1. Co-Occurring Disorders Steering Committee
Anne Arundel County Department of Health
Co-Occurring Disorders Steering Committee
June 15, 2012
Dr. Angela M. Wakhweya
Health Officer

2. Anne Arundel County Department of Health
DOH VISION
Our vision is a vibrant Anne Arundel County in which healthy people reside in healthy communities
Anne Arundel County Department of Health

3. Anne Arundel County Department of Health
DOH MISSION (1)
Our mission is to preserve, promote and protect the public health for Anne Arundel County residents
Anne Arundel County Department of Health

4. Anne Arundel County Department of Health
DOH MISSION (2)
We are committed to providing leadership, guidance and information to ensure that all residents have seamless access to public health services
Anne Arundel County Department of Health

5. Anne Arundel County Department of Health
DOH MISSION (3)
Critical to achieving our vision and mission are strong, sustainable partnerships with public sector agencies, individuals, community-based organizations, health care providers and payers, academic institutions, businesses and other private sector agencies
Anne Arundel County Department of Health

6. Healthy Anne Arundel Coalition
“A Ripple Effect”
Updated May 14, 2012
Healthy Anne Arundel Coalition

7. Healthy Anne Arundel Coalition VISION
Healthy County,
Healthy People!
Updated May 14, 2012
Healthy Anne Arundel Coalition

8. Healthy Anne Arundel Coalition MISSION
Working together as a community to promote the health and wellness of Anne Arundel County residents
Updated May 14, 2012
Healthy Anne Arundel Coalition

9. Anne Arundel County ~ Who Are We?
Area: 416 square miles
Population 537,656 (2010) §
Geography:
Rural south county
Urban/suburban northern and mid-county
§ US Census, 2010; * American Community Survey, 2010; ¶ BRFSS, 2010; † Bureau of Labor Statistics, January 2011
Anne Arundel County ~ Who Are We?
Anne Arundel
Maryland
U.S.
Racial/Ethnic Breakdown:
White
72.4%
54.7%
63.7%
Black
15.2%
29.0%
12.2%
Hispanic
6.1%
8.2%
16.3%
Asian
3.4%
5.5%
4.7%
Median Household Income (2010) *
$79,843
$69,193
$50,221
Unemployment (January 2011) †
6.5%
7.5%
9.8%
Uninsured Adults (2010) ¶
10.3%
12.9%
17.8%
Individuals Below Poverty (2010)
6.8 %
9.2%
14.3%
Updated May 14, 2012
Healthy Anne Arundel Coalition

10. Healthy Anne Arundel Coalition
Public Health Context
Reductions in federal, state and local funding for public health has required a collaborative approach to leveraging local resources to improve the public’s health
Economic and policy incentives (inc. Health Care Reform) will require public and private sector providers to promote:
Prevention and wellness
Health equity and reduction in health disparities
Patient satisfaction
Updated May 14, 2012
Healthy Anne Arundel Coalition

11. Healthy Anne Arundel Coalition
Background to the SHIP
Maryland’s Health Reform Coordinating Council has recognized the importance of local health improvement coalitions (LHICs)
The Maryland Governor and Legislature have committed State support to LHICs in SFY 2012 budget
The Maryland Hospital Association provided start-up funds to LHICs
The Maryland Community Health Resources Commission provided implementation funding to LHICs
Local health improvement plans are a prerequisite for local health department accreditation
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

12. Rationale for SHIP and LHICs
Federal goals related to Healthy People 2020
Reductions in federal, state and local funding for public health
Increased health care costs related to preventable health conditions
Increased focus on prevention and wellness
The reduction in federal, state and local funding for public health requires a collaborative approach to leveraging health improvements.
Changing economic conditions and policy initiatives are resulting in an increasing importance being placed on the prevention of potential health problems.
There is a move towards public health department accreditation that will require a focus on outcomes, quality of care, monitoring and evaluation.
Federal funding reductions: $465,000
State funding reductions: $5 million
County funding reductions: $1.7 million
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

13. State Health Improvement Process (SHIP)
Provides a framework for accountability, local action, and public engagement
Identifies 39 critical health measures
Requires each County to develop a Local Health Improvement Coalition (LHIC)
Requires each LHIC to develop and implement a Local Health Improvement Action Plan
Updated May 14, 2012
Healthy Anne Arundel Coalition

14. What Affects “Good Health?”
Environment
Lifestyle
Human Biology
Management of Illness
Source: Presentation by Rodney B. Glotfelty, RS, MPH, Garrett County Health Officer. "Public Health A Maryland Perspective." Maryland Association of Counties Winter Conference, January 4, 2007
Relative effect of environment, lifestyle, illness care delivery, and human biology on good health.
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

15. Public Monies Spent on “Good Health”
Management
of Illness
Human
Biology
Lifestyle
Environment
Source: Presentation by Rodney B. Glotfelty, RS, MPH, Garrett County Health Officer. "Public Health A Maryland Perspective." Maryland Association of Counties Winter Conference, January 4, 2007
Updated May 14, 2012
Healthy Anne Arundel Coalition

16. A Paradigm Shift “From Treatment To Prevention”
Pay Now
for PREVENTION
Instead of Paying
Later for Care and
Treatment
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

17. Anne Arundel County SHIP Data
Anne Arundel County High Impact Objectives
High Morbidity Impact
Reduce ED visits from:
Asthma
Diabetes
Hypertension
Behavioral health conditions (mental health and substance abuse)
High Mortality Impact
Reduce deaths from cancer and heart disease
Multiple Impact
Reduce overweight/obesity
Improve maternal and infant health
Reduce tobacco use
Increase access to health care
The SHIP measures can be viewed many different ways. Many of the measures often interact, Eg. Reducing overweight and obesity can also affect measures related to cancer, diabetes, and heart disease.
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

18. Selected SHIP Measures (1) Obesity
Indicator
Anne Arundel County Baseline
Maryland Baseline
Maryland 2014 Target
Percentage of adults who are at healthy weight (not overweight or obese) (BRFSS )
33.5%
34.0%
35.7%
Percentage of youth (ages 12-19) who are obese (MYTS 2008)
10.8%
11.9%
11.3%
Rate of heart disease deaths per 100,000 age-adjusted population
(VSA, )
198.8
194
173.4
Updated May 14, 2012
Healthy Anne Arundel Coalition

19. Selected SHIP Measures (2) Behavioral Health
Indicator
Anne Arundel County Baseline
Maryland Baseline
Maryland 2014 Target
Rate of emergency department visits for a behavioral health condition per 100,000 population (HSCRC, 2010)
1134.9
1206.3
1146.0
Updated May 14, 2012
Healthy Anne Arundel Coalition

20. Selected SHIP Measures (3) Disparities
For many indicators, the story is in the health-related disparities (race/ethnic, gender, age, location etc.)
Anne Arundel County
Indicator
White
Black
Hispanic
Rate of diabetes-related emergency department visits per 100,000 population (HSCRC 2010)
255.0
728.3
63.8
Updated May 14, 2012
Healthy Anne Arundel Coalition

21. Leading Causes of Death Anne Arundel County, 2010
Heart Disease
Cancer
Stroke
Chronic Lower Respiratory Diseases
Diabetes
Unintentional Injuries
Influenza and Pneumonia
Septicemia
Alzheimer’s Disease
Suicide
Anne Arundel County Report Card available at
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

22. Healthy Anne Arundel Coalition
Rank Health Outcomes Rank Health Factor
1 Howard Howard
2 Montgomery 2 Montgomery
3 Queen Anne's 3 Frederick
4 Frederick Talbot
5 Carroll Carroll
6 Calvert Calvert
7 St. Mary's 7 Anne Arundel
8 Talbot Harford
9 Harford Queen Anne's
10 Anne Arundel Baltimore
11 Charles Charles
12 Washington St. Mary's
13 Baltimore Kent
14 Worcester Garrett
15 Prince George's Worcester
16 Garrett Washington
17 Kent Prince George's
18 Cecil Allegany
19 Wicomico Wicomico
20 Caroline Cecil
21 Somerset Caroline
22 Dorchester Dorchester
23 Allegany Somerset
24 Baltimore City Baltimore City
Source: County Health Rankings 2012, available at
Updated May 14, 2012
Healthy Anne Arundel Coalition

23. Healthy Anne Arundel Coalition
Partnerships are key to public and community health. As you just learned, local health departments across the state, have formed local health improvement coalitions. Anne Arundel’s LHIC is the Healthy Anne Arundel Coalition.
Source: County Health Rankings 2012, available at
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

24. Public Health Partnerships
Successful public health initiatives often have multiple and diverse partners including:
Public Sector
Health Care Providers/Payers **
Community Based Partners
Employers/Business Community
Academic Partners
Philanthropy
** Health Care Providers/Payers
Hospitals
FQHCs
Pharmacies
Insurers
Community Health Centers
Health Care Professionals
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

25. Structure of the Healthy Anne Arundel Coalition
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

26. Healthy Anne Arundel Coalition Structure
Steering Committee
Network
Partnership for Children, Youth, & Families
CBOs/FBOs/ Volunteers/ Community Reps
School Health Advisory Council
Drug and Alcohol Abuse Council
County Board of Education
County Detention and Corrections Facilities
Department of Social Services
Department of Aging and Disabilities
County and City Recreation and Parks
Mental Health Agency
Arundel Community Development Services
Anne Arundel County Public Schools
County Agencies, Offices, Departments and Partners
Examples
Boards, Coalitions, Councils and Committees
Conquer Cancer Coalition
Co-Occurring Steering Committee
City Housing Authority & County Housing Commission
County and City Police and Fire Department
Large Employers & Businesses
American Heart Association
Led by Health Officer in coordination with lead LHD staff
Consists of representatives from the partnership areas
Set the vision, mission, goals, action plans
Will consist of existing health-related groups in the County, some examples are shown.
Will assist in achieving the priorities and also in implementing the action plans
Many levels of engagement and opportunities for participation exist
Updated May 14, 2012
Healthy Anne Arundel Coalition

27. Healthy Anne Arundel Coalition Implementation Structure
Steering
Committee
Promotion and Publicity Subcommittee
Co-Occurring Disorders Steering Committee
Community Health Needs Assessment Subcommittee
Community Outreach Subcommittee
Obesity Prevention Subcommittee
Leadership Team and Finance Subcommittee
Updated May 14, 2012
Healthy Anne Arundel Coalition

28. Healthy Anne Arundel Coalition Levels of Engagement
Steering Committee Member
Resource Partner
Consumer/Client/ Former Patient
Sub-Committee Member
Community Representative
Network Group Member
Observer
Network-Steering Committee Liaison
Volunteer
Technical Assistance
Presenter
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

29. Healthy Anne Arundel Coalition Management and Staffing
Chair and Chair Designees
Vice Chairs
Steering Committee
Sub-Committees
Network Members
Staffing Support
Will discuss mission and vision in a few minutes
Updated May 14, 2012
Healthy Anne Arundel Coalition
Updated March 1, 2012

30. Healthy Anne Arundel Coalition Guiding Principles
Utilize Existing Groups
Flexibility
Inclusive and Welcoming
Embrace Change
Transparent
Utilize existing groups (e.g., committees, councils, commissions, boards, organizations, agencies, Departments) that exist in the County
Flexible to add new groups as necessary
Inclusive and welcoming of new partners
Able to respond to changes in Coalition focus areas and/or priorities
Transparent in being open to the public and the community with relevant materials available on the web-site
Updated May 14, 2012
Healthy Anne Arundel Coalition

31. Healthy Anne Arundel Coalition Strategies
COMMUNICATING - exchanging information through networking for mutual benefit and to achieve a common purpose
COORDINATING - exchanging information and altering activities for mutual benefit and to achieve a common purpose
COOPERATING - exchanging information, altering activities, & sharing resources for mutual benefit and to achieve a common purpose
COLLABORATING - exchanging information, altering activities, sharing resources, and enhancing the capacity of another for mutual benefit and to achieve a common purpose
Updated May 14, 2012
Healthy Anne Arundel Coalition

32. Healthy Anne Arundel Coalition Intervention Framework
Individual/Group level
Community/Societal
Structural/Policy
Updated May 14, 2012
Healthy Anne Arundel Coalition

33. Healthy Anne Arundel Coalition Social-Ecological Model
Source: Marjorie Buchanan, RN, MS, CPH, Clinical Director, Community and Public Health Nursing, University of Health School of Nursing
Updated May 14, 2012
Healthy Anne Arundel Coalition

34. Healthy Anne Arundel Coalition Measures of Success
Decreased emergency department visits
Decreased preventable hospitalizations
Decreased hospital readmissions
Decreased pharmaceutical costs
Increased quality of life
Joint Community Needs Assessment to gain a baseline and monitor success
Updated May 14, 2012
Healthy Anne Arundel Coalition

35. Coalition Influence and Reach (1)
Organization
Employees
Reach
Wellness Program*
A.A. Co. Dept. of Health
710
All Co. residents
Yes
Anne Arundel Health System
3,600
80,000+ ED visits; 25,000+ inpatient
Baltimore Washington Medical Center
2,600
100,000+ ED visits; 30,000 in outreach
A.A. Co. Public Schools
8,000+
76,000+ students
A.A. Community College
1,000+
15,000+ students
Preliminary Data – Healthy Anne Arundel Coalition May 2012
Updated May 14, 2012
Healthy Anne Arundel Coalition

36. Coalition Influence and Reach (2)
Organization
Employees
Reach
Wellness Program
A.A. Co. Dept. of Aging & Disabilities
100
Older and disabled Co. residents
Yes
A.A. Co. Dept. of Detention Facilities
400
7,800 inmates/year
A.A. Co. Dept. of Recreation & Parks
300
500,000+ County residents & visitors
A.A. Co. Dept. of Social Services
350
60,000+ families
A.A. Co. Executive’s Office/County Employees
19/TBD
500,000+ County residents
City of Annapolis
600
38000
Preliminary Data – Healthy Anne Arundel Coalition May 2012
Updated May 14, 2012
Healthy Anne Arundel Coalition

37. Coalition Influence and Reach (3)
Organization
Employees
Reach
Wellness Program
MedStar Harbor Hospital
1,400
Approx. 185,000 County residents
Yes
Rite Aid Corporation
150 (in Co.)
15,000 customers per week in County
CareFirst BlueCross BlueShield
5,000 (in Baltimore/ DC area)
3.4 million in MD
People’s Community Health Centers, Inc.
121
14,600 unduplicated clients/ year
TOTAL
~ 20,000
~ 300,000+
ALL!
Preliminary Data – Healthy Anne Arundel Coalition May 2012
Updated May 14, 2012
Healthy Anne Arundel Coalition

38. Healthy Anne Arundel Coalition Health Improvement Focus Areas
Obesity*
Mental Health & Substance Abuse as Co-Occurring Disorders*
Cancer and Tobacco Use
Dental Care
Sexual Health
Housing and Environmental Conditions
Obesity affects a number of chronic conditions and is a large driver of health care costs for individuals, families, employers and society.
*Designated Priority Areas
Updated May 14, 2012
Healthy Anne Arundel Coalition

39. Priority # 1 Obesity Prevention
Updated May 14, 2012
Healthy Anne Arundel Coalition

40. Adult Obesity – Not Sustainable!
Percent of Obese Adults By Year for Anne Arundel County, Maryland, and the US
Data source: National BRFSS
Bend the obesity curve ~ a call to action!
Updated May 14, 2012
Healthy Anne Arundel Coalition

41. Healthy Anne Arundel Coalition
Adult Obesity
Weight Status by Race for Anne Arundel County, 2007
Data source: Anne Arundel County Behavioral Risk Factor Survey, 2007
Updated May 14, 2012
Healthy Anne Arundel Coalition

42. Healthy Anne Arundel Coalition
Childhood Obesity
Weight Distribution by Age Group for Children and Adolescents, 2006
Data source: Anne Arundel County Department of Health Provider-based County Survey of Children and Adolescents, 2006
Updated May 14, 2012
Healthy Anne Arundel Coalition

43. Healthy Anne Arundel Coalition
Health Disparities
disparities
Updated May 14, 2012
Source: Maryland Health Services Cost Review Commission
Healthy Anne Arundel Coalition

44. Healthy Anne Arundel Coalition
Health Disparities
disparities
Updated May 14, 2012
Source: Maryland Health Services Cost Review Commission
Healthy Anne Arundel Coalition

45. Healthy Anne Arundel Coalition
Priority # 2 Mental Health and Substance Abuse as Co-Occurring Disorders
Updated May 14, 2012
Healthy Anne Arundel Coalition

46. Healthy Anne Arundel Coalition
Rate of Emergency Department Visits for Substance Abuse* by ZIP Code of Residence, Anne Arundel County,
July 2010 – June 2011
Substance Abuse
*Includes alcohol, illegal drugs and nonmedical use of prescription drugs.
Data Source: Rates calculated based on 2010 U.S. Census; MD Health Services Cost Review Commission.
Updated May 14, 2012
Healthy Anne Arundel Coalition

47. Healthy Anne Arundel Coalition
Suicide
Rate* of Suicide-related Emergency Department Visits by Age Group.
Anne Arundel County, July 2010 – June 2011
* Crude rate calculated based on 2010 U.S. Census.
Data Source: Maryland Vital Statistics Annual Report, Division of Health Statistics, Maryland DHMH; Injury Center, CDC; MD Health Services Cost Review Commission
Rate per 100,000 persons
Updated May 14, 2012
Healthy Anne Arundel Coalition

48. Healthy Anne Arundel Coalition
Suicide
Age-Adjusted Suicide Death Rates, Anne Arundel and Maryland,
Data Source: Maryland Vital Statistics Annual Report, Division of Health Statistics, Maryland DHMH; Injury Center, CDC; MD Health Services Cost Review Commission
Rate per 100,000 persons
Updated May 14, 2012
Healthy Anne Arundel Coalition

49. Healthy Anne Arundel Coalition
Health Disparities
disparities
Updated May 14, 2012
Source: Maryland Health Services Cost Review Commission
Healthy Anne Arundel Coalition

50. Healthy Anne Arundel Coalition Contacts
Laurie Fetterman, MSW
Phone:
Charis Jones, MPH
Phone:
Updated May 14, 2012
Healthy Anne Arundel Coalition

51. Healthy Anne Arundel Coalition
County Executive John R. Leopold
Department of Health
J. Howard Beard Health Services Building
3 Harry S. Truman Parkway
Annapolis, Maryland 21401
Phone: Fax:
Maryland Relay (TTY):
Steering Committee Member Organizations:
A.A. Co. Office of the County Executive
A.A. Co. Dept. of Aging and Disabilities
A.A. Co. Dept. of Detention Facilities
A.A. Co. Dept. of Health
A.A. Co. Dept. of Recreation & Parks
A.A. Co. Dept. of Social Services
A.A. Co. Public Schools
A.A. Co. Mental Health Agency, Inc.
Anne Arundel Community College
Anne Arundel Economic Development Corporation
Anne Arundel Health System
Arundel Community Development Services, Inc.
Baltimore Washington Medical Center
CareFirst BlueCross BlueShield
City of Annapolis Mayor’s Office
Johns Hopkins Bloomberg School of Public Health
MedStar Harbor Hospital
Northrop Grumman
People’s Community Health Centers, Inc.
Rite Aid Corporation
School of Public Heath, University of Maryland
Walmart
Anne Arundel County Department of Health Representatives:
Angela M. Wakhweya, M.D., MSc.Econ., Health Officer
Jinlene Chan, M.D., M.P.H., Deputy Health Officer, Healthy Families Administration
Kelly Russo, M.D., M.P.H., Deputy Health Officer, Healthy Communities Administration
Ronna Gotthainer, Deputy Health Officer, Operations
Antigone Vickery, M.P.H., Director,
Office of Assessment, Planning and Response
Laurie Fetterman, M.S.W., Health Planner,
Charis Jones, M.P.H., Technical Advisor,
Updated May 14, 2012
Healthy Anne Arundel Coalition