Approval of Minutes: March 22, Next Board Meeting: May 24, Swinburne St., 2nd Fl., Rm. 2132

Transcription

1 1 of 3 Wake County Human Services and Environmental Services Board April 26, 2012 AGENDA Human Services Ctr Swinburne St. 2nd Fl., Rm 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: March 22, 2012 Next Board Meeting: May 24, Swinburne St., 2nd Fl., Rm Meet Mr. Joseph Threadcraft, Environmental Services Director Regular Agenda 7:45 am Public Health Committee: Mr. Benny Ridout, Chair (Items Deferred from March Meeting): Review/Discuss Public Health Quarterly Report (#2.4) Review/Discuss State of the County's Health (SOTCH) Report (#39.4a) 8:00 am Environmental Services Committee: Ms. Leila Goodwin, Chair Board Letter in Support of Proposed Changes to 15A NCAC 18A (Food Protection and Sanitation of Food Establishment) 8:10 am Recognition of Departed Board Member - Dr. Dianne Dunning, Board Chair --Mr. James (Jim) Edgerton: January 19, March 22, :15 am Board Advocacy Workgroup: Dr. Sharon Foster, Chair Updates on Board Advocacy and Highlights of Meeting with Wake Legislative Delegation

2 2 of 3 Housing Committee: Ms. Melissa Jemison, Chair 8:30 am Endorse Housing Funding Request - Coleman Street Apartments 8:35 am Endorse Affordable Housing Action Plan and Update on Program Accomplishments 8:50 am Updates on Alliance Behavioral Healthcare (new MCO name) Transition/ HS Boards Structure/ and Wake County Behavioral Health Services - Mr. Joe Durham, Ms. Denise Foreman, Mr. Ramon Rojano 9:05 am Human Rights/Consumer Affairs: Mr. Pablo Escobar, Chair Review HRC Complaint Report and History Data Social Services Committee: Dr. Paul Norman, Chair 9:15 am Comments/Highlights on April 23 Summit 9:20 am Update on Human Capital Development 9:40 am HS&ES Directors' Q & A --Update on Local/State Budgets --Ongoing Activities 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 3 of 3 FY 2011 Board s Top Six Priorities: #1 Prevent Child Abuse and Support Families #2 Housing for Vulnerable Populations #3 Obesity Prevention and Nutrition #4 Access to Mental and Physical Health Services #5 Protect Wake County s Water Resources #6 Human Capital Development (added 10/28/10)

4 Human Services and Environmental Services Board Quarterly Meeting Schedule May 2012 Sun Monday Tuesday Wednesday Thursday Friday Sat am-10:30am Social Services, Rm pm-5pm WakeBrook Recovery Ctr., 1-Yr Anniversary Celebration 111 Sunnybrook Rd. 7 BOC 2pm Noon 2pm - LME Advisory, 401 E. Whitaker Mill Rd., Rm BOC 2pm (County Holiday) 12:45pm 2pm HRC Rm am 10am Bd. Executive Cmte. Rm Board Packet Distribution 10am 11am Regional Networks Cmte., Rm :30pm 5:15pm - Housing & Cmty. Revitalization, Rm :30am 10am HS & ES Board Mtg. Rm :30am 1:30pm Environmental Services Library Admin., 4020 Carya Dr. 18 Noon 2pm Public Health, Rex Women Ctr., Rm. 100B June 2012 Sun Monday Tuesday Wednesday Thursday Friday Sat 1 9am-10:30am Social Services, Rm BOC 2pm :30am 1:30pm Environmental Services Library Admin., 4020 Carya Dr am 10am Bd. Executive Cmte. Rm BOC 2pm :30am 1:30pm Wake County Links Annual Graduation & Promotion Ceremony (2012 Graduating Class) Commons Bldg :45pm 2pm HRC Rm Noon 2pm - LME Advisory, 401 E. Whitaker Mill Rd., Rm :30pm 5:15pm - Housing & Cmty. Revitalization, Rm :30am 10am HS & ES Board Mtg. Rm :30am 1pm LME Human Rights, HS Millbrook Ctr., 2809 E. Millbrook Rd. Noon 2pm Public Health, Rex Women Ctr., Rm. 100B July 2012 Sun Monday Tuesday Wednesday Thursday Friday Sat 1 2 BOC 2pm (County Holiday) am 10am Bd. Executive Cmte. Rm No BOC Mtg :45pm 2pm HRC Rm Noon 2pm - LME Advisory, 401 E. Whitaker Mill Rd., Rm. 210 (Contingent) 5 6 9am-10:30am Social Services, Rm :30pm 5:15pm - Housing & Cmty. Revitalization, Rm :30am 10am HS & ES Board Mtg. Rm :30am 1:30pm Environmental Services Library Admin., 4020 Carya Dr Noon 2pm Public Health, Rex Women Ctr., Rm. 100B

5 Assignments to Committees Executive Committee 2 nd Thursday 8am 10am Rm 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 Community and Public Health 3 rd Friday, noon Rex Women Ctr. Benny Ridout 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 Environmental Services 2 nd Fri., 11:30am, Library Admin. Carya Dr. Leila Goodwin Dianne Dunning Frank Eagles Benny Ridout Melissa Jemison Jeff Smith Staff: Joseph Threadcraft 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 Social Services 1 st Friday 9am 10:30am Rm Paul Norman Burton Horwitz Julian Smith 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 LME Advisory 3 rd Tues., Noon, 401 E. Whitaker Mill Rd. Rm. 210 Stephanie Treadway Pablo Escobar Kent Earnhardt Melissa Jemison Staff: Carlyle Johnson Ann Wood Community: Ann Akland James Hartye, WakeMed Marc Jacques Rhonda Spence Affordable Housing & Community Revitalization 3 rd Thursday 3:30pm 5pm, Rm Melissa Jemison Dianne Dunning Staff: Annemarie Maiorano Bob Sorrels Community: Emmett Curl Steven Hess Michele Grant Teresa Piner José M Serrano Mark Shelburne Trace Stone-Dino Yolanda Winstead Regional Networks Development Qtrly, Rm Frank Eagles Benny Ridout Staff: Darryl Blevins Rosena West Ross Yeager Regina Petteway Staff: Matt Burton Sharon Brown Andre Pierce Bob Sorrels Community: Arsenio Carlos, ERC Rev. Lenwood Long, NRC Eugenia Pleasant, NRC Lunette Vaughan, SRC Human Rights/ Consumer Affairs 4 th Mon., 12:45-2pm Rm Pablo Escobar Kent Earnhardt Osama Said Staff: Brian Gunter Leticia Mendez Fabiola Sherman Community: Laura Goddard Phillis Ross John Sowter Don Wiseman LME Human Rights Subcommittee Bi-monthly, 3 rd Friday, Varying Times HS Millbrook Ctr. Rich Greb Laura Goddard Bruce Benedict Martha Brock Kent Earnhardt Marc Jacques Martha Pitts Staff: Glenda Reed

6 Wake County Welcomes Joseph Threadcraft as Environmental Services Director Joseph Threadcraft joined Wake County on Monday, March 26, 2012, as the new Director of Environmental Services. As the County's Environmental Services Director, he will oversee the Animal Control, Solid Waste Management, Water Quality, and Environmental Health and Safety Divisions. Joseph is a registered Professional Engineer in both Alabama and Georgia. His experience includes engineering design and construction management, working with the EPA and serving as the vice president of technical services for the Alabama State Port Authority. He holds an MBA from Albany State University; Master of Civil Engineering from Norwich University; BS in Civil Engineering Technology from Florida A&M University; and is currently a Ph.D. Candidate in Construction Management at Indiana State University. Welcome, Joseph!

7 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: Executive Committee: March 8, 2012 HS & ES Board: March 22, 2012; Deferred to April 26, 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 4 th quarter of calendar year 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

8 P u b l i c H e a l t h Prevent Promote Protect W A K E C O U N T Y H U M A N S E R V I C E S P U B L I C H E A L T H R E P O R T F O U R T H Q U A R T E R O C T O B E R D E C E M B E R, Wake County Human Services Public Health Division 10 Sunnybrook Road P.O. Box Raleigh, NC 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

9 Topic Table of Contents 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 Page 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

10 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 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

11 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 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 Percent NC Wake County 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 , 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 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

12 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 SL (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. 300 Figure 4 Number of Complaints and Violations of the North Carolina Smoke- Free Restaurants and Bars Law in Wake County Businesses during 2010 and Number 150 # complaints #businesses #violations 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 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 QUITNOW ( ). 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

13 250 To b a c c o U s e Figure 5 Number of Wake County Residents Registered in Quitline in 2010 & Number Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Month Source: NC Quitline Monthly Data Reports for Jan. Dec and Jan. Dec Figure 6 Percent of Wake County Respondents Answering the Quitline Question " How did you hear about the Quitline?" in 2010 compared to N= 496 Website Tv Radio Outdoor ad Newspaper 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 and Jan. Dec Contact: Sonya Reid, Health Promotion Chronic Disease Prevention Section sreid@wakegov.com 6

14 P h y s i c a l A c t i v i t y a n d N u t r i t i o n OVERWEIGHT AND OBESITY Figure 7 Overweight or Obese % BRFSS Respondents Who Have a Body MassIndex (BMI) > 25 BMI Underweight: BMI <18.5 Recommended Range: BMI 18.5 to 24.9 Overweight: BMI Obese: BMI > Year NC Wake A measure of body mass index (BMI) is often used to identify possible weight problems. Adults with BMI of 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 ( ** Health Promotion and Disease Prevention Annual FY 11 Report Contact: Sonya Reid, Health Promotion Chronic Disease Prevention Section sreid@wakegov.com 7

15 P h y s i c a l A c t i v i t y a n d N u t r i t i o n 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 19,400 Active WIC Participation September ,200 19,000 C a s e l o a d 18,800 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 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 Sharon.Dawkins@wakegov.com 8

16 School Health SCHOOL NURSE REFERRALS In the first quarter of , there was a 13% increase in the number of students referred to the school nurse compared to (see Figure 9). When comparing the second quarter of to the second quarter of , 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 and School Year 1st Quarter (July-September) and 2nd Quarter (October-December) Number School Year School Year 0 1st Quarter Quarter 2nd 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 Increasing Numrsing Time Responses 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 School Year More time 5 days a week More services More days More than 1 day More Nurses More hours 2 days Principals of Wake County Public Schools (WCPSS) respond to a yearly survey given by WCHS School Health Nursing Program. 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) Number of Responses Source: Principal Survey , WCHS School Based Nursing Service, June

17 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 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 Number of responses for each category *Some respondents gave multiple answers to the question. Source: Principal Survey , 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 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 , the ratio in Wake County was one nurse for 2,715 students. In NC the ratio was one nurse for 1,201 students. Figure 12 Contact: Roxanne Deter, Public Health Division rdeter@wakegov.com 10

18 Sexually Transmitted Diseases CHLAMYDIA AND GONORRHEA Preliminary data from the Communicable Disease Branch, NC Division of Public Health from 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 Chlamydia and Gonorrhea Case Rate (per 100,000 population) in Wake County from Chlamydia Gonorrhea 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 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

19 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 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). Number of Tests and Test Positivity Rate (%) at Non-Traditional Testing Sites in Wake County from October to December (9.6 %) 500 (1.4%) 39 (12.8%) 680 (0.4%) 682 (0.1%) HIV Syphilis Gonorrhea Chlamydia Hepatitis C Figure 14 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.) 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 (0%) 76 (15.8%) 61 (0%) 90 (0 %) 91(0%) HIV Syphilis Gonorrhea Chlamydia Hepatitis C Source: Wake County Human Services 12

20 Sexually Transmitted Diseases Number of Tests and Test Positivity Rate (%) at Expanded Testing Sites in Wake County from October to December 2011 Figure (6.9%) 398 (0%) HIV Hepatitis C testing is not offered at Expanded Testing Sites (jail, detention). 406 (2.5%) 407 (2%) Syphilis Gonorrhea Chlamydia Source: Wake County Human Services (WCHS) HIV VIRAL LOAD AND DISEASE TRANSMISSION Figure 17 Source: WCHS CAREWare Copies/ml Average Viral Load Among Clients at Wake County Human Services from YEAR Average All Average All on ART Average All Not on ART Linear (Average All) Linear (Average All on ART) 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 ytorres@wakegov.com or Edie Alfano-Sobsey, Epidemiologist Public Health Division Edie.AlfanoSobsey@wakegov.com 13

21 I n f e c t i o u s D i s e a s e s a n d F o o d b o r n e I l l n e s s SEASONAL FLU VACCINES GIVEN Figure 18 Figure 19 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 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 jdouglas@wakegov.com 14

22 I n f e c t i o u s D i s e a s e s a n d F o o d b o r n e I l l n e s s REPORTABLE GENERAL COMMUNICABLE DISEASE INVESTIGATIONS Figure Investigations Reportable Communicable Disease Investigations January -December 2011**** Jan - Mar Apr - Jun Jul - Sep Oct - Dec Foodborne Illness* Tickborne Illness** Hepatitis B*** *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 Cases Number of Active TB Cases Reported to Centers for Disease Control and Prevention (CDC) Wake County Human Services TB Control Source: Wake County Human Services Tuberculosis Control Annual Report Total Number Cases reported to CDC 15

23 I n f e c t i o u s D i s e a s e s a n d F o o d b o r n e I l l n e s s Figure 22 Percent of Active TB Cases by Race WCHS TB Control 2010 and % 50% 0% 19% 41% 43% 14% 38% 45% 2010 (N=37) 2011 (N=29) Asian White Black Source: 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 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent of WCHS Active TB Cases Foreign Born Compared to Those Born in the United States % 63% 65% 60% 68% 37% 54% 46% 35% 40% 32% % 34% Source: Wake County Human Services Tuberculosis Control Annual Report Percent cases were foreign born Percent cases were were USborn 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

24 Figure I n f e c t i o u s D i s e a s e s a n d F o o d b o r n e I l l n e s s Number of Critical Violations Associated with CDC Risk Factors* at Wake County Restaurants/Food Stands October-December 2011 Oct-11 Nov-11 Dec 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 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 (p. 1745). Contact: Ruth Lassiter, Epidemiology and Surveillance Section, ruth.lassiter@wakegov.com 17

25 C h r o n i c D i s e a s e s 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 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 Edie.AlfanoSobsey@wakegov.com 18

26 E m e r g e n c y P r e p a r e d n e s s 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

27 DISASTER PREPAREDNESS PROGRAM MONITORING E m e r g e n c y P r e p a r e d n e s s OM 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) 3.5 No. of Public Healt h Situations* in Wake County Number of Situations (Jan-Feb-Mar) (Apr-May-Jun) (Jul-Aug-Sep) (Oct-Nov-Dec) No. of Public Healt h Situations* responded to by WCHS/WCES No. of Public Healt h Situations Responded to with Partners** * 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 bmcfeaters@wakegov.com 20

28 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 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 3. Decrease the percentage of people exposed to secondhand smoke in the workplace in the past seven days 25.8% (2009) 15.0% 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% Injury and Violence Current 2020 Target 1. Reduce the unintentional poisoning mortality rate (per 100,000) population 11.0 (2008) Reduce the unintentional falls mortality rate (per 100,000) population 8.1 (2008) Reduce the homicide rate (per 100,00) population 7.5 (2008) 6.7 Maternal and Infant Health Current 2020 Target 1. Reduce the infant mortality racial disparity between whites and African Americans 2.45 (2008) Reduce the infant mortality rate (per 1,000 live births) 8.2 (2008) Reduce the percentage of women who smoke during pregnancy 10.4% (2008) 6.8% 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) 8.7% 3. Reduce the rate of new HIV infection diagnoses (per 100,000) population 24.7% (2008) 22.2 Substance Abuse Current 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% ( ) 6.6% 21

29 Mental Health Current 2020 Target 1. Reduce the suicide rate (per 100,000 population) 12.4 (2008) Decrease the average number of poor mental health days among adults in the past 30 days 3. Reduce the rate of mental health related visits to emergency departments (per 100,000) population 3.4 (2008) (2008) 82.8 Oral Health Current 2020 Target 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 ( ) 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 ppm 2. Increase the percentage of the population being served by community water systems (CWS) with no maximum contaminant level violations (among persons on CWS) 3. Reduce the mortality rate from work-related injuries (per 100,000 equivalent full time workers ) 62.5% ( ) 100.0% 92.2% (2009) 95.0% 3.9 (2008) 3.5 Infectious Disease and Foodborne Illness Current 2020 Target 1. Increase the percentage of children aged 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 Social Determinants of Health Current 2020 Target 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% ( ) 3. Decrease the percentage of people spending more than 30% of their income on rental housing 94.6% 41.8% (2008) 36.1% Chronic Disease Current 2020 Target 1. Reduce the cardiovascular disease mortality rate (per 100,000 population) (2008) 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 Cross Cutting Current 2020 Target 1. Increase average life expectancy (years) 77.5 (2008) 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% 22

30 A c k n o w l e d g e m e n t s 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,

31 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: Executive Committee: March 8, 2012 HS & ES Board: March 22, 2012; Deferred to April 26, 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

32 State of the County s Health Report 2011

33 TABLE OF CONTENTS County Vision and Mission Page 3 Overview: Population and Projected Trends Page 3 Educational Attainment Page 5 Health Indicators Page 6 Major Morbidity and Mortality Page 7 Priority Issues: Page 8 #1 Overweight and Obesity Page 8 Physical Activity and Nutrition Page 15 #2 Access to Healthcare Page 19 Significant Public Health Issues Page 23 Disaster Preparedness Page 23 Rabies Exposure Investigation Page 23 E. Coli Outbreak Page 24 Emerging Issues Page 25 Current Economic Climate Challenges for Public Health Page 25 Sexually Transmitted Infection Reduction Efforts Page 25 Environmental Services Page 28 Recruitment of New Director Page 28 Waste Water Management Page 28 Animal Shelter Page 29 Healthcare Reform Page 29 Conclusion Page 29 Distribution Plan Page 30 2 P a g e

34 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 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 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, 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 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 In 2010 the poverty rate in Wake County was 12%. The Unemployment Rate was 8.2% in 2010, decreasing to 7.7% in October Source: Wake County Planning Department. 3 P a g e

35 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 P a g e

36 Educational Attainment According the U.S. Census Bureau, for the School Year , 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: American Community Survey 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 16.1% 17.8% 30.9% 25.8% 25.9% 18.3% 15.9% 8.9% 5% Educational Attainment by Race Group for Population 25 Years and Over 35.4% 7.3% 19.7% 30.9% 27.9% Total population White 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 37.4% 29.1% 13.7% 11% 14.2% 8.7% Asian 6.6% 11.4% 16% 23.2% 42.8% Hispanic or Latino 5 P a g e

37 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 P a g e

38 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 32 3 Hispanic Total Infant Live births North Carolina 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 Years Of Age North Carolina and Wake County Rate per North Carolina State Center for Health Statistics Wake North Carolina The number of pregnancies and rate for years of age continue to decline in Wake County and North Carolina. 7 P a g e

39 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 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 P a g e

40 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 Interventions/Actions Strategies Progress To-date (Jan Dec 2011) Establish community protocols to assess the impact of community policy changes and design on health and well-being Develop a plan to increase the usage of greenway systems in Wake County 9 P a g e 1.1 A - Assure adequate staff training for the Health Impact Assessment (HIA) process 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 A - Provide upkeep (maintenance) of greenways 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 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

41 1.3 - Promote worksite wellness to improve the health and wellbeing of Wake County s workforce Increase access to and consumption of fresh fruits and vegetables & other healthy food choices 1.2 B - Distribute materials to promote the use of the greenways 1.2 C Incorporate technology and social media venues 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 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 21 st Century Farmers Market sites 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 21 st Century Farmers Market Program in order to accept EBT funds (approval pending). Contact: Kristen McHugh, WCHS 10 P a g e

42 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 D Provide nutrition education and trainings in community settings 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 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. 11 P a g e

43 12 P a g e 1.4 E - Connect families and businesses to local farmers 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 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

44 1.5 - Promote healthy eating and increased physical activity policies and practices in child care facilities Promote breastfeeding support policies in child care facilities 1.7 Establish appropriate and accurate obesity baseline measures 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 Self- Assessment 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 Cooking Matters classes from the Inter- Faith 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 1.4 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 13 P a g e

45 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

46 Physical Activity and Nutrition 15 P a g e

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50 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 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

51 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) 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 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 B - WCHS clinics to begin operating Presumptive Eligibility program for pregnant women 2.1 C - Increase Carolina Access enrollment of Medicaid recipients 2.1 D - Implement business processes that enhance Medicaid access and utilization 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 2.2 B - Complete a standardized risk screening on each pregnant Medicaid patient in the practice 2.2 C - Coordinate an integrated pregnancy care plan among CCNC, the Pregnancy Care Manager (PCM) and WCHS 2.1B - The presumptive eligibility and billing have begun. Contact: Ida Dawson, WCHS 2.1C - A new position was created to focus on increased Carolina Access enrollment. Contact: Liz Scott, WCHS 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 Contact: Liz Scott, WCHS 2.1 E - Increased focus on this beginning January 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 - Pregnancy Care Managers engage in care management of identified Medicaid patients from each practice that meet the risk screening criteria. 2.2 C1 - Identified case management is provided to these patients through their six week post-partum period

52 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 Provide early engagement of 1 st time, at-risk low-income mothers in selected Wake County zip codes. (Nurse-Family Partnership (NFP)) Improve access to adolescent health services Provide chronic disease management and primary care services for low-income, uninsured adults living in Wake and neighboring counties. 2.2 D- Participate in medical records review to assure quality improvement 2.3 A - Recruit 75 clients from prenatal education classes and Maternal Health Liaison at WakeMed 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 C - Connect with local college and university health services for referrals 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 2.4 B - Seek additional youth health resources 2.5 A - Provide prescription assistance to eligible patients 2.5 B - Provide healthcare services to eligible patients 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 - Enrolled by 16 weeks (46%), 28 weeks (98%) 2.3 C - In progress 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 - 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 B1-950 total patient visits - this has doubled since June P a g e

53 2.6 - Establish appropriate and accurate baseline measures for improving health care access Access to Healthcare Abbreviations: 2.6 A - Collect baseline data on healthcare access 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 2.5 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 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

54 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, 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/ /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, P a g e

55 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

56 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 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

57 o 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. o Evidence- based intervention programs will be targeted toward young adults (15-29 years of age) with emphasis on African-Americans in this age Syphilis Wake County Sexually Transmitted Disease Cases 2009 vs HIV Disease Gonorrhea Chlamydia Source: NCDHHS, Communicable Case Rate (per 100,000 population) 26 P a g e

58 Wake County Gonorrhea Cases (%) by Age Group and Race/Ethnicity, (N= 2152) Percent < >40 Age Group All Black/African American White Other, Hispanic Source: Public Health Division, WakeCounty Human Services Wake County Chlamydia Cases (%) by Age Group and Race/Ethnicity, (N=8110) All Percent < >40 Age Group Black/African American White Other, Hispanic Other, Non-Hispanic Source: Public HealthDivision, Wake County Human Services 27 P a g e

59 Wake vs. NC HIV/Syphilis Comorbidity* Cases % of Total Syphilis Cases NC * HIV/Syphilis comorbidity is defined as HIV diagnosis before or within 6 months of syphilis diagnosis Source: NCDHHS, Communcable Disease Branch Wake 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 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

60 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

61 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 sue.ledford@wakegov.com 30 P a g e

62 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: April 26, 2012 Committee/Item: Environmental Services Committee/Food Code Specific Action Requested: Endorsement of Board comments in support of proposed state rule changes, to 15A NCAC 18A (Food Protection and Sanitation of Food Establishment) Item Summary: Wake County s 2010 Risk Factor Study identified some specific gaps in the regulations followed by food service providers. Wake County is not authorized to adopt local rules or amendments to the state code. The gaps identified by Wake County (discussed below) would be filled by the state s proposed rule change which adopts the FDA 2009 Food Code by reference. The Commission for Public Health summarizes the changes on their website ( and that page is attached. Purpose for Action (Proposed Solutions/Accomplishments): Wake County EHSs are authorized as agents of the state of North Carolina and enforce the North Carolina.2600 Rules Governing Sanitation of Food Service Establishments (Title 15A Subchapter 18A of the North Carolina Administrative Code) and the appropriate sections of the North Carolina General Statutes that relate to public health (Chapter 130A). These sections c set forth as jurisdiction of retail food service establishments. Food processing establishments and agricultural commodities produced in the state are in the jurisdiction of the North Carolina Department of Agriculture. North Carolina s Rules Governing the Sanitation of Food Establishments were initially adopted in 1976 and based on the 1976 Food Service Sanitation Manual Including a Model Food Service Sanitation Ordinance. Subsequent amendments have been adopted through the normal rules-making process, which involves public notification, review by the North Carolina Rules Review Committee, and adoption by the North Carolina Commission on Public Health. Wake County is not authorized to adopt local rules or amendments to the state code. When compared to the 2005 FDA Food Code, the current North Carolina Food Establishment (.2600) rules conformance rates are shown: Regulatory Foundation Intervention/Risk Factor Controls Good Retail Practices provisions Compliance and Enforcement 2005 FDA Food Code Comparison 1 of 11 categories met 49.5% conformance 6 of 12 categories met The current North Carolina rules do not adequately address:

63 bare hand contact of ready-to-eat foods employee health policy consumer advisory for undercooked foods date marking cold holding at 41 F specialized food processes variances The 2010 Risk Factor Study demonstrated a number of gaps in the state s regulatory foundation. As the state pursues adoption of the FDA 2009 Food Code as the regulatory foundation for North Carolina retail food service establishments, the data collected from the 2010 Wake County Risk Factor study has been incorporated into the fiscal note, training strategies and public hearing information of the process. The study data provided accuracies for the change in costs to industry, detail of current existing equipment and behaviors, and demonstrated the justification of change needed by in- and out-of-compliance statistics. Next Steps: Monitor rule adoption process and if necessary make further comment to members of the Commission on Public Health. Date (2012) Milestone Wake HS ES Board Action March 15 Food Code adoption rules NA published in the NC Register March 15-May 14 Rules Comment Period Written comment supporting the rules April 12 Public Hearing (DPH Office in Raleigh) Oral comment (2012 letter; 2010 letter, powerpoint, and fact sheet also submitted to be entered in to the record) May 16 Commission for Public Health approval (if necessary) personal contact to members of the Commission June 21 Rules Review Commission (if approved by CPH in May) NA July 1 Proposed Date to Adopt NA Effective Date NA Sept. 1 (or later if necessary) Attachments: 2010 letter in support of the rule changes, including powerpoint to Board and fact sheet 2012 letter in support of the rule changes Printout of Commission for Public Health website summary of the proposed rule changes Opportunities for Advocacy, Policy or Advisory: Submittal of written comments during the comment period (DONE) Oral comment at the April 12, 2012 public hearing (DONE)

64 Personal contact by Board or committee members to the members of the Commission on Public Health Connections to Other Committees: Public Health Committee

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66 15A NCAC 18A Food Protection and Sanitation of Food Establishment Page 1 of 3 4/16/ A NCAC 18A Food Protection and Sanitation of Food Establishment The Food Protection Program (FPP) of the Environmental Health Section, NC DHHS/DPH, oversees the food protection rules governing food establishments. The current rules, 15A NCAC 18A.2600, were adopted in 1976 and have been periodically amended to address specific needs. However, changes in consumer consumption patterns, recent emphasis on increased government efficiency, as well as shifts in the national food safety focus necessitate a more fundamental change to North Carolina's retail food protection rules. As a result, the FPP proposes to adopt the U.S. Food and Drug Administration's 2009 Food Code. The purpose of adopting the Food Code is to replace what has proven to be a labor-intensive and ineffective process of updating North Carolina's food protection rules with a more efficient and effective method. The legislature recognized that need and passed a law (S.L , Section 15(a)) in 2011 that provides the Department with the authority to adopt the 2009 Food Code by reference. The Food Code offers proven scientific reasons behind each rule. The FPP's adoption of the Food Code has a variety of advantages and has gained support from all stakeholders within the food safety spectrum; industry, consumer groups, academia, regulators, and local, state, and federal agencies. For members

67 15A NCAC 18A Food Protection and Sanitation of Food Establishment Page 2 of 3 4/16/2012 of the food service industry, many of which are associated with the national chains, the Food Code brings needed uniformity and consistency with the food safety rules of other states. The Food Code also provides effective means of reducing the risks of foodborne illnesses within food service facilities, thus protecting consumers and industry from potentially devastating health consequences and financial losses. Local, state, and federal agencies and regulators support the adoption of the Food Code because it provides a comprehensive approach to food safety management, superior supporting documents and training, and is consistent with the national integrated food safety management system. A public hearing will be held on April 12, 2012 at 2 pm in the Cardinal Room, located at: 5605 Six Forks Road, Raleigh, NC The public comment period is from March 15, 2012 through May 14, 2012 Proposed Rule: Fiscal Note: Federal Certification: Adopted Rule: 15A NCAC 18A Food Protection and Sanitation of Food Establishment (Notice Date: 03/15/2012) Fiscal Impact of 2009 FDA Food Code Adoption N/A N/A (Comments for this rule will not be accepted after 05/14/2012)

68 15A NCAC 18A Food Protection and Sanitation of Food Establishment Page 3 of 3 4/16/2012 Submit Comment Written comments can be mailed to: Chris G. Hoke, JD 1931 Mail Service Center Raleigh, NC Changes Additional Links

69 Schedule for adoption of regulation changes which will incorporate the FDA 2009 Food Code by reference Date (2012) Milestone Wake HS ES Board Action March 15 Food Code adoption rules published in the NC NA Register March 15-May 14 Rules Comment Period Written comment supporting the rules April 12 Public Hearing (DPH Office in Raleigh) Oral comment May 16 Commission for Public Health approval NA June 21 Rules Review Commission (if approved by CPH NA in May) July 1 Proposed Date to Adopt NA Sept. 1 (or later if necessary) Effective Date NA

70 Food Code Adoption Rules Public Hearings NC Division of Public Health 5605 Six Forks Rd Raleigh, NC Cardinal Room, Building 3, April 12, :00-4:00 PM Wilson County Agricultural Building 1806 SW Goldsboro St Wilson, NC April 17, :00 AM-12:00 Noon McDowell Technical College 54 College Dr Marion, NC Harold Smith Bldg, Room 113 April 25, :00 12:00 AM Town Hall Meetings Bladen County Health Department 300 Mercer Mill Rd Elizabethtown, NC April 20, :00 AM 12:00 Noon Haywood Community College 185 Freelander Dr Clyde, NC Auditorium Bldg. #1500 April 24, :00 5:00 PM Mooresville Public Library 304 S Main St Mooresville, NC April 25, :30-4:30 PM Central Carolina Community College Campus 764 West St Pittsboro, NC Building 2 Multipurpose room April 27, :00 AM-12:00 Noon Martin Community College 1161 Kehukee Park Rd Williamston, NC Building 1, Room 14 April 30, :00-4:00 PM RSVP Anna.Beamer@dhhs.nc.gov (Town hall meetings only)

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77 Executive Summary Human Services and Environmental Services Board Advocacy Agenda The Wake County Human and Environmental Services Board Advocacy Agenda priorities were developed through the Board s committee structure, reviewed by the Advocacy Committee and Executive Committee, and then adopted by the full Board in March, The priorities are connected to the Wake County Board of Commissioners priorities, the Human and Environmental Services Board s priorities, and the Human Services and Environmental Services Departments priorities. The advocacy priorities adopted by the Wake County Human Services and Environmental Services Board during their March 2012 meeting are: 1. Support the Wake County Board of Commissioners proposal for the composition of Human Services Boards. The proposal would modify Section (c)(1) to state that a consolidated human service board not exercising powers and duties of an area mental health/developmental disability/substance abuse board shall include four persons who are consumers of human services. All other components of the board structure are proposed to stay the same. 2. Develop a Community Advisory Council (CAC) and secure a Western Regional Center for Wake County. A CAC, with staff support, currently exists in the Northern, Southern, and Eastern Regions. A CAC in the West is needed to ensure ongoing feedback and support from the community perspective, as the proposed plan for a Western Regional Center continues to be solidified. Continued communication with municipal and other leaders in Cary, Apex, Morrisville and the unincorporated area in the West should be ongoing. 3. Decrease disparities in key disease indicators such as infant mortality and chronic disease morbidity and mortality. The emphasis for this agenda item is on maintaining competitive Medicaid rates and prioritizing the implementation of North Carolina Families Accessing Services through Technology (NC FAST). 4. Prevent Child Abuse and Support Children and Their Families. Maintain funding levels for Temporary Assistance for Needy Families (TANF) and Title IV-E funding for foster care children. 5. Support the adoption of the US Food and Drug Administration s (FDA s) Food Code as outline by the Environmental Services Committee. Support proposed changes to 15A NCAC 18A (Food Code Protection and Sanitation of Food Establishment), which will adopt by reference the US FDA 2009 Food Code. 6. Increase the Affordable Housing Supply, particularly as it affects low-wage working families, people trying to move out of extreme poverty status, and those with mental illness and developmental disabilities. Support increasing funding for the Housing Trust Fund, and support recommendations outlined by the Legislative Study on Supportive Housing. 7. Support Human Capital Development. Continue the use of discretionary County dollars to support programs and partners that demonstrate contribution to Human Capital Development outcomes. 8. Continue to Build Information Technology Infrastructure. Support the continued deployment of resources for technology infrastructure to prepare Human Services for mandated changes from the state and federal government, and for health care reform. All Advocacy Agenda priorities will be shared with the Wake County Board of Commissioners and other stakeholders. In addition, items 1, 3, 4, 5, and 6 will be shared with the Wake Delegation.

78 Detailed information on Advocacy Agenda Priorities The following information contains details about each of the Advocacy Agenda Priorities. Advocacy Priority: Support the Wake County Board of Commissioners proposal for the composition of Human Services Boards. The ASK : Support the proposal that would modify Section (c)(1) to state that a consolidated human service board not exercising powers and duties of an area mental health/developmental disability/substance abuse board shall include four persons who are consumers of human services. All other components of the board structure are proposed to stay the same. Connected to all HS/ES Board Priorities (helps to ensure structure to meet statutory and accreditation requirements for public health and social services.) Connected to HS/ES Board Committee(s): All Connected to HS Service Priorities: All 60 Justification/Speaking Points: Language for the proposal is as follows: o A consolidated human services board appointed by the board of county commissioners shall serve as the policy-making, rule-making, and administrative board of the consolidated human services agency. o The consolidated human services board shall be composed of no more than 25 members. The composition of the board shall reasonably reflect the population makeup of the county and shall include: (1) Note, the proposal will eliminate this language: Eight persons who are consumers of human services, public advocates, or family members of clients of the consolidated human services agency, including: one person with mental illness, one person with a developmental disability, one person in recovery from substance abuse, one family member of a person with mental illness, one family member of a person with a developmental disability, one family member of a person with a substance abuse problem, and two consumers of other human services. The proposal is to replace the deleted language with this language: Four persons who are consumers of Human Services. The following language will remain the same: (2) Eight persons who are professionals, each with qualifications in one of these categories: one psychologist, one pharmacist, one engineer, one dentist, one optometrist, one veterinarian, one social worker, and one registered nurse. (3) Two physicians licensed to practice medicine in this State, one of whom shall be a psychiatrist. (4) One member of the board of county commissioners. (5) Other persons, including members of the general public representing various occupations. Stakeholders to be educated and updated: Human and Environmental Services Board Members The Wake Delegation Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 2

79 Advocacy Priority: Secure a Western Regional Center for Wake County The ASK : 1 -Develop and implement a Community Advisory Committee for the Western Region. 2 - Build or secure a location/existing building for a Western Regional Center. Connected to HS/ES Board Priority #1: Prevent Child Abuse and Support Families, 4: Access to physical and mental health services, and #6 Human Capital Development Connected to HS/ES Board Committee(s): Regional Networks Connected to HS Service Priorities: all 60 Justification/Speaking Points: A Community Advisory Committee should be established for the Western Region, as outlined in the Regional Community Advisory Committee Operating Procedures, revised Staff support will also need to be identified in order for the CAC to be effectively linked to the departments. The Regional Center model has proven to successfully bring local access and seamless service delivery to citizens in the North, South, and Eastern areas of the County. There has been notable population growth in the Western part of the County. According to the 2010 Census, from , Cary grew 41.5%, Apex grew 85.4%, and Morrisville grew 257.7%. Per the 2010 Census, of the 900,993 people living in Wake County, 205,787(23%) live in Cary, Apex, Morrisville, or the unincorporated area of the West. Although the western municipalities have higher median household incomes than the State and the rest of Wake County, there are still 6,826 people living below the poverty level in Cary, Apex and Morrisville combined. There are 2,199 people with addresses in the Western Region already receiving Human Services. That does not include the number receiving other County Services that are delivered through existing regional centers, including but not limited to services from the Board of Elections, City/County Bureau of Investigation, Fire and Rescue Inspections, Food Safety Inspections, the Sheriff s Office, and the Department of Revenue s tax services. These services have the potential to reach all residents of the region. Stakeholders to be educated and updated: Municipal Mayors People who reside in the Western Region Business leaders who may be able to help leverage resources for a Regional Center Human services partners and faith based partners about the increased potential for partnerships with a Regional Center, and ask for their advocacy. Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 3

80 Advocacy Priority: Decrease disparities in key disease indicators such as infant mortality and chronic disease morbidity and mortality. The ASK : Maintain competitive Medicaid rates and prioritize the implementation of North Carolina Families Accessing Services through Technology (NC FAST). Connected to HS/ES Board Priority #4: Access to physical and mental health services Connected to HS/ES Board Committee(s): Public Health, Social Services Connected to HS Service Priorities: all Public Health; Clinic; Children, Youth and Families; and juvenile priorities. 26 out of 60 priorities (almost half) Justification/Speaking Points: North Carolina Families Accessing Services through Technology (NC FAST) is a program designed to improve the way the NC Department of Health and Human Services and county departments of social services do business. NC FAST introduces new technological tools and business processes that will enable workers to spend less time on administrative tasks and more time assisting families. Staying on target for implementation of NC FAST should be a priority for the State and county governments in order to increase system efficiencies and to help meet the increased demand for services. Maintain competitive Medicaid rates for providers. Do not further reduce rates for physicians, and increase Medicaid rates for dentists. If the Medicaid rates for providers are reduced, dentists may no longer be able to afford to accept Medicaid patients. We need more providers who will accept Medicaid. Example: besides Wake County Human Services and WakeMed Hospitals, only five private providers accept pregnant Medicaid patients, and in a limited capacity. Support and fund educational campaigns that emphasize maximizing enrollment of citizens who qualify for Medicaid and strategies for keeping them enrolled. Talk about access to health care in general and support of the network of safety net providers in health care (Alliance Ministries, Open Door Clinic, Wake Health Services, etc.). Stakeholders to be educated and updated: Community groups such as citizens advisory councils, civic groups, municipal boards Health coalitions Wake Legislative Delegation Physicians Need an awareness campaign for the community about disparities Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 4

81 Advocacy Priority: Prevent Child Abuse and Support Children and Their Families. The ASK : Protect Temporary Assistance for Needy Families (TANF), and Title IV-E Funding for Foster Care Children. Keep child care subsidy funding for working families, provide health insurance for children and parents, and support health and development resources for children, youth and families. Connected to HS/ES Board Priority #1: Prevent Child Abuse and Support Families Connected to HS/ES Board Committee(s): Social Services and Public Health Connected to HS Service Priorities: 29 of 60 priorities for Social Services; Children, Youth and Families; and Public Health (almost half) Justification/Speaking Points: The State of North Carolina is in jeopardy of losing $29 million dollars in TANF funding. This will affect our Human Services outcomes at the County level by reducing staff and operational dollars for service delivery. We need for our elected officials to protect the funding in jeopardy of being cut. Wake County is in jeopardy of losing $1-1.5 million dollars in 4E funding. This funding supports foster care children who are 4E certified. These cuts will result in serious reductions in staff and our ability to provide services to foster families. We need for our elected officials to protect the funding in jeopardy of being cut. We need to continue to support and not reduce services for children and families. The Wake County Child Welfare philosophy is to protect children by strengthening families. Whenever possible, Wake County seeks to support families in keeping children safely at home. When children must be taken into foster care, Wake County seeks to safely reunify them with parents or find permanent placements with other family members. In FY 2011 there were 6741 reports of suspected child abuse or neglect, of which 5019 reports were accepted for a Child Protective Services Assessment (Child Welfare statistic, 2012). Children were found to have been abused, neglected or dependent in 1,269 CPS assessments in FY There were 5,495 cases on the waiting list for Wake County as of July, 2011 for child care subsidy assistance. The Governor s budget is recommending a $300,000 reduction in Child Care Subsidy administrative dollars. This will reduce our ability for timely processing of applications and issuing of vouchers. Food and Nutrition Services handled 35,809 cases in FY 2011, up 18% from the previous end of year caseload count of FY2010. Stakeholders to be educated and updated: The Wake Delegation Wake Board of Commissioners Community partners and funders Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 5

82 Advocacy Priority: Support the adoption of the FDA Food Code as outline by the Environmental Services Committee The ASK : Support proposed changes to 15A NCAC 18A (Food Code Protection and Sanitation of Food Establishment), which will adopt by reference the US FDA 2009 Food Code. Connected to HS/ES Board Priority #2: Access to physical and mental health services (physical includes environmental public health services) Connected to HS/ES Board Committee(s): Environmental Health Connected to Environmental Service Priorities for access to safe food sources for the public Justification/Speaking Points: The Wake County Department of Environmental Services is strongly supportive of the adoption of the proposed food code, scheduled for July The Food Code is based on the latest food science, and will get us up to the federal standards. The Food Code is updated every four years with a rigorous process involving diverse stakeholders. There is a short advocacy window for this item. The Commission for Public Health is scheduled to vote on approval of regulation changes on May 16, The Rules Review Commission will vote on approval on June 21, 2012 if approved by the Commission, and the proposed date to adopt the regulation changes is July 1, Adopting the FDA Food Code will protect the health of all our citizens. The Environmental Services Committee of the Board requests that the Wake County Human Services and Environmental Services Board write a letter of support to the Department of Health and Human Services, supporting the proposed changes. They should also try to send a representative of the Board to one of the public hearings to voice their support of the proposed changes. Once the proposed changes pass, the Board will continue to monitor implementation of the changes through the Environmental Services Committee. Stakeholders to be educated and updated: Board of Commissioners by the Environmental Services Department Staff Wake Delegation Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 6

83 Advocacy Priority: Increase the Affordable Housing Supply, particularly as it affects low-wage working families, people trying to move out of extreme poverty status, and those with mental illness and developmental disabilities. The Ask: Support increasing funding for the Housing Trust Fund, and support recommendations outlined by the Legislative Study on Supportive Housing. Connected to HS/ES Board Priority #2: Housing for Vulnerable Populations, the Foundation for Success and a Necessity for the Economy Connected to HS/ES Board Committee(s): Housing Connected to HS Service Priorities: #33 Housing, #34 Cornerstone/Supportive Housing, and #40 Housing Supports Voucher Program, and Human Capital Development/Middle Class Express Justification/Speaking Points: There is a need for 23,300 affordable housing units in the County for people who are working, such as teachers and firemen; and people who have mental illness or developmental disability challenges, but who can live somewhat independently with housing support. There are elderly, disabled, emotional/mental or developmental disabilities working poor, and homeless people, as well as victims of domestic violence who either do not have enough money or are paying more than they can afford for housing. As a result, their lives are unstable and they are constantly moving from one place to another. Stable housing is the one of the best guarantors of success. Thank the municipalities and County for supporting affordable housing, and ask them to continue to partner to find ways to increase the affordable housing supply. Ask for increased funding for the Housing Trust Fund. Ask policy makers to support the recommendations of the Legislative Study on Supportive Housing. Stakeholders to be educated and updated: Municipalities and their communities Business leaders County and State policy makers Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 7

84 Advocacy Priority: Support Human Capital Development through the continued use and provision of County discretionary funding The ASK : Advocate & support programs and partners that demonstrate contribution to the following outcomes: Increased number of HS Clients with earned income >200%FPL Increased retention of stable employment Reduced number of families receiving Medicaid and Food Assistance > 5 consecutive years Increased number of clients securing stable housing Increased use of practiced preventive health care Connected to HS/ES Board Priority #6: Human Capital Development Connected to HS/ES Board Committee(s): HS Agency and Wake Board of Commissioners Priority; Social Services Committee Priority Connected to HS Service Priorities: All priorities Justification/Speaking Points: We need to continue to support people who want to stop being dependent on government services, and maintain economic and social self-sufficiency, and not continue to provide only safety net services. Many individuals and families need specific, time-limited support in order to become self-sufficient and support their families. Community partners are available and willing to help with Human Capital Development. Stakeholders to be educated and updated: Board of Commissioners Wake Delegation Community partners and potential partner Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 8

85 Advocacy Priority: Continue to Build Information Technology Infrastructure The ASK : Continue to deploy resources to support technology to prepare Human Services for health care reform and mandated changes from the state and federal government. Connected to HS/ES Board Priority #1: Prevent Child Abuse and Support Families; #4: Access to physical and mental health services. Connected to HS/ES Board Committee(s): Public Health and Social Services Committees Connected to HS Service Priorities: all priorities Justification/Speaking Points: In order to remain competitive, improve communication with our communities and clients, and address increased demand with limited resources, WCHS needs to continually address needed technology upgrades Current upgrades in place include replacement of the public health information system; putting into place a document management system for the Division of Social Services and the Child Welfare Division; assisting with human capital development client tracking, and working with the County and WCHS on a re-design of the webpage. Ask for support for staying on target for implementation of NC FAST. This should be a priority for State and county governments in order to increase system efficiencies and to help meet the increased demand for services. Stakeholders to be educated and updated: Thank Wake County Government for their deployment of information technology resources to the County. Identify State stakeholders for technology issues that affect the County. Draft 4 -April 12, 2012 HS/ES Board Advocacy Agenda Page 9

86 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: April 26, 2012 Committee/Item: Housing Committee/Affordable Housing Development Funding Request Specific Action Requested: That the board recommend a loan of up to $500,000 in Federal HOME funds to Passage Home, Inc. to develop Coleman St. Apartments in Raleigh. Item Summary: Wake County s Housing and Community Revitalization program (HCR) in partnership with the City of Raleigh s Community Development Department distributed a Request for Proposals (RFP) for affordable housing development in September This RFP is considered a rolling RFP, with no specific date for submission of proposals. The RFP remains open as long as funds are available for funding. The City and County partner in this process because both have affordable housing programs that target similar population groups. Passage Home, Inc., a nonprofit affordable housing developer, has requested funding of up to $500,000 to develop Coleman St. Apartments, located at 1002 Coleman St. in Raleigh at the intersection Coleman St. and Martin Luther King, Jr. Boulevard. The site is located on the bus line and is accessible to shopping, healthcare, transportation, and Wake County Human Services. The apartment complex will have 18 2-bedroom units. The development will add a total of 18 units of affordable housing. Eight units will be affordable to households earning at or below 40% of the area median income (AMI) and 10 units will be affordable to households earning at or below 80% AMI. The application was reviewed by Wake County and City of Raleigh Staff. The criteria used for review are: Financial Feasibility Affordability: The number of units in the development that are affordable to families earning at or below 40% Area Median Income (AMI). This is a High Priority for the HCR program because families who are earning at this income level and below have the hardest time finding market rate affordable housing. Location: Proximity to transportation and services Special Needs: Whether or not the units serve persons with special needs (homeless, physically or mentally disabled, etc.), this is a High Priority for the HCR program because people who are disabled are generally very low-income and have a hard time finding market rate units that are affordable. Development Quality Developer Experience Wake County subsidy per unit Energy Efficiency 1

87 The application was presented to and reviewed by the housing committee on March 15, The housing committee recommended providing a loan of up to $500,000 at 0% interest to Passage Home. $76,989 would be amortized over 30 years and the balance would be paid as a balloon in year 30. The City of Raleigh has committed $1.2 million to the project in HOME and Neighborhood Stabilization Program (NSP) funds. Wake County would be in second lien position behind a bank loan. Lender Funding Status Bank Loan $ 518,983 Pending Wake County $ 500,000 Pending City of Raleigh HOME $ 400,000 Secured City of Raleigh NSP $ 800,000 Secured Total $ 2,218,983 The City of Raleigh utilized Neighborhood Stabilization Program (NSP) funds for this development. NSP funds are federal stimulus funds. The City of Raleigh used NSP funds to purchase and clear the site and is now using them for redevelopment of the site. The City s funds for the project were accessed through a special RFP that the City released. The City is retaining ownership of the property and will lease the site to Passage Home for 99 years. Passage Home expects the construction to be complete by November Purpose for Action (Proposed Solutions/Accomplishments): Next Steps: The Board of Commissioners will vote on approval of the loan at the Board of Commissioners meeting on May 21, Attachments: Opportunities for Advocacy, Policy or Advisory: Connections to Other Committees: 2

88 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: April 26, 2012 Committee/Item: Housing/2012 Action Plan Specific Action Requested: To endorse the 2012 Affordable Housing Action Plan to the Board of Commissioners Item Summary: The Housing Division has prepared the 2012 Action Plan. The plan defines the housing and community development needs of low-income families in Wake County and describes what the Housing Division will do to address those needs using federal funds from the U.S. Department of Housing and Urban Development (HUD) and local funds over the next fiscal year. The federal grants that are included in the Action Plan are: Community Development Block Grant (CDBG), HOME Investment Partnerships (HOME), and Housing Opportunities for Persons with AIDS (HOPWA). The Action Plan describes the specific actions to be carried out in the next fiscal year (July 1, 2012-June 30, 2013) using the grant funds, local funds and program income generated from grant expenditures in prior program years. The total anticipated budget for next year is $4,404,517. Of that, $3,359,967 is from federal grants and program income. The plan will go to the Board of Commissioners on May 7, 2012 for approval. The following population groups were identified as top priorities in the Consolidated Plan for funding over the next five years. These groups were chosen because they have the greatest housing need: High Priority: Renters earning at or below 40% Area Median Income (AMI) (currently $31,960 per year); Homeless individuals and families; Non-homeless individuals and families with special needs. Medium Priority: Renters earning at or below 50% AMI (currently $39,950 per year); Homeowners earning at or below 50% AMI (currently $39,950 per year). Low Priority: Renters earning at or below 80% AMI (currently $63,900 per year); Homeowners earning at or below 80% AMI (currently $63,900 per year).

89 Below are tables of our funding Sources and Proposed Uses: SOURCES AMOUNTS CDBG $1,424,265 CDBG Projected FY12-13 Program Income $260,000 CDBG Excess Program Income from FY11-12 $107,079 CDBG Public Facility Town Match $228,020 HOME $512,001 HOME Projected FY12-13 Program Income $150,000 HOPWA $678,603 County Funds $830,000 County Projected FY12-13 Program Income $170,000 County Excess Program Income from FY11-12 $44,549 Total $4,404,517 USES AMOUNTS TOTALS CDBG: Public Facilities $784,970 (Town Match) $228,020 Housing Rehabilitation $441,901 Affordable Housing Development $280,000 Administration $284,473 CDBG Total $2,019,364 $2,019,364 HOME: Affordable Housing Development $534,001 Community Housing Development Organization $76,800 Administration $51,200 HOME Total $662,001 $ 662,001 HOPWA: Housing, Rental Assistance, and $658,245 Support Services for people with HIV/ AIDS Administration $20,358 HOPWA Total $678,603 $678,603 CIP: Affordable Housing Development $587,742 Rental subsidies for people with a mental illness $400,000 Support Circles coordinator position $56,807 CIP Total $1,044,549 $1,044,549 Grand Total $4,404,517 $ 4,404,517

90 Purpose for Action: Next Steps: Attachments: Opportunities for Advocacy, Policy or Advisory: Connections to Other Committees:

91 Housing and Revitalization Division Accomplishments April 13, 2012 FY and FY Wake County allocated a total of $4,499,381 to projects during FY from the following sources: SOURCES CDBG AMOUNTS $ 1,446,687 CDBG Program Income $ 322,000 CDBG Public Facility Match HOME $ 277,901 $ 750,495 HOME Program Income $ 210,000 HOPWA $ 459,800 ESG $ 106,249 ESG Match $ 106,249 County Funds $ 650,000 County Program Income $ 170,000 Total $4,499,381

92 Accomplishments FY * HOME # of Units Constructed 88 affordable units have been added to the stock; 42 of these are for 40% and below AMI 272 affordable units have been committed; 102 of these for 40% and below AMI # of Units Committed CIP # of Units Constructed 62 affordable units have been added to the stock; 24 of these are for 40% and below AMI # of Units Committed 279 affordable units have been committed; 92 of these for 40% and below AMI 40 (25 County and 15 MH High Utilizer) # of County Vouchers used # of Families assisted with Support Circles; CIP 27 families assisted with housing through a funded Coordinator Support Circle in FY10-11 HOPWA # of HOPWA Vouchers used 80 (70 in Wake, 10 in Johnston County) CDBG # of Public Facilities Projects Completed 4 projects completed # of Public Facilities Projects Under N/A Construction # of People assisted with Rehabilitation 48 homeowners Program *2010 CAPER (Consolidated Annual Performance and Evaluation Report)

93 Wake County allocated a total of $4,367,131 to projects during FY from the following sources: SOURCES AMOUNTS CDBG $1,329,187 CDBG Projected FY11-12 Program Income $310,000 CDBG Public Facility Match HOME $191,961 $656,084 HOME Projected FY11-12 Program Income $200,000 HOPWA $678,603 County Funds $830,000 County Projected FY11-12 Program Income $170,000 County Excess Program Income from FY10-11 $1,296 Total $ 4,367,131

94 Accomplishments FY HOME # of Units Constructed 84 affordable units have been added to the stock; 23 of these are for 40% and below AMI # of Units Committed 30 affordable units have been committed; 14 of these for 40% and below AMI CIP # of Units Constructed 204 affordable units have been added to the stock; 80 of these # of Units Committed 12 affordable units have been committed; 12 of these for 40% and below AMI 60 (25 County, 15 MH High Utilizer, 20 Project # of County Vouchers in use 77) # of Families assisted with Support Circles; CIP 28 families assisted with housing through a funded Coordinator Support Circle in FY11-12 HOPWA # of HOPWA Vouchers in use 78 (68 in Wake, 10 in Johnston County) CDBG # of Public Facilities Projects Completed or Under Construction # of Public Facilities Projects In Design 3 # of People assisted with Rehabilitation 28 Program 2

95 FY Funds Committed through April 16, 2012 Funds Sources Action Plan Budget Committed as of 4/16/12 Difference CDBG $ 1,329,187 $ 1,329,187 $ - CDBG Projected FY11-12 Program Income $ 310,000 $ 232,568 $ (77,432) CDBG Public Facility Match $ 191,961 $ 191,961 $ - HOME $ 656,084 $ 552,360 $ (103,724) HOME Projected FY11-12 Program Income $ 200,000 $ - $ (200,000) HOPWA $ 678,603 $ 678,603 $ - County Funds $ 830,000 $ 91,658 $ (738,342) County Projected FY11-12 Program Income $ 170,000 $ - $ (170,000) County Excess Program Income from FY10-11 $ 1,296 $ - $ (1,296) Total $ 4,367,131 $ 3,076,337 $ (1,290,794)* *HCR has received and is currently reviewing requests totaling $6,064,000 for affordable housing development. Annual Program Income from the grants helps to sustain the HCR program and continue the work the following year. Program Income received through April 30, 2012* Sources Budget Amount Received thro Difference CDBG Program Income $ 310,000 $ 232,568 $ (77,432) HOME Program Income $ 200,000 $ 158,459 $ (41,541) CIP Program Income $ 170,000 $ 146,602 $ (23,398) Total $ 680,000 $ 537,629 $ (142,371) *Program Income is generated through loan repayments.

96 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: April 26, 2012 Committee/Item: Human Rights-Consumer Affairs Specific Action Requested: Review and receive report on current and historical complaint data reviewed by the Board. Item Summary: The most recent quarterly complaint data revealed encouraging trends in several areas. To place the data in context, the report summarizes the process for clients who report complaints, and touches on the review of data about complaints by the Human Rights- Consumer affairs Committee. Purpose for Action: Inform the Board of the nature of the complaint data reviewed Next Steps: TBD Attachments: Summary narrative, quarterly data sheet, fourteen year data summary, poster with OCA contact onformation, and companion case load data Opportunities for Advocacy, Policy or Advisory: Improvements have been inspired historically by reviews of complaint trends. The multi-systems approach to meeting the challenges in Family FNS are the latest example of such efforts. Connections to Other Committees: TBD

97 History and Summary Of Wake County Human Services Consumer Complaint Data: Table of Contents Narrative: History and Summary of Complaint Data, Page 2 Fourteen Year Data Summary and Graph....Page 3 Quick Facts and Agency Response Page 4 Human Rights-Consumer Affairs Committee Quarterly Reviews Page 5 Correlation of Complaint Escalation and Recent Case Load Increases...Page 6 Poster Facsimile (full poster is 11 x 17)....Page 7 Submitted To: Wake County Human Services Board By: Brian Gunter, Program Manager, Office of Community Affairs bkgunter@wakegov.com /26/2012

98 2 History and Summary of Complaint Data, Introduction This report is the first in a short series intended to assist with the review and interpretation of consumer complaint data that is regularly reported to the WCHS Board and administration. The data are compiled by the Office of Community Affairs (OCA). The OCA, a component of the WCHS Division of Administration, maintains a system of telephone, staff and other supports to WCHS customers who have complaints about services. The OCA is affiliated with the WCHS Director s Office---just one aspect of the open door policy of the current Director for customers with concerns. The OCA History and Role The OCA has been assisting WCHS customers with complaints since the formation of the consolidated human services agency in December The office has been located at the Swinburne building since May Prior to consolidation, the Office had been a component of the Wake County s Area Authority for MH/DD/SA Services for more than five (5) years. Since 1998, the OCA has compiled data regarding WCHS complaints in a Microsoft ACCESS database. The database has been used for 15 years by the OCA to compile, analyze, and report complaint-based feedback to agency administration and the WCHS Board. The Human Rights-Consumer Affairs Committee of the WCHS Board reviews detailed, quarterly complaint data prepared by the OCA. Data attachments include: 1- a single page display and break down of fourteen years of OCA complaint data, 2-the most recent quarterly summary data reviewed by the committee, and 3-additional data and analysis regarding caseload growth over five years. How Do Clients Know About Assistance from the OCA? The OCA provides program and contact information to customers with concerns by displaying color, English/Spanish posters at all WCHS service sites (reduced-size copy attached). The posters contain phone and FAX contact information for the OCA. Customers with internet access can also find information about making a complaint on the county s website including a complaint form that can be printed out and mailed or FAXED to the OCA. How and When Do Clients Contact the OCA? An overwhelming majority of the consumers who report complaints to OCA do so by telephone. A handful of customers present in person to the WCHS Director s Office each year. A slightly larger number contact the program in writing each year by mail or FAX using the written complaint form, available at service sites upon request. Generally, WCHS customers who contact OCA have been encouraged to first resolve issues directly with service programs. If that attempt does not resolve the concern, and sometimes for other reasons, the consumer reports their concerns directly to the WCHS Director s Office/OCA. What Does the OCA Complaint Data Measure? The vast majority of customer service concerns are handled by the service providers and their administrative support systems. This is an appropriate step in the consumer complaint resolution process. The OCA complaint response function is an additional resource to WCHS customers and staff in the complaint resolution process. Data from customers who contact OCA for assistance constitute a measure of overflow ---clients whose information needs an additional level of review to try to resolve concerns and issues. Data Summary Table Table 1 on the following page displays a summary of the complaint data compiled over fourteen (14) calendar years. The table shows a complaint total for each year, then breaks the year down by service category, facility, and program. Behavioral Health customers had been historical users of the complaint service since the early 1990s before agency consolidation. The Behavioral Health totals in the table are from all sites across the county.

99 3 TABLE 1 Complaint Data Summary Swinburne Programs by Floor FIRST FLOOR SECOND FLOOR THIRD FLOOR FOURTH FLOOR Year Total Sunnybrk Behav Hlth Swinburne F-FNS F-M-caid Emerg $ Work First Transport A-FNS A-M-caid CPS-F-Care Swinburne % 44% 38% 7% 0% 4% 3% 1% 5% 3% 7% 30% % 30% 37% 5% 4% 2% 4% 3% 2% 1% 1% 22% % 36% 46% 2% 1% 3% 11% 3% 11% 4% 10% 45% % 32% 47% 6% 3% 9% 4% 6% 3% 2% 2% 35% % 30% 40% 3% 2% 3% 12% 5% 5% 5% 5% 40% % 29% 53% 11% 5% 5% 12% 4% 2% 2% 5% 46% % 30% 55% 2% 2% 1% 9% 5% 9% 6% 13% 47% % 47% 41% 1% 2% 2% 1% 10% 1% 3% 6% 26% % 35% 50% 0% 6% 1% 3% 11% 3% 3% 7% 34% % 20% 66% 8% 6% 8% 7% 8% 3% 3% 16% 59% % 18% 53% 10% 7% 4% 2% 2% 5% 4% 12% 46% % 4% 64% 23% 9% 4% 7% 4% 1% 3% 10% 61% % 3% 69% 53% 4% 2% 2% 0% 2% 3% 3% 69% % 1% 87% 63% 8% 3% 1% 2% 4% 2% 2% 85% 2311 GRAPH Individuals with Complaints by Year Total LEGEND Total = Individuals Reporting Complaints to Office of Community Affairs F-FNS = Family Food Stamps: % of Total F-M-caid = Family Medicaid: % of Total Emerg $ = Cash Assistance for Energy & Other Emergencies A-FNS = Adult Food Stamps: % of Total A-M-caid = Adult Medicaid: % of Total CPS- F-Care = CPS, Foster Care, and Adoption Services: % of Total Behav Hlth = All sites for MH/DD/SA service delivery: % of Total Sunnybrk = All services 10 Sunnybrook: % of Total Swinburne 8 = Total of %s of 8 Services in Table-Compare to Swinburne total

100 4 Quick Facts and Historical Trends Behavioral Health customers (all sites) were heavy users historically----averaging 35% of totals for the first eight (8) years Behavioral Health customers averaged less than 3% of totals for the past three (3) years : Sunnybrook averaged 10% of total individuals with complaints : Sunnybrook averaged 3% of totals individuals with complaints Swinburne customers used the service heavily right away---averaging 42% of totals the first seven (7) years Swinburne customers averaged 61% of all individuals with complaints over the last seven (7) years Complaint escalation accelerated in 2009 with the first of three consecutive record annual totals The Escalation ( ) and Recent Positive Trends Greatest increase was in Family FNS---peaking at 63% of all individuals with complaints in 2011 Family FNS Complaint increases substantially outpaced case load increases during the period (see Table 4). Total individuals with complaints have gone down for four (4) consecutive quarters 43% Reduction in individuals with complaints from 4 th Q -CY 2010 to 4 th Q-CY 2011 Family FNS Complaints (4 th Q-CY 2011) were the lowest since 3 rd Q-CY 2010 Agency Response The agency has a long history of responding to clusters of complaints and other trends reported to administration and the Board. Examples Prior to 2008 Improved patient scheduling at Sunnybrook Enhanced Orientation process for Work First customers Increased handicap parking spaces at Swinburne Installed handicap doors at Sunnybrook and Swinburne Since 2008 Created the Customer Services Unit and Manager/Fully staffed the Front Desk at Swinburne in 2008 Implemented a Telephone Team to augment the customer service response for Family FNS in December 2010 Studying and implementing enhancements to the Swinburne 1 st Floor Customer Services Experience since early 2011 Created a new, blended Family FNS and Medicaid Team with a reassigned Team Leader in Sep 2011 Currently implementing document imaging upgrade for loose documents associated with income eligibility Currently preparing for implementation of NC FAST paperless process with FNS as the first priority Human Rights-Consumer Affairs Quarterly Review

101 5 Reviews detailed, de-identified summary of each complaint and response(s) Reviews a statistical summary of each quarter that includes counts by category and location (Tables 2 & 3 below). Category breakdowns and totals include each issue reported by complainants in the quarter (vs. # of reporting individuals: See Table 1) Note: Current quarterly data is highlighted. Prior three quarters is displayed for comparison TABLE 2 Complaint Report Categories: th Q-CY rd Q-CY nd Q-CY st Q-CY 2011 Agency lost Information Calls not returned Benefits Delayed Benefits Incorrect Worker Behavior Program Regulations Wait Time Facility Concerns General Question Other Totals TABLE 3 Locations of Services in Complaints: th Q-CY rd Q-CY nd Q-CY st Q-CY 2011 Swinburne Sunnybrook Southern Regional Center Eastern Regional Center Northern Regional Center S. Wilmington Street Shelter Wake County Office Building Correlation of Recent Case Load Changes and Complaint Escalation

102 6 FNS cases increased from 19,300 in 2007 to 36,800 in an increase of 91%. Medicaid individuals increased from 61,500 in 2007 to 83,700 in 2011 an increase of 36%. Individuals with complaints increased from 98 in 2007 to 537 in an increase of 448%. GRAPH 2 FNS Active Cases TABLE 4 Increases Over Prior Calendar Year Individual Complainants Family - FNS Complainants as Proportion of the Total FNS (total) Caseloads % 25% 9% 11% % 130% 29% 9% % 130% 21% 8% % 19% 13% 4% Medicaid (total) Caseloads GRAPH 3 Medicaid Eligibles 90,000 80, , , ,500 50,000 40,000 30,000 20,000 10,

103 You Have Rights! Usted Tiene 7 Der The Consumer Affairs Office was established to support customers and assist them with concerns about services. Call For information about: La Oficina de Asuntos del Consumidor s respaldar a los clientes y ayudarles con acerca de los servicios Llam Para información s Rights Based on Your Services Filing Complaints Appeals & Disqualifications Discrimination Concerns Working with the Agency Volunteer Committees: *Human Rights-Consumer Affairs Wake County Human Services Consumer Affairs Office PO Box Raleigh, NC Phone: Fax: Office of Community Affairs Division of Administration Servicios Humanos del Condado de Wake Oficina de Asuntos del Consumidor PO Box Raleigh, NC Teléfono: Fax: Oficina de Asuntos de la Comunidad Division Administativa Derechos Basado Servicios Proceso de Queja Apelación y Desc Discriminación Trabajando con l Comités de Volun *Derechos y Asu

104 HUMAN SERVICES AND ENVIRONMENTAL SERVICES BOARD AGENDA ITEM Agenda Date: April 26, 2012 Committee/Item: Social Services Committee; Human Capital Development Update Specific Action Requested: Receive Information Item Summary: Wake County Human Services continues its transformation from a traditional social services model to a human capital development model focusing on the human side of the economy. Overall, there has been tremendous progress as the County has developed new venues, new partners and new ways to reaching out and promoting Human Capital Development. While the economic downturn and expanded eligibility for some programs have presented challenges, the effort continues to gain momentum and is helping to improve lives in our County and inspire efforts statewide. By the end of FY 2011, the Human Services Academy had delivered more than 6,914 units of staff training supporting agency transformation. The HCD Cabinet, the agency s internal management group has worked to enroll more than 1130 individuals in 14 defined HCD projects. The initial prototype for building human capital, the Middle Class Express continues to help clients achieve success and has been important in helping to promote efforts across the state. Purpose for Action (Proposed Solutions/Accomplishments): Build knowledge and understanding of current efforts. Provide meaningful opportunities for the Board to share recommendations that could enhance the work. Next Steps: Continue the work and keep the Board of Commissioners, Social Services Committee and Wake County Human Services Board updated. Attachments: Opportunities for Advocacy, Policy or Advisory: Human Capital Development is listed on the Board s advocacy agenda primarily for local advocacy regarding the continued use of discretionary county dollars in support of programs, projects and partners with documented contribution to HCD outcomes. Connections to Other Committees: Social Services, Public Health & Affordable Housing

105 4/18/2012 Wake County HUMAN CAPITAL DEVELOPMENT March 2012 Update Human Capital Development A Wake County Goal The Wake County Board of Commissioners has adopted Human Capital Development as a goal every year since 2008 Human Capital Development 1

106 4/18/2012 A New Way of Doing Human Services Human Capital Development Process dedicated to transforming Human Services Agencies by actively promoting self sufficiency and independence while still providing traditional social services programs. The goal is not to fight poverty, but to build middle class. Human Capital Development Wake County HCD Campaign Process Human Capital Development BOC Adopts Goal Work with community to build and maintain Middle Class while reducing dependency on government subsidies Agency Transformation HCD Partnerships HCD Initiatives, Venues and Programs Several venues and programs are now in place Infrastructure developed to manage initiative Processes to do business differently are in place WCHS promoted HCD in the community and engaged Multiple partners Human Capital Development 2

107 4/18/2012 HCD 2011 Summary Report HCD Continues to grow in Wake County Over 1000 individuals served 14 Different Initiatives are Active HCD Growing in the Community Two large partnerships established The Economic Recession had major impact Clients have shown upward economic mobility The Middle Class Express Received National Award & supported Statewide efforts in HCD Human Capital Development HCD Participant Count Middle Class Express Club Choice ERC E Logic HCD Fairs Windows of Opportunity FASST ( Families & Students Succeeding Together) CW Employment Pipeline Fostering Brighter Futures Club de Mentoras HCD South Wilmington St. Shelter Step Up Ministries Total Human Capital Development 3

108 4/18/2012 Tools Developed HCD Staff Orientation Life Coaching Curricula and Training Self Serve Tool Kits Social Marketing: Inviting Clients to think differently HCD Data Bank: process for data collection and analysis Human Capital Development Indicators Tracked Income Employment Education Housing Health Benefit Utilization (In progress) Human Capital Development 4

109 4/18/ Tracks of Development to Build Human Capital 1. Employment 2. Financial Literacy & Entrepreneurship 3. Formal Education 4. Training and skill sets 5. Attitude and Mindset 6. Access and Utilization of Resources 7. Healthy Lifestyle 8. Family and Community Human Capital Development 74% currently employed 22% started unemployed Now employed. 70% of individuals working with the same employer greater than 3 months have a raise in pay or promotion. 52% have enrolled in some educational program 17% have obtained credential 61% maintained stable housing or moved to a better situation 5 new homeowners Middle Class Express Sample Results Average reported income for participants is $17,503; median income is $19, 916. Human Capital Development 5

110 4/18/2012 MCE New Homeowners Raleigh Assessed Value: $ 209,409 Knightdale Assessed Value: $ $127,921 Raleigh Assessed Value: $ 101,141 Raleigh Value: $ 146,377 Zebulon Assessed Value: $124,069 Human Capital Development HCD Partnerships Expand Impact Leverage Resources Build Capacity Fostering Brighter Futures: With WakeTechand Business Leaders Step Up Ministries: Implementing the MCE Model Passage Home: An HCD Housing Model Youth Thrive: Formerly known as Collaborative Partnership for Excellence in Youth Development Raleigh College and Community Collaborative: Postsecondary Success Initiative Human Capital Development 6

111 4/18/2012 Metrics Services: At Wake Tech Adult Mentoring Tutoring Life Skills Training Financial Advising and Assistance Counseling Current or Expected Outcomes Maintain 2.5 GPA or higher Assisted 29 former youth in foster care. Increased GPA from 1.0 to tutors, 8 mentors and 10 volunteers. 8 life skills workshops a year, plus counseling. First graduate in May 2012 Current or Expected Outcomes Maintain 2.5 GPA or higher 25% increase in program retention 25% increase in part time employment 50% decrease in risky behaviors Human Capital Development Program Goal Partner with Wake County s Human Capital Development effort to help successful graduates of one year StepUpLife Skills program achieve independence and obtain stable employment providing a livable wage of $15.00/hour. (Train 36 people a year) Target Population Individuals entered StepUpunderemployed or unemployed, and in many cases homeless but with the capacity for independent living and stable employment. Current or Expected Outcomes Gains in earned income Sustainable jobs Post secondary credential Human Capital Development 7

112 4/18/2012 P H C D I Goal Partner with Wake County s Human Capital Development Initiative to increase Economic Self Sufficiency among families in affordable housing Target Population Families in Affordable Housing and Low wealth neighborhoods owned and managed by Passage Home Metrics Families will show improvements in financial security through reduced debt, improved credit and increased savings; Work able adults enrolled will explore and secure employment that offers more income and opportunities to progress on a career path and self sufficiency plan Families will meet stated outcomes identified in the Middle Class Express program goals and objectives Staff will become trained and certified in Life Coaching Programs and integrate this approach into case management services Human Capital Development Program Goal: All young people in Wake County are safe, physically and mentally healthy, cared for, successful in school and in life, and prepared to become productive adults. Target Population: School aged youth, 5 18 years of age Accomplishments: In April 2011, the John Rex Endowment announced 1.25 million dollar award to develop Youth Thrive. A diverse Steering Team is in place, Action Teams representing more than 24 agencies are now engaged in implementation A Director has been hired by United Way Youth Leadership Academy, County wide GIS Asset Mapping, Provider Training Institute and Web based Outcome Management Systems are all in development. Human Capital Development 8

113 4/18/2012 Expected Outcomes: Short term: Youth and their families have increased awareness of and access to community resources. Increased number of PYD opportunities designed in partnership with youth. Partners are sharing resources and serve as mentors in peer support relationships. PYD gaps that can be addressed with existing resources or policy/practices changes are resolved. Long term: Wake County measures and achieves shared community PYD outcomes for school aged youth. Partner agencies serve a greater number of youth and produce improved PYD outcomes. Human Capital Development Raleigh Colleges and Community Collaborative The Leaking Wake County Student Pipeline In Wake County, for every 100 ninth grade students 78students graduate from high school four years later 52students immediately enter college 38students are still enrolled in their second year and31students graduate with either an associate s degree within three years or a bachelor s degree within six years. Human Capital Development 9

114 4/18/2012 Raleigh Colleges and Community Collaborative The Leaking Wake County Student Pipeline In Wake County, for every 100 low incomeninth grade students 68students graduate from high school four years later 40students immediately enter college 27students are still enrolled in their second year and18students graduate with either an associate s degree within three years or a bachelor s degree within six years. Human Capital Development Education Pipeline Strategy 16 years old 26 years old High School Transition to College College Retention Employment Low income students in Wake County will: Be Preparedfor post secondary education Be Supportedinside and outside school Succeedacademically Enroll and succeed in some form of postsecondary credentialing program Graduate and are employed Human Capital Development 10

115 4/18/2012 Human Capital Development Goes Statewide North Carolina Association of County Commissioners Human Capital Task Force 8 separate presentations or consults with groups statewide including Buncombe, Mecklenburg, Vance Counties, the NC Rural Center and at the Association of City and County Managers Meeting in February, Help develop website for NCACC Building Human Capital through HOPE Components of Human Capital Delivery: Transforming Social Services Staff to Life Coaches Wake County Story: Human Capital Development NCACC task force on board with 'Middle Class Express Wake program provides a 'trampoline' to self sufficiency for county DSS clients NCACC task force on board with Middle Class Express Wake program provides a 'trampoline' to self sufficiency for county DSS clients County Lines : January 2011 Human Capital Development 11

116 INFORMATION ITEMS Board Fund Report (Separate) Invitations/Fliers Articles Committee Reports/Minutes Commissioners Agenda Items Related to HS&ES April 16, 2012

117 WakeBrook Recovery Center 111 Sunnybrook Road Raleigh, NC COME CELEBRATE THE 1 st ANNIVERSARY OF THE WAKEBROOK RECOVERY CENTER (WBRC) (Hospital Treatment for the Alcoholic, Addict, and their Families) Building Healthier, Stronger Lives, Families and Communities All are invited, friends, family and most of all YOU! Please Come Join Us On Sunday May 6, :00 PM 5:00 PM At the WakeBrook Recovery Center

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122 Wake County Environmental Health and Safety Division report for 3rd Quarter - FY 2012 (January - March, 2012): Attached is a link: ftp://wakeftp.co.wake.nc.us/es/ehs/fy12/2012_quarter%203.pdf Points of interest: Net operating facilities increased by 1.4% since April 2011 (page 2) Critical violations per inspection are declining over time. (page 3) 43% of complaints allege foodborne illness. (page 5) Staff track elevated blood lead levels in children according to State law (page 6) ServSafe, a food safety course, was presented in February 2012 to 21 managers (page 8) FoodCode adoption timetable is shown (page 9) There are nearly 1100 public pools in Wake County (page 12) Temporary food events increase during the spring (page 14) *Please advise if you would like to be removed from this distribution, or if you know of someone who might be interested in receiving this report. Also please report if you are unable to open the link, and I'll be glad to you the attachment. Andre C. Pierce, MPA, REHS Wake County Environmental Services Environmental Health and Safety Director apierce@wakegov.com Phone Fax

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128 Wake County Board of Commissioner Present Wake County Manager s Office Present: Joe Durham Human Services Board Members Present: Leila Goodwin Frank Eagles Clarence (Benny) Ridout Melissa Jemison Jeffrey Smith Kent Earnhardt Human Services Board Members Absent: Dianne Dunning DRAFT Environmental Services Committee February 10, 2012 Library Administration Wake County Office Park 11:30 a.m. Community Member Absent: Buck Kennedy Les Hall Jack Sowter Rodney Dickerson Phillip White Bryan Hicks Suzanne Harris Julian Prosser Paula Thomas Kenny Waldroup Glenn Harris Liz Turpin Julie Wilkins Staff Present: Matt Roylance Andre Pierce Elliott Cornell Deborah Peterson Sue Ledford John Roberson Staff Absent: Britt Stoddard Sarah Williamson-Baker Guests/Others: Douglas Botting Yvette Apodaca Marie Brewer Melissa Anderson Community Members Present: Bob Rubin Henk Schuitemaker Don Haydon John Whitson Ed Buchan 1

129 DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date I. Call to Order Chair Leila Goodwin called the meeting to order at 11:45 A.M. II. Minutes III. Update on Animal Services Division The January 12, 2012 minutes were approved as written. Highlights Animal Services Director Position The Animal Services Director, Dennis McMichael has resigned and Matt Roylance will function as the Interim Animal Services Director during the recruitment process until a new director is hired. Matt and staff will continue to move forward with developing the Animal Advisory Committee and secure a request for proposal to conduct a comprehensive assessment/evaluation of the procedures/protocols at the Animal Center to help staff do a better job with taxpayers dollars. TNR (Trap Neuter and Release) Ordinance The Draft TNR Ordinance is to be considered by the Wake County Board of Commissioners at their March 19, 2012 Meeting. Andre is scheduled to meet with Sue Ledford today after the Environmental Services Committee to determine when the draft ordinance will go before the Public Health Committee and the Human Services Board. Copies of the Draft TNR Ordinance and flowchart are available through Andre for Environmental Services Committee members that have not had a chance to review it. Committee Member Joe Durham Joe Durham Andre Pierce 2

130 DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date III. Update on Animal Services Division (Continued) Highlights (Continued) Mayor Frank Eagles requested to present the Wake County Animal Services Division with a Proclamation adopted by the Town Board of Rolesville. The Proclamation stated the Town of Rolesville expects Wake County Animal Control to offer the TNR option to Rolesville citizens. Joe Durham explained to Mr. Eagles that at the current time there is nothing written in the current ordinance that allows this process to take place. Mr. Durham also explained this is the reason Wake County is moving forward with the draft ordinance to the Wake County Board of Commissioners for review at their March meeting. IV. Introduction of Guests Douglas Botting and Yvette Apodaca Mr. Douglas Botting is the owner of a newly formed company, Zero Waste Today. Ms. Yvette Apodaca is responsible for the marketing and public relations for the business. The focus of this business to develop ways to divert items from the Wake County landfill. Zero Waste Today is currently developing ways to coordinate ideas with restaurants in Wake County. Melissa Anderson Melissa Anderson is a volunteer with Operation Cat Nip, SPCA of Wake County and member of animal advocacy group Wake Voice for Animals. 3

131 IV. Introduction of Guests (Continued) V. Update on FDA Food Codes (added agenda item) DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date Highlights Marie Brewer Marie Brewer is a board member for Operation Cat Nip, Vice President of Alley Cats and Angels and works with Wake Voice for Animals Cat Committee.. The adoption of the FDA Food Code at the state and local level is to Andre Pierce promote uniformity. To gauge compliance with the 2009 FDA Code, Wake County designed and conducted a baseline survey of risk factors associated with foodborne illness in the spring of The survey identified risk factors that were in need of priority attention. The FDA Code has now been approved and filed by the Department of Health and Human Services. The next step is for the Code to be heard by the Commission on Public Health in May. If approved, the FDA Code would then become rules that will become effective in October

132 DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date VI. Public Health Update Highlights Changes at State Government: Sue Ledford announced that Dr. Laura Gerald was appointed as the new State of North Carolina Health Director effective January 1. Dr. Gerald replaced Dr. Jeff Engel. Dr. Engel is now the senior health policy adviser to incoming acting Health and Human Services Secretary Al Delia. Al Delia replaced Lanier Cansler. Terry Pierce retired from the position, Director of the Division of Environmental Health effective January 31. Also the State of North Carolina Environmental Health and Rural Health both have been placed under the jurisdiction of the State of North Carolina Division of Public Health. Sue Ledford State Fair Health Task Force: State Fair Health Task Force on Ecoli had two meetings. The last meeting was held on January 26. The Task Force toured the possible areas where contamination could have taken place and retrieved information from various sources. The Task Force also formed subcommittees. Sue is working with a Subcommittee on Sanitation Handwashing. 5

133 DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date VI. Public Health Update (Continued) Highlights (Continued) Internships Request: Dr. Jay Levine of North Carolina State University College of Veterinary Medicine contacted Sue to let her know that some of the universities (NC State, UNC, etc.) are requesting internships dealing with animal issues. There is also a Student Epidemiologist needing to be placed. For further discussion contact Sue Ledford EPI and Communicable Disease Items: Flu season very low for this time of the year. The H3N2 strain of the Flu has not appeared in North Carolina. Communicable Disease Report - Dr. Jay Lavine stated his group is currently working with 2 probable TB Cases in felines The group is currently reviewing DNA test results. Norovirus Outbreak Currently working with 8 Assisted Living Facilities 93 residents and 19 staff members affected VII. Solid Waste Ten- Year plan Highlights The Ten-Year Solid Waste Management Plan has been updated every three years to meet the State requirements. John Roberson 6

134 DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date VII. Solid Waste Ten- Year plan (Continued) Highlights (Continued) Ten-Year Solid Waste Management Plan will be a shared plan between Wake County and the 12 municipalities. Draft Plan was submitted to the Solid Waste Technical Advisory Committee on February 1. Draft Plan will be available for public review/comment in March or April Goals: Have Draft Plan available for public review between Mar 2012 and April 2012 Have the Resolution adopted by each municipality at their board/council meeting between April 2012 and June 2012 Hold Public Meeting between May 2012 and June 2012 Plan approved by Wake County Board of Commissioners in mid-june Submit final plan to the State by June 30 7

135 DRAFT Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due Date VIII. Future Agenda Topics and Meeting Frequency Highlights Current Human Services Board s operation procedures for Board and Subcommittees are being reviewed by Scott Warren, Leila Goodwin Wake County Attorney. Environmental Services Committee members agreed to continue meeting monthly and when no topics for discussion are available, the meeting would be would be cancelled. Suggested Agenda Items Neuse Rules (Stage 1 Restriction), Beta Methyl Amino Alanine (Neurotoxin produced by Blue- Green Algae) IX. Adjourn THE NEXT MEETING IS SCHEDULED FOR FRIDAY, APRIL 13, THE LIBRARY ADMINISTRATION BUILDING, WAKE COUNTY OFFICE PARK, ROOM 102, 4020 CARYA DRIVE. 8

136 Wake County Human Services Board LME Advisory Committee Meeting Community Services Center 401 E. Whitaker Mill Road, Rm. 210 Minutes March 20, 2012 Members Present: Staff Present: Guests/Community: Ms. Stephanie Treadway, Committee Chair / HS Board Mr. Pablo Escobar, Committee Vice Chair / HS Board Ms. Ann Akland, Advocate / NAMI Dr. George Corvin, HS Board Ms. Melissa Jemison, HS Board Ms. Denise Foreman, Assistant to the County Manager Mr. Paul Gross, HS Finance Officer Dr. Carlyle Johnson, LME Administrator Mr. Ramon Rojano, HS Director Mr. Grady Britt, Advocate Mr. Tad Clodfelter, SouthLight, Inc. Ms. Lisa Jackson, State Division of Mental Health Members Absent: Dr. Kent Earnhardt, HS Board / HRC Mr. Jim Edgerton, HS Board Dr. Jim Hartye, Horizons Healthcare / WakeMed Ms. Rhonda Spence, Advocate Agenda Item Call to Order Approval of Minutes Agenda Items Announcements Discussion, Conclusions, Recommendations, Follow-up The LME Advisory Committee meeting, facilitated by Ms. Stephanie Treadway, opened at 12:03 p.m. Upon motion by Ms. Melissa Jemison, seconded by Dr. George Corvin, the committee approved the February 21, 2012, committee minutes. Agenda: Business/Finance Report Merger Updates Wake Site Overview LME Director/Administrator Updates Good of Order MCO Board: On March 19, the Wake Board of Commissioners appointed five of their six MCO Board members. Appointed were: Ms. Ann Akland, Dr. George Corvin, Mr. Jim Edgerton, Mr. Bill Stanford and Mr. Scott Taylor. The county is seeking candidates to fill the sixth board seat. Because of the conflict of interest, this will be the last committee meeting for Ms. Akland, Dr. Corvin, and Mr. Edgerton. State Division of Mental Health Staff Realignment: Ms. Lisa Jackson said their team leader is realigning state LME liaisons so that the same liaison is working with all of the merging programs. As a result, Ms. Yvonne French, is the new state representative to Wake/Durham County. Ms. French will begin attending the committee meetings starting in April.

137 Agenda Item LME Budget/ Finance Report Discussion, Conclusions, Recommendations, Follow-up Mr. Paul Gross presented the LME Monthly Financial Reports as of March 20, The committee reviewed and discussed the reports. Highlights Included: Wake LME Purchase of Service (POS) UCR Expenditures: LME is currently overspending by $541,857. This projection has decreased from last month. Talking with the county manager s office and the state on options. In the past, the state has allowed the county to transfer LME Systems Administration dollars to cover the overspending. Recalled that Wake LME took a State IPRS Funding reduction of $1.2 million in October $400,000 was taken from Wake Behavioral Health Services and 6 FTEs were RIF. The other $800,000 was to be recouped from a change in the benefit plans, which went into effect January 1, Projected LME Systems Administration savings of $684,622. However, there are some additional expenses to be covered: o $222,000 projected vacation payout for LME employees who are leaving. o $498,000 in severance payout. Both the state and the county have severance policies. Inquiring with the state on their position. Need a ruling from the state if the uncommitted LME Systems Admin. dollars could be used for severance pay. In July, a $11,000 payroll lag adjustment will be recouped from LME employees (from overpayment when the county switched payroll systems several years ago). Also have to factor in costs to backfill LME positions, overtime and temps. Dr. Johnson noted that savings accrue as positions become vacant. The committee calculated that if monthly expenditures remained around $1.2 million as was in January, then the final gap would only be around $200,000. Dr. Johnson said providers have made significant layoffs as a result of the benefit plans changes. Dr. Johnson said demand is up. Wake has more people requesting services than it has funding for. He said there is a potential during the last quarter of the year to cut off referrals and put people on waiting lists. Wake LME Expenditures by Service Category This report shows expenditures by service category for calendar year Staff expects to see a savings from the benefit plans changes in the Behavioral Health Outpatient (BHO) line item. Consumer Priority Groups FY12 (July-Feb) This report shows the dollar amount and client count for each of the consumer priority groups served year to date in FY12. Do not include HHH inpatient and/or Wake Behavioral Health Services. Client Trends by Month and Account Trends of number of clients (IPRS only) served over the last 18 months. Need to validate theories on decreased capacity in Wake County Behavioral Health Services. Providers are also working on their future business models. LME needs to evaluate what is the commitment to capacity building within the provider network. IPRS UCR Earnings: Staff is researching a computer glitch that accounts for the low percentage earned in the Child Mental Health category.

138 Agenda Item MCO Merger Updates Discussion, Conclusions, Recommendations, Follow-up Dr. Johnson gave a powerpoint overview on the update of staffing. The presentation color coded vacancies and closeout crew by unit/division and staff who have been offered positions by the MCO and/or Wake County. The current vacancy rate is 40 percent. These charts help to show where and how current LME operations are being performed through June 30. Highlights: Completing interviews for MCO supervisors this afternoon. Have interviewed 27 people for Wake Site positions. Will make more announcements next week. Effective April 1, CrossRoads will cover phone rollover at the Access Center beginning at 7:00 p.m. instead of 9:00 p.m. This is the main strategy for addressing the losses in the Access Center. Current salaries for transition staff are being paid by the Wake LME Systems Management dollars. These are legitimate LME tasks. Wake is continuing to do required LME functions. There are startup tasks that staff will need to start doing in June. Conducting staff orientation/training ahead of time. Staff is also responding to a closeout audit this week. Merger and Transition Timelines Ms. Denise Foreman: March 1, 2012 authority to begin merger transition. July 1, 2012 Merger Operation Date. Still many issues to work through until June. The county commissioners will need to adopt a resolution to create the MCO. Ms. Foreman said staff was waiting until after the legislation was approved that pulls out mental health. However, the resolution approval process may be sped up in order to give the MCO Board the authority it needs to make decisions. Expect the funding appropriation to be on the April 2 Wake BOC agenda (for half of the $4 million). The other $2 million appropriation will be requested prior to June 30. Work through and bring forward the contract for purchase of services from the MCO to Wake BOC before June 30. Developing an agreement between Wake/MCO on how the closeout will work. Wake BOC approved yesterday an action that employees who are moving to the MCO and are eligible for retirement do not have to retire (take 30 days off) to receive their retirement medical benefits, they only have to meet eligibility. The MCO Board will be discussing what other committees/advisory volunteer groups will exist within the MCO. There are opportunities for the folks that have been involved to continue in other capacities. Staff is working on IT systems transitions, merge, and details.

139 Agenda Item Wake Site Overview Discussion, Conclusions, Recommendations, Follow-up -The main functions for the Wake Site are: Provider Relations Community Relations Care Coordination (IDD and MH/SA). -Dr. Johnson announced/introduced the following new Wake Site Supervisors: Kay Birdwhistell and Kathy Baldwin, IDD Care Coordination Supervisors Miki Jaeger and Jessica King, MH/SA Care Coordination Supervisors Patti Beardsley, Provider Network Specialist Supervisor Dede Severino, Community Relations Supervisor Karen Timkey, Supervisor UM Katherine Neely, Supervisor Access Site Jeanna Berry, Facilities Manager Anna Heule, Supervisor -Next step is hiring staff under the supervision level. -Twenty-nine (29) employees have been placed in Wake County positions. -Dr. Johnson recognized exempt staff that do not earn overtime, but have put in many extra hours during the transition. -Only 33 out of the original 98 staff on the RIF list are left to be placed. Follow up: Mr. Rojano will send Denise Foreman the list of staff placements. -Ms. Akland asked if the CIT Coordinator position(s) would be continued or would there be only one for the MCO. Dr. Johnson said this has not yet been determined. Support positions (such as housing, disposition specialists, etc.) will be discussed. -Mr. Rojano reiterated the three-prong approach: 1. Building the new MCO 2. Operating the current Wake LME until July 1; then operating Wake/Durham LME July 1 through December Closeout the current Wake LME -Sites: MCO Corporate Site RTP area Local Wake Site Local Durham Site -The role of the local sites is connecting with providers, consumers/family members, and stakeholders; understanding local needs and gaps and how to address them; developing local systems of care, collaboratives, and care coordination. Local sites will work with the corporate site on resource issues and centralized management (such as UM and benefit plans). Still developing how the local sites will participate actively on the management team. Also what needs to be different at the local sites. CFAC Planning: There have been meetings and lengthy discussions between all four area CFACs on how to restructure and form a consolidated effective CFAC. Staff is helping CFAC find a facilitator. Criteria for Site Selection: Dr. Johnson said the current Community Services Center is the location for the Wake Site for the next six months. As the search for a new Wake Site moves forward, Dr. Johnson encourages collaborative feedback at the committee level and at the HS&ES Board level on what the criteria and characteristics should be for a highly effective, visible site selection.

140 Agenda Item LME Director/ Administrator Updates Discussion, Conclusions, Recommendations, Follow-up Mr. Ramon Rojano asked Ms. Lisa Jackson to report back to the state on what is happening at Wake. He made points about the closeout and merger. He asked the state to recognize that additional staffing from other county departments have been deployed to help. He requested that the state validate Wake s actions and give flexibility in managing the funding and allowing funding transfers to enable the county to cover its obligations and complete the LME closeout process. Dr. Johnson said a challenge that Wake faces is that cross area services program funding no longer align with the MCO. Ms. Lisa Jackson agreed to relay the messages at the state level and applauded the efforts of Wake LME. Good of Order Meeting Adjourned Ms. Akland announced that the NAMI Walk is May 5 th on the Dorothea Dix Campus. Details are on the NAMI NC website. Meeting adjourned at 1:40 pm. Next meeting is April 17, 2012, CSC 12:00 pm 2:00 pm

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