AGENDA

COUNTY COUNCIL OF ANNE ARUNDEL COUNTY, MARYLAND

VIRTUAL BUDGET MEETING

Legislative Session 2020, Legislative Day No. 16

May 13, 2020 – 9:00 A.M.

A. Invocation (Fiedler) B. Pledge of Allegiance C. Open Meetings Act Statement D. Announcement of Items not Appearing on Agenda E. Council Sits as Board of Health F. Operating Budget Review

● Health Department

● Aging

● Social Services

● Central Services

● Law

● Personnel

● Information Technology

● Budget

● Finance

G. Other Business

H. Adjourn

OPERATING BUDGET REVIEW – MAY 13, 2020 Group

Budget Analyst Presenters

Health Department Beth McCoy Nilesh Kalyanaraman, Billie Penley, Becky Asher, Adrienne Mickler

Aging Samantha Chiriaco Pam Jordan, Karrisa Gouin, Joelle Ridgeway, Wendy Carrasquillo

Social Services Beth McCoy Carnitra White, Jim Coburn

Central Services Samantha Chiriaco Christine Romans, Bess Glebus

Law Samantha Chiriaco Greg Swain, Hamilton Tyler, Sharon Darden

Personnel Steven Theroux Sherri Dickerson, Anne Budowsk, Susan Herrold, Jacqueline Atkinson, Doug Hart, Natalie Fretz

Information Technology Darlene Flynn Rick Napolitano

Budget Samantha Chiriaco Jim Beauchamp

Finance Samantha Chiriaco Karin McQuade, Laureen Toney, Helen Shomberg

Anne Arundel County

Board of Health Presentation

Nilesh Kalyanaraman, M.D.

Health Officer

Anne Arundel County Department of Health

May 13, 2020

County Council

Annapolis, Maryland

Mission and Vision

Mission

To preserve, promote and protect the health of all people who

live, work and play in Anne Arundel County.

Vision

A vibrant Anne Arundel County with healthy people in healthy

communities.

Key Staff

• Tonii Gedin: Deputy Health Officer for Public Health

• Shawn Cain: Deputy Health Officer for Operations

• Billie Penley: Chief Financial Officer

• Sandy O’Neill: Director, Behavioral Health Services

• Becky Asher: Director, Disease Prevention & Management

• Don Curtian: Acting Director, Environmental Health

• Karen Siska-Creel: Director, School Health Services

• Thomas McCarty: Director, Family Health Services

• Elin Jones: Public Information Officer

• Krystle Coldiron: Director, Office of Assessment & Planning

COVID-19

• SARS-CoV-2 virus is a new virus to humans

• First discovered in China in December 2019

• First case in U.S. on January 20, 2020

• Planning at DOH began in early February

• DOH Incident Command Structure Initiated on March 2

• First case in Maryland on March 6

• First case in Anne Arundel County March 11

• As of May 11, over 2,400 cases and 110 deaths

COVID-19• Education

• Testing

• Contact Tracing

• Case Management

• Isolation/Quarantine

• Call Center

• Community/Business/

Agency Guidance

• Enforcement

• Mental Health

• Vulnerable Populations

COVID-19• Reassigned over 150 staff to new functions

• Created new divisions

• Creating new positions to continue the work once staff

return to their current positions

• Rapidly evolving situation

Healthy Anne Arundel Coalition (HAAC)

• Countywide collaborative led by the DOH

• faith-based institutions,

• community organizations,

• economic development,

• federally qualified health centers,

• hospitals

• county government agencies.

• Goal:

• Identify and address priority health needs

• Align the resources within each member organization to

achieve a common purpose.

Healthy Anne Arundel Coalition (HAAC)

• Local Health Improvement Coalition

• Relaunched after 3-year hiatus

• First meeting of the guiding coalition was February 6

• Community meeting was scheduled for March 27 to

develop priority areas through input from community

members and leaders – meeting canceled due to

COVID-19

Health Disparities

• Identify disparities by income, race/ethnicity

and geography.

• Address key drivers including poverty and racism

• Implement targeted interventions

Community Engagement

• Include affected communities in building solutions

• Restart HAAC with community representation

Social Determinants of Health

• Conditions in which we live, work and play that impact on

our health

• Integrate these factors into our work (e.g., food pantry)

Health Equity

Life Expectancy

Source: www.beckershospitalreview.com

Education Economic Stability Racial/Ethnic Minority

Race

Geography

Income

Education

Life Expectancy

Drivers of Life Expectancy

COVID-19 Health Equity Initiative • Race and Ethnicity

• Targeted educational material

and distribution channels

• Walk-up testing

• Case management during

contact tracing

COVID-19 Race & Ethnicity

Brooklyn Park Healthy Food Pantry

• Opened February 2019

• Addresses the Brooklyn Park food

desert by providing fresh vegetables

and fruit, meat, dairy and shelf stable

foods

• Partnership with Anne Arundel

County Food Bank, Anne Arundel

County Public Schools and

Recreation and Parks, Brooklyn Park

Community of Hope, Maryland Food

Bank and Restoration Community

Development Corporation

Brooklyn Park Healthy Food Pantry

• During COVID-19 initiated

contactless curbside pick-up of food

and health education

• May 2019 – Feb 2020, served an

average of 53 families each week

with a reach of 177 residents

• March – April 2020, served an

average of 86 families each week

with a reach of 365 residents

• Maryland Community Health

Resources Commission (CHRC)

awarded 2020 grant to continue

Pantry and Brooklyn Park Farmers

Market projects.

• CHRC awarded new food pantry site

in Annapolis in partnership with

Housing Authority

REACH Program works with the uninsured

in the county to connect them with

medical providers and specialists at

reduced fees

In FY 2020, REACH coordinated

care for 1,244 enrolled members

and 106 emergency cases for the

following services

• Primary Care: 965

• Specialist: 953

• 80 Emergency Room Visits

Adding a new coordinator will allow

us to serve an additional 350

people for access to care who are

not currently being served.

Timely access to MAT with buprenorphine is limited which leads to missed

opportunities to care for people seeking treatment

The Wellmobile, launched April 2019, provides

• on demand initiation of buprenorphine treatment

• referrals to ongoing treatment and wrap around services

247 individuals have been served

since Wellmobile’s launch

81% of those served have

successfully been linked to a

community provider

Wellmobile

Normal operations were

• 2 days a week in

Glen Burnie

• OOCC-funded

expansion added

2 days weekly

in Annapolis

Operations changed during COVID-19 pandemic

• Telehealth services for entire county

• Services at Langley Road clinic in Glen Burnie

• Services at Bestgate Road clinic in Annapolis

Wellmobile Is Now Virtual

Gun Violence Intervention Team

• Gun Violence Prevention Task Force met during 2019

and identified gun violence as a public health issue

• Preliminary report published December 2019

• Final report to be published in May 2020

• Gun Violence Intervention Team formed and led by

Department of Health

• Assesses recommendations from report for feasibility,

impact and cost

• Range of agencies evaluate and implement

recommendations

• Social Ecological Model as framework

Suicide• County Council resolution to address suicide

• Continue work from the Youth Suicide Report

• Family Life and Safety in Home Environment

• Special Populations at Risk

• Identify Community Risk

• Role of Social Media and Cyberbullying

• Mental Health Initiatives for Older Adults

• Gun Violence Intervention Team will have a focus on

suicide as it accounts for over 60% of gun deaths

• Mental Health Task Force with Anne Arundel County

Public Schools – prioritize initiatives and implement

recommendations

Crisis• Focus on crisis stabilization, alleviate need for increased level of care

• Warmline

• 24/7/365, Average 2,024 calls/month; 22.4%+ during COVID

• Mobile Crisis Teams

• 196% increase in calls to schools (current school yr through Mar.)

• Crisis Intervention Teams

• Designed to reduce

• Hospitalizations

• Incarcerations

• Homelessness

• Care Coordination

• Eliminate barriers for vulnerable populations

• Connect people to treatment resources. Connect them to benefits.

Crisis – Jail Diversion

• Established in FY 2015

• Pre-trial. Screen positive for Mental Health/Substance

Use Disorder

• Develop plan of care in cooperation with criminal justice

partners

• 7% Recidivism Rate (Average rate over 5 years)

Crisis – Hospital Diversion

• Provide support to most vulnerable residents who do

not meet inpatient criteria

• Develop and coordinate plan of care

• Reduce homelessness and/or incarceration

• Prevent suicide

Crisis – Training

• Mental Health First Aid (MHFA)• Identify signs and symptoms of mental illness

• First in the country to train all police officers (now part of curriculum)

• Training to all AACPS administrators and librarians

• Summer 2020 – scheduled training for all school nurses, health aides and teachers (on hold due to COVID)

• Critical Incident Stress Management (CISM)• 40-hour training to prepare police officers in specialized,

intense mental health training

• Trained Anne Arundel County Police, Annapolis Police, secret service, airport police, many other law enforcement partners statewide and nationally

Safe Stations

• Available 24/7/365 - individuals welcomed into any

police or fire station seeking substance use disorder

treatment

• Clinical staff assesses the individual and together they

develop plan of care

• Reduce barriers for treatment success (criminal justice

involvement, transportation, lack of insurance)

• Served 1,998 people since program began (4/20/17 –

4/30/20) with 70% of people connected to substance

use disorder services

AA POWER

AA Power mobilizes people who have

lived experience with substance use

disorders to:

• support substance users with risk

reduction strategies

• provide information to help reduce

the spread of infectious diseases and

improve overall health

• work with community members to

conduct overdose prevention

trainings, distribute naloxone and

distribute fentanyl test strips

o 806 Narcan kits and 1320

fentanyl strips distributed

(Annapolis & Glen Burnie)

• Peers in hospital emergency

departments offers OD survivors

path to treatment and wrap

around services

• Peers, in local ED, guide

survivors through the process of

connecting to care during and

after ED visit

Individuals Assisted (FY20)

• 427 - Baltimore Washington

Medical Center

• 453 - Anne Arundel

Medical Center

Overdose Survivors Outreach

Services (ODSOS)

Judiciary Training in Behavioral Health

Training curriculum for judges to improve outcomes for individuals

with substance use and mental health disorders in the criminal

justice system

• Curriculum, grounded in evidence-based practices,

• initiates and sustains a dialogue with the judiciary

• creates vital partnerships

• enhances the judiciary's ability to make more informed

decisions regarding individuals with substance use and

mental health related disorders

• develops outcomes associated with these training

opportunities

• 7 training sessions conducted to date with 19 circuit court judges

trained

Road to Recovery at Ordnance

Road Correctional Center

Opioid overdose death risk is 40-120 times higher on re-entry without

treatment

• Provides methadone and Vivitrol to incarcerated inmates and

connects them to care on release

• Starting an injectable buprenorphine program in 2020

• Served 174 YTD FY20 and 100% were connected to

community treatment upon release

• One of the few fully accredited medication assisted treatment

programs in the correctional setting in the United States

• Recognized as a National Promising Practice in July 2019

• Provides nutritional counseling and

dietary supplements for pregnant

and postpartum low- income

women and children

• Provides lactation counseling and

support to nursing mothers

• Average monthly participation rate

is 6,232 participants.

Women, Infants

and Children (WIC)

Healthy Start Home Visiting Program

• Program was expanded in July 2019 to provide wrap around support, health

information and parenting education through peers to high-risk

pregnant/postpartum women and children up to the age of two.

• Focus is on women with substance use disorders, women experiencing

poverty and minority women

• Goals: prevent infant mortality and reduce health disparities

In FY 2020, we have served

• 103 women (21 with substance

use)

• 101 infants (20 substance

exposed)

• Provided 2,321 services

• Clinical services for insured and uninsured youth and

select adults at the Annapolis and Glen Burnie clinics

• Oral health patient care coordination for underserved

and at-risk patients

In FY 2020

• 4,112 clinical visits for children, includes examinations,

cleanings, X-rays, fluoride treatments, sealants, fillings,

extractions, and space maintainers

• 941 clinical visits for adults: pregnant women, people

with HIV and urgent referrals from the emergency room

• 377 people received care coordination connecting them

to a network of providers

Dental Sealant Program

• Sealants prevent cavities and are done for 6 to 9 year olds

• 133 children were screened at Mills-Parole Elementary and

Brock Bridge Elementary Schools and 241 sealants were

placed.

Dental Services

School Health Services 2019-2020 School Year (September- February)

● 447,390 Health Room Visits to over 87,000 Students

● 115,890 Medications Administered

● 66,870 Treatments Performed

● 6,840 Health Room Visits for Crisis Interventions

● 3 Narcan Doses Administered

● 44,439 Health Education Instructions Provided

• School Health conducts state mandated vision

screenings for children in pre-kindergarten,

kindergarten, first and eighth grade, students new

to Anne Arundel County schools, and for students

referred for screening by their parent or teacher.

• Vision screenings are also done at Head Start

programs and MSDE approved private schools

and nursery schools.

• 23,531 children screened at all 126 public schools

• 3,504 (15%) referred for further assessment

• 611 (17%) received recommended follow-up or

declined to date

• Partnerships with local providers help to give low-

cost glasses to children in need

Vision Screening Services2019-2020 School Year (September- February)

Since March 2019, students seeking help

with substance use issues now have another

place to turn. In STAR, school health nurses

use technology to connect Anne Arundel

County public high school students in a tele-

session with a licensed therapist from the

Department of Health. Sessions take place

through a secure portal to ensure privacy

To date, 15 students have been screened

through STAR.

STAR (Screening Teens to Access Recovery)

Tobacco 21As of October 1, Maryland law prohibits sale of

tobacco products, including e-cigarettes and

vaping devices, to people under 21 years old.

The Department of Health partners with local law

enforcement to prevent illegal sales of tobacco

products. In FY19, there were:

• 754 tobacco sales compliance checks

completed

• 95 civil citations issued (12.5% failure rate)

• 3 citations referred to the Maryland

Comptroller for further action

PrEP (Pre-Exposure Prophylaxis)The PrEP program, begun May

2019, offers HIV-prevention

medication to people at high risk of

getting HIV

The program has:

• Provided health information at

29 community events including

the First Annapolis Pride Festival

• Provided PrEP education to 220

individuals

• Linked 9 people to PrEP care

with Truvada

The program, in place since 2017, runs from May through October

• Secure garbage cans were distributed to Brooklyn Park in 2017

• Educational materials were distributed to houses with conditions

contributing to rodent infestation

• Free pesticide services provided when conditions are corrected

• Code enforcement when conditions are not corrected

• Chesterfield and Glen Burnie: new communities started in 2019

Property Assessments

Brooklyn Park Chesterfield Glen Burnie

Residential Properties Assessed 1969 1527 1986

Commercial Properties Assessed 49 2 378

Complaints Opened from Violations Observed 65 39 77

Referrals for Pesticide Services 103 61 132

Rodent Control Program

Bay Restoration Fund

• Seeks to improve water quality in

the bay by reducing nutrient runoff,

especially nitrogen, that lead to

algal blooms

• For FY 2020, the Department of

Health has $3.47 million, and to

date $2.57 million has been

allotted for:

• 15 public sewer connections

• 186 BAT (Best Available

Technology) installations

Stop the Bleed Training• The Office of Emergency

Preparedness and Response offers

Stop the Bleed training, which teaches

bystanders to help in a bleeding

emergency before professional help

arrives.

• OEPR partnered with OEM and

County Fire to train all county

employees.

Charity is no substitute for

justice withheld-St. Augustine

The Mission

The Department of Aging and Disabilities provides long term care services, aging and disability resource services, and disability and community services for older adults, individuals with disabilities, caregivers, and anyone interested in planning for their future to enable them to live independent and meaningful lives and to improve the quality of life for all citizens.

ACCOMPLISHMENTS AND INNOVATIONS

● Using existing resources, increased support of critical needs of special populations through a Critical Case Manager, Veterans Specialist, and a Housing Navigator and a Transportation Specialist.

● Enhanced our Critical Case Management with Fire Department to fully create a Mobile Integrated Community Health Team.

● Provided Dementia Live education and training to 509 employees to include Anne Arundel County Police, Fire, and Library personnel.

● Assisted over 3,000 residents, individually, with Medicare navigation and successfully implemented the new Medicare Path Finder tool.

● Served and supported ongoing supports planning for 330 waiver participants to avoid nursing home placement.

● Increased community wellness through increasing participation in Evidenced-Based Health Promotion programs by 50%.

● Successfully opened Brooklyn Park Senior Activity Center and expanded Anne Arundel Community College classes now offered in all 7 Senior Activity Centers throughout the county.

● Increased Taxi Voucher program participation by over 100% since July 1, 2019 through increased community outreach and access to services.

DoADBefore

COVID-19

COVID-19 RESPONSECOMMUNITY RESPONSE

● 10,000+ CALLS FOR WELL-BEING AND RESOURCE NAVIGATION● RE-ENTRY NAVIGATION FOR VETERANS AND PREVIOUSLY INCARCERATED INDIVIDUALS

EXPANDED NUTRITION SERVICES

● IMMEDIATE COORDINATION OF 7 FOOD DISTRIBUTION SITES AND 12 CONGREGATE DISTRIBUTION SITES IN PARTNERSHIP WITH POLICE DEPARTMENT, EOC, AND SHERIFF'S OFFICE

● LOCAL FRESH PRODUCE AT DISTRIBUTION SITES AND GROCERY DELIVERY THROUGH PARTNERSHIP WITH FOOD BANK, ACCESSIBLE RESOURCES FOR INDEPENDENCE, AND KINGDOM KARE

VIRTUAL SENIOR ACTIVITY CENTERS

● R.O.V.E.R.S (Remote, Online, and Virtual Education Resources for Seniors)

INCREASED REMOTE MONITORING OF NURSING HOMES AND ASSISTED LIVING FACILITIES

RECLASSIFICATION NR-19

● The Department requests reclassification of 2 vacant NR-19 positions consistent with complex duties performed to the classification of the Assistant Director of Aging position (NR-22.)

● The NR-22 Assistant Director of Aging position currently exists within County Code.

● The current financial impact of this request was achieved through the difference of base salary of the 2 vacant NR-19 positions and the base rate of the NR-22 Position.

● FY21 Fiscal Impact: $ 43, 617

CAPITAL REQUEST● SOUTH COUNTY INTERIOR REPURPOSE, ANTERIOR

2,000 SQUARE FT EXPANSION, AND PARKING LOT ADDING APPROXIMATELY 5 ACTIVITY SPACES

● ARNOLD SENIOR ACTIVITY CENTER-FEASIBILITY STUDY TO IDENTIFY SPACE FOR PROGRAMMING CURRENTLY HELD OFF-SITE

General County FY21 FY22

COO2118 $1,827,000 $648,000

FY21 Budget Presentation

May 13, 2020Carnitra D. White, DirectorHelping Build Stronger, Safer and More

Self-Sufficient Families and Adults1

Organization Chart

2

Christine NagleAssistant Director

Administration

Tanya ClementsDivision Director,

CommunityInitiatives and Programs

Carnitra WhiteDirector

Edith HarrisonDeputy Director

Family Investment

Susan TyzackAssistant Director

Child Welfare

Rachael MaconachyAssistant Director

Child Welfare

Dominique YoungbloodCommunications Officer

Karen TaylorSpecial Assistant

Staffing

346 employees:● 259 state positions● 87 county positions● 14 county merit● 73 county contractual positions

90% of the 87 county positions are funded in part by alternative funding streams, including grants, state funds and federal reimbursements.

45% of these 87 county positions are entirelyfunded by alternative funding streams.

3

AACoDSS FY21 Proposed Budget

● AACoDSS utilizes a $3.2 million County investment to leverage $2 million in additional revenues to support Adult Protection Programs, Homeless Resources, the Family Support Center and Child Welfare Services

● The recommended County Investment is $297,600 less than FY20 budget due largely to contractual pay adjustments.

4

FY21 County Budget Recommendation

Program # of county

staff

FY21 Budget

Total County

Investment

Leveraged Revenue

1661- Adult Services

26 $2,271,600 $1,068,114 $1,203,486

1662- Family & Youth Services

55 $2,859,100 $2,198,769 $660,331

1664- Family Preservation

6 $200,700 0 $200,700

BUDGET TOTAL 87 $5,331,400 $3,266,883 $2,064,517

Actual FY

2019

Original

FY2020

Estimate FY

2020

Budget

FY 2021

Inc (Dec) from

OrigComments

Administration 1,099,218$ 1,076,500$ 1,076,500$ 1,137,500$ 61,000$ Includes $40,300 for 6 months for Temp Sr MA

Purchasing 2,304,976 2,599,600 2,572,500 2,678,000 78,400 Includes $5,200 for maint & service contracts for

2 mail machines

Facilities

Management17,895,982 18,730,600 18,753,100 18,952,200 221,600

Includes $123,700 for Arundel Ctr armed security, and

$415,800 cost of doing business (data plans, custodial

services, janitorial supplies, uniform & mat rentals)

Real Estate 1,147,067 1,241,100 1,197,100 2,872,300 1,631,200

Includes $1,603,200 for Commerce Park rent, and

installation of bulletproof window film & backup

generator for Public Safety tenants

Risk Management 21,025,815 23,966,900 23,829,100 24,315,100 348,200 Increase to claims costs expected based on actuary

reports

Vehicle Operations 15,166,142 15,710,900 14,883,700 15,528,600 (182,300)

Decrease in gas & diesel prices anticipated;

Includes $102,900 for wheel alignment machine & tire

changing machine

Vehicle Replacement 12,694,123 11,098,300 11,096,600 12,782,500 1,684,200 Includes $190,600 for add'l MDC for purchase &

replacement

TOTAL 71,333,323$ 74,423,900$ 73,408,600$ 78,266,200$ 3,842,300$

Office of Central Services Operating Budget Summary - FY2021

OIT STRATEGY UPDATE

• February 2015

FY21 OpEx ReviewMay 2020 county Council

1

2

Accelerate Secure Digital Adoption to create a more effective and efficient County Government for our

employees, citizens and communities

Foster Digital Dexterity, Eliminate transactional friction, provide thoughtful innovation & enable better systems integration

Trusted advisors

bringing force

multipliers to help

respond quickly,

effectively, and

efficiently

KPIs

Double Transaction Velocities

Halve Outages

Square Employee Engagement

Build a Customer centric, Cyber safe Culture

ACCELERATE SUCCESS

OIT Vision & Mission Statement: Blue= Goals; Burgundy = Values; Green =KPIs

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Who Benefits from IT Projects?

4

FY21 OpEx SummaryMajor Drivers to FY21 OpEx Plan

Overview $1.5M increase• Personnel: Pay package increases & Land

Use Sys Adm • Software license fees

Software Maintenance $1M

• Capital Rollover: Police RMS, Procurement Vendor Mgt, Cyber

• More Licenses: AWS, eBuilder, Google, Zoom

• Multiyear Payments: Encryption SW • Vendor Maintenance Increases:

Contractual agreement increases