anne arundel county department of health co-occurring disorders steering committee june 15, 2012 dr....

Anne Arundel CountyDepartment 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


DOH MISSION (1)

Our mission is to preserve, promote and protect the

public health for Anne Arundel County residents


DOH MISSION (2)

We are committed to providing leadership,

guidance and information to ensure that all residents have seamless access to public health services


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


Healthy Anne Arundel Coalition 6

Healthy Anne Arundel Coalition

“A Ripple Effect”

Updated May 14, 2012


Healthy Anne Arundel CoalitionVISION

Healthy County,

Healthy People!



Healthy Anne Arundel Coalition MISSION

Working together as a community to promote the

health and wellness of Anne Arundel County residents



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%

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



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



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



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



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



What Affects “Good Health?”

Environment

Lifestyle

Human BiologyManagement

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



Public Monies Spent on “Good Health”


Managementof Illness

HumanBiology

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


Pay Now for PREVENTION

Instead of Paying Later for Care andTreatment

A Paradigm Shift “From Treatment To Prevention”



Anne Arundel County SHIP DataAnne 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



Selected SHIP Measures (1)Obesity

IndicatorAnne 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



Selected SHIP Measures (2)Behavioral Health

IndicatorAnne 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



Selected SHIP Measures (3)Disparities

Indicator White Black Hispanic

Rate of diabetes-related emergency department visits per 100,000 population (HSCRC 2010)

255.0 728.3 63.8


For many indicators, the story is in the health-related disparities (race/ethnic, gender, age, location etc.)Anne Arundel County


Leading Causes of Death Anne Arundel County, 2010

1. Heart Disease

2. Cancer

3. Stroke

4. Chronic Lower Respiratory Diseases

5. Diabetes

6. Unintentional Injuries

7. Influenza and Pneumonia

8. Septicemia

9. Alzheimer’s Disease

10. Suicide

Anne Arundel County Report Card available at www.aahealth.org/statistics



Rank Health Outcomes Rank Health Factor1 Howard 1 Howard 2 Montgomery 2 Montgomery3 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



Source: County Health Rankings 2012, available at www.countyhealthrankings.org



Public Health Partnerships

1. Public Sector

2. Health Care Providers/Payers **

3. Community Based Partners

4. Employers/Business Community

5. Academic Partners

6. Philanthropy

** Health Care Providers/Payers

• Hospitals• FQHCs• Pharmacies• Insurers• Community Health

Centers• Health Care

Professionals

Successful public health initiatives often have multiple and diverse partners including:



Structure of the Healthy Anne Arundel Coalition



Healthy Anne Arundel Coalition StructureCoalition

Steering Committee

CoalitionNetwork

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

Examples

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



Steering

Committe

e

Co-Occurring Disorders Steering

Committee

Leadership Team and Finance

Subcommittee

Healthy Anne Arundel Coalition Implementation Structure



Healthy Anne Arundel CoalitionLevels of Engagement

Steering Committee Member

Sub-Committee Member

Network Group Member

Network-Steering Committee Liaison

Resource Partner Consumer/Client/

Former Patient Community

Representative Observer Volunteer Technical Assistance Presenter



Healthy Anne Arundel CoalitionManagement and Staffing

Chair and Chair Designees

Vice Chairs

Steering Committee

Sub-Committees

Network Members

Staffing SupportUpdated May 14, 2012


Healthy Anne Arundel CoalitionGuiding Principles

Utilize Existing Groups

Flexibility

Inclusive and Welcoming

Embrace Change

Transparent Updated May 14, 2012


Healthy Anne Arundel CoalitionStrategies

1. COMMUNICATING - exchanging information through networking for mutual benefit and to achieve a common purpose

2. COORDINATING - exchanging information and altering activities for mutual benefit and to achieve a common purpose

3. COOPERATING - exchanging information, altering activities, & sharing resources for mutual benefit and to achieve a common purpose

4. COLLABORATING - exchanging information, altering activities, sharing resources, and enhancing the capacity of another for mutual benefit and to achieve a common purpose



Healthy Anne Arundel CoalitionIntervention Framework

Individual/Group level

Community/Societal

Structural/Policy



Healthy Anne Arundel CoalitionSocial-Ecological Model

Source: Marjorie Buchanan, RN, MS, CPH, Clinical Director, Community and Public Health Nursing, University of Health School of Nursing



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



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

Yes

Baltimore Washington Medical Center

2,600 100,000+ ED visits; 30,000 in outreach

Yes

A.A. Co. Public Schools 8,000+ 76,000+ students Yes

A.A. Community College 1,000+ 15,000+ students Yes

Preliminary Data – Healthy Anne Arundel Coalition May 2012




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 Yes

A.A. Co. Dept. of Recreation & Parks

300 500,000+ County residents & visitors

Yes

A.A. Co. Dept. of Social Services

350 60,000+ families Yes

A.A. Co. Executive’s Office/County Employees

19/TBD 500,000+ County residents

Yes

City of Annapolis 600 38000 Yes





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

Yes

CareFirst BlueCross BlueShield

5,000 (in Baltimore/ DC area)

3.4 million in MD Yes

People’s Community Health Centers, Inc.

121 14,600 unduplicated clients/ year

Yes

TOTAL ~ 20,000 ~ 300,000+ ALL!



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

*Designated Priority Areas



Priority # 1Obesity Prevention



Adult Obesity – Not Sustainable!


Percent of Obese Adults By Year for Anne Arundel County, Maryland, and the USData source: National BRFSS

0

5

10

15

20

25

30

35

AA

MD

USBend the obesity curve ~ a call to action!


Adult Obesity


Weight Status by Race for Anne Arundel County, 2007Data source: Anne Arundel County Behavioral Risk Factor Survey, 2007


Childhood Obesity


Weight Distribution by Age Group for Children and Adolescents, 2006Data source: Anne Arundel County Department of Health Provider-based County Survey of Children and Adolescents, 2006


disparities

Source: Maryland Health Services Cost Review Commission

Health Disparities



disparities


Health Disparities



Priority # 2Mental Health and

Substance Abuse as Co-Occurring

Disorders



Rate of Emergency Department Visits for Substance Abuse* by ZIP Code of Residence, Anne Arundel County,July 2010 – June 2011

*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.

Substance Abuse



Suicide


10-17 years

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65 and older

336.5300.0 288.3

246.7

179.8

90.3

34.6Ra

te p

er

10

0,0

00

p

ers

on

s

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


Suicide


2005-2007 2006-2008 2007-2009 2008-2010

10 9.4 9.4 9.5

Anne Arundel Maryland

Rat

e pe

r 10

0,00

0 p

erso

ns

Age-Adjusted Suicide Death Rates, Anne Arundel and Maryland, 2005-2010Data Source: Maryland Vital Statistics Annual Report, Division of Health Statistics, Maryland DHMH; Injury Center, CDC; MD Health Services Cost Review Commission


disparities


Health Disparities



Healthy Anne Arundel Coalition Contacts

Laurie Fetterman, MSW

Phone: 410-222-7203

Email: [email protected]

Charis Jones, MPH

Phone: 410-222-4495

Email: [email protected]

www.HealthyAnneArundel.org



County Executive John R. Leopold Department of HealthJ. Howard Beard Health Services Building3 Harry S. Truman Parkway Annapolis, Maryland 21401Phone: 410-222-7375 Fax: 410-222-4433Maryland Relay (TTY): 1-800-735-2258www.aahealth.org

Anne Arundel County Department of Health Representatives:Angela M. Wakhweya, M.D., MSc.Econ., Health OfficerJinlene Chan, M.D., M.P.H., Deputy Health Officer, Healthy Families AdministrationKelly Russo, M.D., M.P.H., Deputy Health Officer, Healthy Communities AdministrationRonna Gotthainer, Deputy Health Officer, OperationsAntigone Vickery, M.P.H., Director, Office of Assessment, Planning and ResponseLaurie Fetterman, M.S.W., Health Planner, Office of Assessment, Planning and ResponseCharis Jones, M.P.H., Technical Advisor, Office of Assessment, Planning and Response

Steering Committee Member Organizations:A.A. Co. Office of the County ExecutiveA.A. Co. Dept. of Aging and DisabilitiesA.A. Co. Dept. of Detention FacilitiesA.A. Co. Dept. of HealthA.A. Co. Dept. of Recreation & ParksA.A. Co. Dept. of Social ServicesA.A. Co. Public SchoolsA.A. Co. Mental Health Agency, Inc.Anne Arundel Community CollegeAnne Arundel Economic Development CorporationAnne Arundel Health SystemArundel Community Development Services, Inc.Baltimore Washington Medical CenterCareFirst BlueCross BlueShieldCity of Annapolis Mayor’s OfficeJohns Hopkins Bloomberg School of Public HealthMedStar Harbor HospitalNorthrop GrummanPeople’s Community Health Centers, Inc.Rite Aid CorporationSchool of Public Heath, University of MarylandWalmart


anne arundel county department of health co-occurring disorders steering committee june 15, 2012 dr....

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