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

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

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

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

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

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

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

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

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

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

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

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

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

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 101 - 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

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 101 - A Maryland Perspective." Maryland Association of Counties Winter Conference, January 4, 2007 Updated May 14, 2012 Healthy Anne Arundel Coalition

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

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

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 2008-2010) 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, 2007-2009) 198.8 194 173.4 Updated May 14, 2012 Healthy Anne Arundel Coalition

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

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

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 www.aahealth.org/statistics Updated May 14, 2012 Healthy Anne Arundel Coalition Updated March 1, 2012

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

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 www.countyhealthrankings.org Updated May 14, 2012 Healthy Anne Arundel Coalition Updated March 1, 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Healthy Anne Arundel Coalition Suicide Age-Adjusted Suicide Death Rates, Anne Arundel and Maryland, 2005-2010 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

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

Healthy Anne Arundel Coalition Contacts Laurie Fetterman, MSW Phone: 410-222-7203 Email: HDFETT00@aacounty.org Charis Jones, MPH Phone: 410-222-4495 Email: HDJONE11@aacounty.org www.HealthyAnneArundel.org Updated May 14, 2012 Healthy Anne Arundel Coalition

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: 410-222-7375 Fax: 410-222-4433 Maryland Relay (TTY): 1-800-735-2258 www.aahealth.org 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