Local sites will have direct impact on consumers by developing their treatment plans and helping them move between levels of care. Dr. Johnson said the local site will provide opportunities for: 1. Clinically perspective - make sure people are getting the care they need and the right level of care that has an impact on the outcomes we want. 2. MCO financial perspective – figure out how to get people into more relevant community-based care, appropriate recovery oriented services to identify gaps in the system. The local sites will be working with the corporate office on these items as they develop the benefit plans and identify further community needs. 3. Hospital perspective - opportunity to work better with EDs and crisis facilities to set up a system of care that keeps people out of the high cost services. 4. Collaboration with provider network and stakeholders to create an effective system of care (ties together housing, transportation, food stamps, etc.). Dr. Johnson said Wake already has a great relationship with the Wake social services and public health departments. Dr. Johnson said after the Wake site supervisors are hired, the Wake site will begin looking for a location. The Wake site will remain in the current CSC Building up to six months. Dr. Johnson said he has been asked when will Wake start the site search and what is he looking for. Dr. Johnson posed the questions to the committee. He said he thought the question should be posed to the community about what does local presence mean to them, what is important to them as we set up the site, and how do we have the dialogue with the Board, stakeholders, etc. Mr. Rojano said the people that will be served by the MCO are the same people that are served by the DSS programs. Before they can become clients of the MCO, they have to be clients of WCHS. Dr. Corvin said this is an opportunity for the committee to offer feedback on: 1. How do we define local presence, and 2. How do we translate it. (Cont.) Agenda Item Discussion, Conclusions, Recommendations, Follow-up Local Site Planning: -Overview and Feedback about Community Expectations and Priorities (Cont.) Committee Feedback/Suggestions: • Ms. Jemison said since clients will need services from both entities, it makes sense for location to be in close proximity. • Dr. Hartye suggested renting the Falstaff Building (ATC). It is on a bus line and walking distance to other services. • Dr. Johnson said he did not expect many clients to come to the local site. However, there may be local CFAC meetings and advisory meetings. His sense is that this is the local face of having a presence in the community so people know what an LME is, and they can come in and address complaints directly. He wants it to be a receptive/welcome place. People will be coming to the facility largely for meetings. Need meeting space and office space. • Ms. Nelson said it will also maintain partnerships (school system, Juvenile Justice and Criminal Justice Systems, housing, DSS, public health, WakeMed, etc.). • Dr. Johnson suggested that staff do geomapping to see where the clients are. • The Wake site currently comprises 67 total staff. Need to plan for growth. The final formula has not been determined. • Mr. Eric Fox suggested making technology available at the Wake site. • Dr. Hartye suggested that staff track positions by staff function crosswalk and title changes (housing specialist, disposition team, etc.). The community needs to know where they will be stationed and/or what they will be called. • Mr. Rojano asked Ms. Denise Foreman to elevate this to a community communication plan to inform the community of the details in the spring. Ms. Foreman said Deputy Manager Joe Durham is talking with Wake’s Public Affairs Office to coordinate with Mr. Doug Fuller (MCO Communications-Corporate Office) who is leading this effort. They will soon send out some communications to partners and plan some forums. Dr. Johnson said there is a MCO workgroup on communication that is discussing when do we start redirecting to MCO. Phone numbers, email addresses, and website all will change. Dr. Johnson’s goal is to identify who will be replacing current staff and take them to partnership meetings and introduce them. • Dr. Hartye said it is important for MCO Board members to be able to advocate for services that Wake feels are crucial/ important that MCO may not see as useful. It will be important to identify what battles Wake feels are important or that Wake choses to fight or not fight. • Ms. Foreman said the rent for the Wake site, technology costs, salary/benefits costs will all come out of the same bucket and the less you pay for rent, the more you have for other items. She asked how does this fit as a factor? Mr. Edgerton suggested that staff draw up specs and put it out for bid. Dr. Johnson said the plan is to understand and layout the parameters and get a consultant to find some suitable places. Any savings get reinvested into the services. • Dr. Corvin said to the extent that the niceness of the facility does not directly enhance delivery of services, he believed the funds are better spent in the other areas that Ms. Foreman highlighted. • Ms. Akland said she understands that the site will not be an open door for consumer services, but felt that it is important to have a good functional space for staff. She suspected that there are some good deals in this economic environment. • Mr. Rojano suggested using the approach of WCHS, which outposts staff in different locations (regional centers, hospitals, WakeBrook,etc.). • Dr. Johnson said at the budget retreat last week, all four counties had identified transportation as a common theme in the gap assessments. Agenda Item Discussion, Conclusions, Recommendations, Follow-up LME Director/ Administrator Updates Mr. Ramon Rojano, LME Director, highlighted some of the recent accomplishments and challenges of the LME. Highlights included: • In 2007, Wake BOC put mental health as a top priority. • Developed Nine Initiatives Plan that generated an additional $10 million (Wake County) over the last four years. • Been very sequential and intentional in a team approach for the past six months to make the MCO merge happen. • The Adolescent PRTF facility in Garner is a coming attraction in September 2012. • Challenge: Wake will still have issues of allocation of beds in the state facilities. • Challenge: State cut of $1 billion in Medicaid. The state will implement an aggressive strategy to recoup payments. • Mr. Rojano serves on the Governance Subcommittee of the Legislative Oversight Committee led by Representative Nelson Dollar. The subcommittee has been reviewing all the matters of G.S. 122c. There is general agreement in what the members of the MCO board should be. The subcommittee will submit a modification to the Bill. Also, the N.C. Council of Community Programs and some legislators are proposing some changes to Bill 916 in the next session. Good of Order Mr. Edgerton asked what percentage of Wake LME clients served has Medicaid. Mr. Rojano said the LME primarily serves clients through IPRS (state dollars). Mr. Edgerton asked what will happen to clients after January 1, 2013, who are not eligible for Medicaid. Mr. Rojano said it depends on a decision of the federal lawsuit filed by the Department of Justice. Dr. Johnson said the LMEs are responsible for the aggregate public funds including Medicaid (i.e. responsible for managing the whole system). With 2014 Healthcare Reform, as the Medicaid eligibility goes up to 138% of poverty level, the concern is there may be an incentive for the state to pull those state dollars into the match. Dr. Johnson said there are two advocacy points: 1. Wake’s disproportionate share of state funding based on the low per capita formula. 2. Valid point that even at 150% to 200% of poverty level, clients still cannot afford out of pocket psychiatric services. Ms. Akland said she, Ms. Holliman, and the executive directors of most associations (NAMI Wake, Disability Rights NC, etc.) met yesterday with the N&O Editorial Board. They discussed two topics: 1. MCO (benefits, risks, points of view) for community messages. 2. Trying to form a foundation that will receive proceeds of any sale of the Dix property to be used for evidence-based services. Trying to push that the property sell price be comparable and that this money be protected. Dr. Corvin expressed his gratitude for the incredible work of the LME and county staff. Meeting Adjourned Meeting adjourned at 1:50 pm. Next meeting is March 20, 2012, CSC 12:00 pm– 2:00 pm HS&ES Board – Advocacy Workgroup February 23, 2012 Meeting Summary The Advocacy Workgroup met following the last Human Services Board meeting Feb 23rd, 2012 from 10:am to 11:am. We vetted the priorities of the Social Services Committee, Human Rights Committee, Public Health Committee, Regional Networks Committee, Environmental Services Committee, Housing Committee. The top five are the following: 1. Decease disparities in key disease indicators, i.e., Infant mortality, chronic disease morbidity and mortality. 2. Build a Western Regional Center: Get this on the County's Capital Improvement Plan (CIP ) with allocated dollars. 3. Child Abuse Prevention: (Includes support for child care subsidy funding for working families, health insurance for children and parents, and support for the health and development of children youth and families.) 4. Support the adoption of the USDA Food Code as outlined by the Environmental Services Committee. 5. Increase the Affordable Housing Supply particularly as it affects the very poor and those with developmental disabilities. Mr. Jim Edgerton will present these priorities at the Monday March 19 Wake County Board of Commissioners meeting. Regina Petteway is trying to set up a meeting with the Wake County Delegation for us to present these priorities. In terms of the Food Code, this will be coming up for adoption on July 1, 2012. Dr. Sharon Foster will contact Senator Bill Purcell to find out who would be the best legislators to send a letter in support of this legislation. Leila Godwin met with us by speaker phone and will provide supporting materials to draft a letter to the appropriate legislators. Mayor Eagles will continue to support the western regional center at all the monthly mayors meetings. No feedback yet from our meeting at the Southern Regional Center. In terms of advocacy for Child Abuse Prevention, we would encourage all Board Members to attend and solicit other interested parties to attend the Building Foundations, Strengthening Families, Preventing Child Abuse Summit Monday April 23, 2012 at the JC Raulston Arboretum from 8:30 am to 12pm. We hope that when Dr. Dunning and Mr. Pablo Escobar meet monthly with the county manager they can share the board's priorities. The next Advocacy Workgroup meeting will be March 22, immediately following the Human Services Board meeting. Respectively submitted, Sharon Foster, Chair
