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

1. 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

2. 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. 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. 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. DOH MISSION (3) Criticalto 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” Healthy Anne Arundel Coalition

7. Healthy Anne Arundel CoalitionVISION Healthy County, Healthy People! 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 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 Healthy Anne Arundel Coalition

10. 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 Healthy Anne Arundel Coalition

11. 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 Healthy Anne Arundel Coalition

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 Healthy Anne Arundel Coalition

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 Healthy Anne Arundel Coalition

14. What Affects “Good Health?” Human Biology Management of Illness Environment Lifestyle 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 Healthy Anne Arundel Coalition

15. Public Monies Spent on “Good Health” Lifestyle Human Biology Environment 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 Healthy Anne Arundel Coalition

16. A Paradigm Shift “From Treatment To Prevention” PayNow for PREVENTION Instead of Paying Later for Care and Treatment Healthy Anne Arundel Coalition

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 Healthy Anne Arundel Coalition

18. Selected SHIP Measures (1)Obesity Healthy Anne Arundel Coalition

19. Selected SHIP Measures (2)Behavioral Health 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 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 www.aahealth.org/statistics Healthy Anne Arundel Coalition

22. Rank Health Outcomes RankHealth 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 Healthy Anne Arundel Coalition

23. Source: County Health Rankings 2012, available at www.countyhealthrankings.org Healthy Anne Arundel Coalition

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 Healthy Anne Arundel Coalition

25. Structure of the Healthy Anne Arundel Coalition Healthy Anne Arundel Coalition

26. Healthy Anne Arundel Coalition Structure Coalition Steering Committee Coalition Network Boards, Coalitions, Councils and Committees Examples County Agencies, Offices, Departments and Partners Examples Anne Arundel County Public Schools School Health Advisory Council County and City Recreation and Parks American Heart Association Drug and Alcohol Abuse Council City Housing Authority & County Housing Commission Mental Health Agency Department of Aging and Disabilities Large Employers & Businesses County Board of Education County Detention and Corrections Facilities Co-Occurring Steering Committee Department of Social Services Arundel Community Development Services CBOs/FBOs/ Volunteers/ Community Reps Partnership for Children, Youth, & Families County and City Police and Fire Department Conquer Cancer Coalition Healthy Anne Arundel Coalition

27. Healthy Anne Arundel Coalition Implementation Structure Leadership Team and Finance Subcommittee Healthy Anne Arundel Coalition

28. 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 Coalition

29. Healthy Anne Arundel CoalitionManagement and Staffing • Chair and Chair Designees • Vice Chairs • Steering Committee • Sub-Committees • Network Members • Staffing Support Healthy Anne Arundel Coalition

30. Healthy Anne Arundel CoalitionGuiding Principles • Utilize Existing Groups • Flexibility • Inclusive and Welcoming • Embrace Change • Transparent Healthy Anne Arundel Coalition

31. Healthy Anne Arundel CoalitionStrategies • COMMUNICATING- exchanging informationthrough networking for mutual benefit and to achieve a common purpose • COORDINATING - exchanging information andaltering activities for mutual benefit and to achieve a common purpose • COOPERATING - exchanging information, altering activities, & sharing resourcesfor mutual benefit and to achieve a common purpose • COLLABORATING - exchanging information, altering activities, sharing resources, and enhancing the capacityof another for mutual benefit and to achieve a common purpose Healthy Anne Arundel Coalition

32. Healthy Anne Arundel CoalitionIntervention Framework • Individual/Group level • Community/Societal • Structural/Policy Healthy Anne Arundel Coalition

33. 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

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 Healthy Anne Arundel Coalition

35. Coalition Influence and Reach (1) Preliminary Data – Healthy Anne Arundel Coalition May 2012 Healthy Anne Arundel Coalition

36. Coalition Influence and Reach (2) Preliminary Data – Healthy Anne Arundel Coalition May 2012 Healthy Anne Arundel Coalition

37. Coalition Influence and Reach (3) Preliminary Data – Healthy Anne Arundel Coalition May 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 *Designated Priority Areas Healthy Anne Arundel Coalition

39. Priority # 1Obesity Prevention 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! Healthy Anne Arundel Coalition

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

42. 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 Healthy Anne Arundel Coalition

43. Health Disparities disparities Source: Maryland Health Services Cost Review Commission Healthy Anne Arundel Coalition

44. Health Disparities disparities Source: Maryland Health Services Cost Review Commission Healthy Anne Arundel Coalition

45. Priority # 2Mental Health and Substance Abuse as Co-Occurring Disorders Healthy Anne Arundel Coalition

46. 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. Healthy Anne Arundel Coalition

47. 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 Healthy Anne Arundel Coalition

48. 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 Healthy Anne Arundel Coalition

49. Health Disparities disparities Source: Maryland Health Services Cost Review Commission Healthy Anne Arundel Coalition

50. 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 Healthy Anne Arundel Coalition