1 of 3 www.wakegov.com Wake County Human Services and Environmental Services Board June 28, 2012 AGENDA Human Services Ctr. - 220 Swinburne St. 2nd Fl., Rm. 2132 Standing Time: 7:30AM – 10:00AM Dianne Dunning, Chair Pablo Escobar, Vice Chair Purpose: Advocacy, Policy, Advisory, Accountability All items on the Consent Agenda are considered to be routine and may be enacted by one motion. If a Board Member requests discussion on an item, the item will be removed from the Consent Agenda and considered separately. 7:35 am Human Rights/Consumer Affairs: Mr. Pablo Escobar, Chair Studies : 1. Latent Tuberculosis Infection - TBTC Study 33 2. NOVIOlencia - Latino Families for Safe Dates Regional Networks Development Committee: Mr. Frank Eagles, Chair 7:40 am • Update on Regional Networks Committee Work Plan 7:45 am Overview of Wake County Transit Plan - Mr. Tim Maloney & Mr. Tim Gardiner, Wake County Planning, Development & Inspections 8:10 am Update on New Composition for Human Services Board - Ms. Denise Foreman, Assistant to the County Manager 7:30 am Meeting Called to Order Invocation Approval of Minutes: May 24, 2012 Next Board Meeting: July 26, 2012 220 Swinburne St., 2nd Fl., Rm. 2132 Consent Agenda Regular Agenda
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www.wakegov.com
Wake County Human Services and Environmental Services Board
June 28, 2012 AGENDA
Human Services Ctr. - 220 Swinburne St. 2nd Fl., Rm. 2132
All items on the Consent Agenda are considered to be routine and may be enacted by one motion. If a Board Member requests discussion on an item, the item will be removed from the Consent Agenda and considered separately.
7:35 am Human Rights/Consumer Affairs: Mr. Pablo Escobar, Chair Studies:
1. Latent Tuberculosis Infection - TBTC Study 33
2. NOVIOlencia - Latino Families for Safe Dates
Regional Networks Development Committee: Mr. Frank Eagles, Chair
7:40 am • Update on Regional Networks Committee Work Plan
7:45 am Overview of Wake County Transit Plan - Mr. Tim Maloney & Mr. Tim Gardiner, Wake County Planning, Development & Inspections
8:10 am Update on New Composition for Human Services Board - Ms. Denise Foreman, Assistant to the County Manager
7:30 am Meeting Called to Order
Invocation
Approval of Minutes: May 24, 2012
Next Board Meeting: July 26, 2012 220 Swinburne St., 2nd Fl., Rm. 2132
8:30 am LME Advisory Committee: Ms. Stephanie Treadway, Chair
• Update on Wake LME Closeout and Recent Actions by Wake County Commissioners re: Alliance Behavioral Healthcare (MCO) - Ms. Denise Foreman
• Update on Wrap Up Committee Meeting & History/Recognition - Ms.
Stephanie Treadway
Executive Committee: Dr. Dianne Dunning, Chair
8:45 am Recognition of Departed Board Member: --Mr. James B. Edgerton: January 19, 2010 - March 22, 2012
8:55 am FY12 - Q3 WCHS Data Report - Ms. Regina Petteway & Ms. CJ Harper
Public Health Committee: Mr. Benny Ridout, Chair
9:05 am • Review/Discuss Public Health Quarterly Report (Jan.-Mar. 2012) - (#2.4)
9:15 am HS&ES Directors' Q & A --Ongoing Activities
9:30 am Chair's Report
9:40 am Time Reserved for Input into WCHS Director's Annual Performance Evaluation Note: The Board may choose to go into closed session to provide input.
10:00 am Adjournment
Information Packet Items
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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)
Environmental Services – Library Admin., 4020 Carya Dr.
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BOC 2pm----
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19 20
3:30pm – 5:15pm - Housing
& Cmty. Revitalization, Rm. 5032
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Noon – 2pm
Public Health, Rex Women Ctr., Rm. 100B
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23 24
12:45pm – 2pm HRC – Rm.
5032
25 26 27
7:30am – 10am HS & ES
Board Mtg. Rm. 2132
28 29
30
Assignments to Committees
Executive Committee 2nd Thursday 8am – 10am
Rm. 5032
Community and Public Health 3rd
Friday, noon Rex Women Ctr.
Environmental Services
2nd Fri., 11:30am, Library Admin. Carya Dr.
Social Services 1st Friday
9am – 10:30am Rm. 5032
Dianne Dunning Pablo Escobar Frank Eagles Leila Goodwin Melissa Jemison Paul Norman Benny Ridout Stephanie Treadway Staff: Regina Petteway Joe Durham Ramon Rojano Joseph Threadcraft Bob Sorrels
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
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 Paula Thomas Liz Turpin Kenny Waldroup Julie Wilkins Phillip White John Whitson
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
Affordable Housing & Community
Revitalization 3rd Thursday
3:30pm – 5pm, Rm. 5032
Regional Networks
Development Qtrly, Rm. 5040
Human Rights/ Consumer Affairs
4th Mon., 12:45-2pm Rm. 5032
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
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
Pablo Escobar Kent Earnhardt Osama Said Staff: Brian Gunter Leticia Mendez Fabiola Sherman Community: Laura Goddard Naima Moussa Martha Pitts Olivia Simons Don Wiseman
HUMAN SERVICES AND ENVIRONMENTAL SERVICES
BOARD AGENDA ITEM
Agenda Date: June 28, 2012
Committee/Item: Human Rights-Consumer Affairs
Specific Action Requested: Review and recommend for approval the attached proposals for
participation in human research proposals by Wake County clients and/or staff.
Item Summary: Attached are proposals for:
1-Participation by clients and staff of the Communicable Disease clinic in a new approach to
treating patients with Latent Tuberculosis Infection (LTBI), and
2-Recruitment of Wake County client parents and teens for a dating violence prevention program
aimed at Latino families.
Purpose for Action: Complete Wake County’s Institutional Review protocols for the protection
of human subjects in research.
Next Steps: TBD
Attachments: Summary Sheet, Study summary for TTBC iAdhere , Study summary for
NOVIOlencia, signed Research Approval Checklists, IRB review data
Opportunities for Advocacy, Policy or Advisory: These are both innovative preventive
proposals. The TTBC 33 Iadhere study aims to prevent the development and spread of TB by
patients whose infection is latent, but requires intervention. The NOVIOlencia proposal seeks to
fill a void for the Latino population because no dating violence prevention efforts have been
designed for these families prior to this effort.
Connections to Other Committees: Public Health
HUMAN SERVICES AND ENVIRONMENTAL SERVICES
BOARD AGENDA ITEM
Agenda Date: June 28, 2012
Committee/Item: Regional Networks Committee
Specific Action Requested: Receive information
Item Summary (Ex: What are major points/data. Is it better or worse.):
Regional Network Committee’s Work Plan for the coming fiscal year. Primary focus is the
development of a Western Regional Community Advisory Committee
Purpose for Action (Ex: Proposed Solutions/Accomplishments):
To define the scope and tenure of work for the Regional Network Committee for the coming fiscal
year
Next Steps (Ex: What is next step for Board or staff):
Receive information
Attachments: RNC Work Plan
Opportunities for Advocacy, Policy or Advisory:
Wake County Human Services and Environmental Services Board Action Planning Worksheet
Date 05/11/12
Priority: Western Region Service Plan Plan Period: 4 Year Plan; 1 Year Strategy
Objective: Establish a coordinated service plan for Western Region citizenry
Strategies/Action Steps Person(s) responsible
Timetable
Start Date Anticipated Completion
Completion
1. Make use of available data to identify opportunities for meeting
citizens’ needs through an array of service strategies and enhanced partnerships within the Western Region.
2. Foster engagement in an intentional manner. Identify and
assemble a Western Regional Community Advisory Committee with representation from existing as-well-as potential partner organizations, entities currently providing services/resources within the community, and local leaders.
Regional Networks Committee and Wake County Staff Regional Networks Committee and Wake County staff and leadership
07/01/12 07/01/12
06/30/13 06/30/13
Performance Indicators (What are the indicators that will let you know you’re meeting your objective?)
Tracking or measuring system (How will you track/account for progress?)
Resource Requirements (What is needed to deliver the expected results)
1.) Update Data within the Western Regional
Assessment document produced in 2011 as new information/data is available.
Study current service provision demands and citizen service trends /dynamics in the Western Region creating a profile of how needs are met or if there are unmet needs.
2.) Identify and appoint a Western Regional
Advisory Committee of no less than six western citizens representing the aforementioned sectors.
Meet on a consistent basis.
1.) Notation and documentation with the Western
Regional Assessment materials to reflect date of update –keep the document relevant
Incorporate this level of analysis into the aforementioned document perhaps as an appendix.
2.) Once identified and vetted candidates to this Western Regional Community Advisory Committee will be appointed by the Regional Networks Committee and have a seat at its quarterly meetings
The Western Regional Advisory Committee will establish a regular meeting schedule and set its work plan
1.) County staff involved in data collection
from approved source data. County Staff time involved in collection, assessment, and detailing of information
2.) County Staff appointed to lead, coordinate and sustain this effort. Ancillary expenses to convene this group.
HUMAN SERVICES AND ENVIRONMENTAL SERVICES
BOARD AGENDA ITEM
Agenda Date: June 28, 2012
Committee/Item:
Specific Action Requested: For update and information purposes.
Item Summary
A draft version of the Wake County Transit Plan (the Plan) was completed late last year. The Plan is derived from various detailed engineering studies and analyses on bus and rail service in Wake County. Compilation of the Plan has been a collaborative effort among key stakeholders including Wake County, Triangle Transit, Capital Area Metropolitan Planning Organization (CAMPO), City of Raleigh Capital Area Transit, Cary C-Tran, Regional Transportation Alliance, and all municipalities. The Plan outlines the priorities for bus and rail service in Wake County and will be used to guide future regional bus and rail investments that may result from the possible creation of a regional revenue source along with assumptions for state and federal participation. At the Board of Commissioner’s November 14, 2011 Work Session, staff presented a draft version of the Wake County Transit Plan. Since that time, Wake County has been meeting with elected municipal officials and other stakeholders to gather feedback on the draft plan. Revisions to the draft Plan are currently underway. The approach to improve transit in our community is outlined in the Plan. It includes a Core Transit Plan that delivers increased bus service and commuter rail with locally generated funds and federal/state formula funds; and an Enhanced Plan that adds light rail only if we are successful in receiving competitive federal and state funds. The local revenue sources for the Plan include:
• A half-cent sales tax: The sales tax proposal must be placed on the ballot by the Board of Commissioners. If approved by voters, the sales tax would generate an estimated $56 million to $60 million annually in the early years of the plan. The sales tax does not apply to food, medicine, utilities and housing.
• A $10 increase in vehicle registration fees: The fee increase would happen if the Wake County Board of Commissioners approves a new $7 fee for vehicles, and the Triangle Transit Board of Trustees approves a $3 increase in existing fees.
The bus portion of the Plan extends service to all municipalities, adds commuter and local routes, increases the frequency of the routes, and streamlines the destinations and connections made. The result would be a near doubling of the number of buses on the road today, all in the first five
years. The bus services in the Plan would cost just over $330 million for both capital and operating. The financial model assumes bus services would receive a similar level of support from state and federal funds as they do today. The Plan includes several elements that would effect and improve service to special needs populations. First, the increase and streamlining of services proposed will make it easier and more efficient for all users to get to and from destinations. The frequency on some fixed route services will be as high as every 15 minutes and all local routes will run every 30 minutes. Second, the Plan proposes to construct sidewalks, shelters, and stations that will make it easier for all users to access the bus system. Third, the Plan includes funding to provide the required special bus services within ¾ mile of fixed transit lines. Lastly the Plan includes funding to augment or expand services currently provided to the rural areas of the County by the TRACS system. The team is still working on the details of how each of these elements will be implemented. Commuter rail would operate in the existing NC Railroad right-of-way from Garner to Durham (37 miles / 12 stations). Commuter rail would cost $650 million. Wake County’s share would be $330 million and Durham would pay $320 million. Commuter rail is projected to be in place in 2019 or 2020. If the commuter rail is implemented the bus lines will be adjusted as needed to connect with all stations. Additionally, should the area be successful in receiving competitive federal and state funding grants, then the first phase of the light rail system would be implemented from downtown Cary to north Raleigh (Millbrook Road) covering 13.9 miles with 16 stations. Light rail is estimated to cost $1.1 billion (2011 dollars) with operating costs at $14 million per year. This investment, particularly, is expected to have a heavy impact on where people choose to live and work and effect land development.
Purpose for Action:
For update and information purposes.
Next Steps:
Attachments: Powerpoint Presentation
Opportunities for Advocacy, Policy or Advisory:
Connections to Other Committees:
Wake County Transit PlanChoose how you move!Choose how you move!
2. 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) 79.5
2. 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%
21 21
We wish to thank all staff for their daily efforts toward improving the health and safety of the citizens
of Wake County.
Contributors to this Public Health Quarterly Report are:
Edie Alfano-Sobsey
Roxanne Deter
JoAnn Douglas
Brian McFeaters
Andre Pierce
Michelle Ricci
Ronda Sanders
Ramsay Hoke
Yvonne Torres
May 18, 2012
A c k n o w l e d g e m e n t s
INFORMATION
ITEMS
• Board Fund Report (Separate)
• Articles
• Housing Multi-Family Development Loans
• LME Financial Reports 6-19-12
• Committee Reports/Minutes
• Commissioners’ Agenda Items Related to HS&ES June 2012
Proposed psychiatric hospital in Wake years away By John Murawski - [email protected]
The News & Observer - May 30, 2012
On any given day WakeMed hospital in Raleigh is caring for mentally ill residents who may be suicidal, psychotic and dangerous. These patients spend anywhere from several days to several weeks down the hall from people recovering from physical illnesses, car wrecks and other accidents because there’s nowhere else for them to go.
Relief may be on the way. UNC Health Care’s proposal, announced last week, to build a 28-bed psychiatric hospital in Wake County is designed to address the problem of mentally ill patients who are crowding emergency rooms and hospital wards throughout Wake County and the region.
“They will stay in the emergency department for hours and days,” said Jack Naftel, vice-chair of clinical affairs in the psychiatry department at UNC-Chapel Hill. “Just imagine someone with a heart attack waiting days to get upstairs for a bed.”
But despite the pressing need, the $30 million hospital could take at least several years to become reality.
Indeed, there’s no guarantee it will win all necessary approvals, although rival WakeMed, which often challenges other hospitals for available beds, has already signed off on the project. That’s because the hospital is part of the deal UNC and WakeMed hammered out to get WakeMed to drop its hostile takeover bid for UNC-owned Rex Hospital. WakeMed officials have long argued that their facilities treat a disproportionate share of the region’s poor, uninsured and mentally ill.
Still, the public handshakes and photo ops belie the hurdles ahead. Simply preparing all the necessary paperwork to submit applications to build a hospital is expected to take a year. It may also require fending off opposition from such health care providers as Holly Hill Hospital, a cross-town competitor and the only private hospital in the county that specializes in psychiatric services.
Groundwork
But first UNC must persuade state officials to increase their need projections for psychiatric beds in Wake County, a number that sets a limit on hospital construction.
In this case, however, much of the groundwork for UNC’s proposal has already been done. UNC and Wake County spent nine months researching need and concluded that 28 more beds are needed in the county, the same amount proposed for the new UNC hospital, said Wake County Manager David Cooke.
That study shows that the psychiatric beds will generate revenue from a newly created financial source: the Affordable Care Act, dubbed by some as Obamacare. The controversial law, which is
being reviewed by the U.S. Supreme Court and could be overturned this summer, would reduce the number of uninsured individuals and expand Medicaid coverage, providing “a much increased revenue stream to support Medicaid substance abuse services” that are in high demand by the mentally ill.
The state is currently estimating a need for just 12 psychiatric beds in its draft 2013 medical facility projection. UNC will request a revision of the final projection to at least 28 new psychiatric beds. Revising the annual limit by petition happens almost every year, usually in the area for hospice beds, and is often granted, said Julie Henry, a spokeswoman for the N.C. Department of Health and Human Services.
The state’s 2012 projection set the limit at 37 beds, and Holly Hill Hospital requested approval to add the full allotment to its facility. A hearing on that request will be held in Raleigh in June. Neither WakeMed nor Rex is objecting to Holly Hill’s application.
If the state does change its 2013 need estimate, UNC – which has not determined where it will build the facility – would have to win approval for the beds through the state’s certificate of need process. It’s not clear whether Holly Hill will view a new mental health hospital in the same county as a competitive threat. Holly Hill officials did not return calls. But a fight would not be surprising in the contentious world of hospitals.
“I would assume Holly Hill would do everything to position itself for a competitive advantage,” said mental health activist Ann Akland, a board member of the Wake County chapter of the National Alliance for Mental Illness. “I doubt they would be overjoyed with UNC entering Wake County.”
Wait times for psychiatric beds have been growing statewide since North Carolina halved the number of beds in its mental hospitals as part of a reform launched in 2001. Dorothea Dix Hospital, which once housed 300 psychiatric beds in Raleigh, is slated to close and now has just 30 patients left. Most of the patients have been moved to Central Regional Hospital, the facility built in Butner to replace Dix, about 40 miles north of Raleigh.
“It was almost like re-institutionalizing all of those people out on a reservation,” Akland said.
The state currently has 2,594 licensed psychiatric beds at county, state and private institutions. But not all are staffed, and some are designated for youth or have other restrictions.
‘If we had 28 beds …’
Putting the 28 needed beds in the Dorothea Dix building is not an option because the aging facility would not meet modern building standards and would have to be renovated, officials said.
The problem of mentally ill patients overflowing to hospitals has become more acute especially in the last several years, said Jim Hartye, manager of behavior health services in the WakeMed
system. He said WakeMed treats between five and 18 mentally ill patients a day, with an average stay of 2.5 to 3 days, with “some staying multiple weeks.”
Hartye said that at WakeMed the patients are assigned to rooms and are visited by a staff psychiatrist, but the hospital is not a psychiatric unit that provides comprehensive treatment to the mentally ill. He said it’s especially difficult to transfer patients who are disruptive or violent, or those who are older and ill.
“I don’t think there’s ever such a thing as ‘solve’ in the mental health profession,” Hartye said. “If we had 28 beds that can take patients who are highly complex, then that would be a huge help.”
Murawski: 919-829-8932
HUMAN SERVICES AND ENVIRONMENTAL SERVICES
BOARD AGENDA ITEM
Agenda Date: June 28, 2012
Committee/Item: Housing and Community Revitalization/Multifamily Housing
Development Loans
Specific Action Requested: Information Only. To receive an update on funding
recommendations made by the Housing and Community Revitalization Committee
Item Summary:
**On June 4th The Wake County Board of Commissioners approved the following loans: The applications recommended for funding are:
1. Timber Spring Apartments, Garner – 48 units for seniors
Developer: Evergreen Construction Company
Evergreen Construction Company has requested funding of up to $480,000 on behalf of the ownership entity to be formed, Timber Spring Housing Associates, LLC, for the construction and permanent financing of Timber Spring Apartments. Timber is located in Garner, near the intersection of Timber Drive and New Rand Road. The Mayor of Garner has written a letter of support for the development. The loan terms requested for the Wake County loan are 1% interest during construction and 1% interest for the permanent loan with a 30 year term. At least $198,339 would be repaid over 29 years; the remainder would be repaid as a balloon in year 30. During construction, Wake County would hold second lien position with a bank construction loan in first lien position. In the permanent phase, Wake County would hold third lien position with a bank loan in first lien position and a NC Housing Finance Agency loan in second lien position. The funding source for this loan would be Federal HOME and Federal HOPWA funds.
Lender Funding Request
Bank $ 750,000 NC Housing Finance Agency Loan $ 720,000 Wake County $ 480,000 State Tax Credit Loan $ 572,177 Federal Tax Credit Equity $ 4,307,752 Total $ 6,829,929 The bank loan has not yet been secured because the development is in the early stages, however, banks generally need to be in first lien position and will not subordinate to public lenders. Per the County’s lien position policy, Wake County has
asked NC Housing Finance Agency to share second lien position. The NC Housing Finance Agency has declined this request. The development will add 12 units affordable to seniors earning at or below 30% AMI (currently $19,200 per year for a two person household) and 12 units affordable to seniors earning at or below 40% AMI (currently $25,570 per year for a two person household). The remaining 24 units will be affordable to seniors earning at or below 60% AMI (currently $38,400 per year for a two person household). Evergreen Construction expects construction to be complete before December 31, 2014.
2. Willow Creek Apartments, Cary – 53 units for seniors
Developer: DHIC, Inc.
DHIC, Inc. has requested funding of up to $530,000, on behalf of the ownership entity to be formed, Willow Creek Seniors, LLC, for the construction and permanent financing of Willow Creek Apartments. Willow Creek is located in Cary, near the intersection of Davis Drive and Morrisville Parkway. The Cary Town Manager has written a letter of support for this development. The loan terms requested for the Wake County loan are 1% interest during construction and 1% interest for the permanent loan with a 21 year term. At least $207,037 would be repaid on an annual basis over 20 years; the remainder would be paid as a balloon in year 20. During construction, Wake County’s loan would hold second lien position with a bank construction loan in first lien position. In the permanent phase, Wake County would hold third lien position with a bank loan in first lien position and the NC Housing Finance Agency loan in second position. The funding source for the loan would be Federal HOME funds.
Lender Funding Request
Bank $ 500,000 NC Housing Finance Agency Loan $ 795,000 Wake County $ 530,000 NeighborWorks Loan $ 250,000 State Tax Credit Loan $ 718,879 Federal Tax Credit Equity $4,652,692 Deferred Developer Fees $ 44,689 Total $7,491,260 The bank loan has not yet been secured because the development is in the early stages, however, banks generally need to be in first lien position and will not subordinate to public lenders. Per the County’s lien position policy, Wake County has asked NC Housing Finance Agency to share second lien position. The NC Housing Finance Agency has declined this request. The development will add a total of 14 units affordable to seniors earning at or below 30% AMI, (currently $19,200 per year for a two person household) and seven units affordable to seniors earning at or below 40% AMI, (currently $25,570 for a two person household). The remaining 32 units will be affordable to seniors earning at or below 60% AMI (currently $25,570 per year for a two person household).
DHIC, Inc. expects construction to be complete before December 31, 2014.
3. Holly Woods Apartments, Holly Springs - 64 units for Families in Holly
Springs
Developer: Halcon Development
Halcon Development has requested funding of up to $640,000 of behalf of Holly Woods LLC, the ownership entity to be formed for the construction and permanent financing of Holly Woods Apartments. Holly Woods Apartments is located in on Lassiter Road near the intersection of Sunset Lake Road in the town of Holly Springs. The Holly Springs Town Manager has written a letter of support for this development. The developer has requested Wake County funds for permanent and construction financing. During construction, Wake County’s loan would hold second lien position with a bank construction loan in first lien position. In the permanent phase, Wake County would hold second lien position with a bank loan in first lien position. The loan terms requested for the Wake County loan are 1% interest during construction and 1% interest for the permanent loan with a 30 year term. At least $230,157 would be repaid on an annual basis over 25 years; the remainder would be paid as a balloon in year 30. The funding source for this loan would be County CIP funds.
Lender Funding Request
Bank $2,550,000 Wake County Loan $ 640,000 State Tax Credit Loan $ 724,108 Federal Tax Credit Equity $5,167,044 Total $9,097,235 The bank loan has not yet been secured because the development is in the early stages, however, banks generally need to be in first lien position and will not subordinate to public lenders. The development will add a total of 16 units affordable to families earning at or below 30% AMI, (currently $23,950 per year for a four person household) and 17 units affordable to families earning at or below 50% AMI (currently $39,950 for a four person household). The remaining 31 units will be affordable to families earning at or below 60% AMI (currently $47,940 for four person household). Halcon, Inc. expects construction to be complete before December 31, 2014.
4. Whitehall Apartments, Wendell – 24 units for Seniors
Developer: Lucius Jones
Lucius Jones has requested funding of up to $240,000 on behalf of the ownership entity to be formed, Whitehall Housing Associates, LLC, for the construction and permanent financing of Whitehall Apartments. Whitehall is located on East Fourth Street in Wendell. The Mayor for the Town of Wendell has written a letter of support for this development. The developer has requested Wake County funds for permanent and construction financing. During construction, Wake County’s loan would hold second lien position with a bank construction loan in first lien position. In the permanent phase, Wake County would hold third lien position with a bank loan in first lien position and the
NC Housing Finance Agency loan in second position. The loan terms requested for the Wake County loan are 1% interest during construction and 1% interest for the permanent loan with a 30 year term. At least $117,045 would be repaid on an annual basis over 25 years; the remainder would be paid as a balloon in year 30. The funding source for this loan would be Federal CDBG and County CIP funds.
Lender Funding Request
Bank $ 175,000 NC Housing Finance Agency Loan $ 360,000 Wake County Loan $ 240,000 State Tax Credit Loan $ 291,498 Federal Tax Credit Equity $ 2,194,549 Deferred Developer Fee $ 45,000 Owner investment $ 100 Total $ 3,306,147 The bank loan has not yet been secured because the development is in the early stages, however, banks generally need to be in first lien position and will not subordinate to public lenders. Per the County’s lien position policy, Wake County has asked NC Housing Finance Agency to share second lien position. NC Housing Finance Agency has declined this request. The development will add a total of six units affordable to seniors earning at or below 30% AMI, (currently $19,200 per year for a two person household) and six units affordable to seniors earning at or below 40% AMI, (currently $25,570 for a two person household). The remaining 12 units will be affordable to seniors earning at or below 60% AMI (currently $38,400 for a two person household). Lucius Jones expects construction to be complete before December 31, 2014.
5. Granite Falls Apartments, Rolesville – 72 units for Families
Developer: Granite Falls LLC
Granite Falls LLC has requested funding of up to $720,000 for the construction and permanent financing of Granite Falls Apartments. Granite Falls is located off Rogers Road in Rolesville. The Mayor for the Town of Rolesville has written a letter of support for this development. During construction, Wake County’s loan would hold second lien position with a bank construction loan in first lien position. In the permanent phase, Wake County would hold second lien position with a bank loan in first lien position. The loan terms requested for the Wake County loan are 1% interest during construction and 1% interest for the permanent loan with a 30 year term. At least $494,500 would be repaid on an annual basis over 29 years; the remainder would be paid as a balloon in year 30. The funding source for this loan would be Federal HOME and County CIP funds.
Lender Funding Request
Bank $ 1,816,660 Wake County Loan $ 720,000 State Tax Credit Loan $ 941,316 Federal Tax Credit Equity $ 6,162,369 Total $ 9,640,346 The bank loan has not yet been secured because the development is in the early stages, however, banks generally need to be in first lien position and will not subordinate to public lenders. The development will add a total of 18 units affordable to families earning at or below 30% AMI (currently $39,950 for a four person household). The remaining 54 units will be affordable to Families earning at or below 60% AMI (currently $47,940 for four person household). Granite Falls LLC expects construction to be complete before December 31, 2014.
Next Steps:
North Carolina Housing Finance Agency will decide which developments receive tax credits by August 15th
Attachments:
Opportunities for Advocacy, Policy or Advisory:
Connections to Other Committees:
1
Wake County Human Services Board
Social Services Advisory Subcommittee
Friday, May 4, 2012
9:00 am – 10:30 am
Swinburne Building, Room 5032
Minutes
Board Members:
Paul Norman
Guest:
Lisa Cauley
Committee Members:
Angie Welsh
Anna Troutman
Dudley Flood
Marjorie Menestres
Staff:
Janny Flynt
Katherine Williams
Liz Scott
Nikki Lyons
Vielka Maria Gabriel
Warren Ludwig
Agenda
Item
Discussion, Conclusions, Recommendations Action,
Follow-up
Responsible
Party
Due Date
I. Welcome
&
Introductions
The meeting was called to order at 9:00 p.m.
Paul
Norman
II. Review
and approval
of the
minutes
Minutes were reviewed and were accepted.
Vielka
Gabriel
2
III. Business
Discussion
And Updates
Child Abuse Prevention Summit Update:
• Summit was held on April 23, 2012 – 8:30 am – 12:00 noon - JC Railston Arboretum
• 106 Attended the summit
• Committee is scheduled to meet next week at the Safe Child office on West Morgan
St. to discuss the outcomes of the summit.
Follow Up Discussion: Child Welfare – Presented by Warren
• Warren’s recapped and update of Lisa Cauly brief presentation to the WCHS Board in
April regarding the upcoming Child and Family Services Review (CFSR).
o CFSR Round III
� Children’s Bureau intends to start Round III of the CFSR in 2012
� North Carolina is scheduled to be the second state reviewed
� Wake County expects to be one of the counties reviewed
� Reviewers are likely to talk with community leaders including WCHS
Board Members
o CFSR Round III has not been scheduled at this time for NC (Wake County).
Round II had not been published. It is a requirement of the Commissioners to
have this document published for review prior to its next review. At this time
Wake County may be delayed until 2013
• Community Child Protection Team: Volunteers are needed to join the team.
o Reviews child death cases not only CPS related
o Has a public health component to make recommendations to reduce child
mortality cases
o The meetings are detailed and very informative regarding the child including
the history of the family (education, siblings, siblings, ect.)
o Group meets the 3rd Thursday of each month.
Action,
Follow-up
Committee
will present
in June the
full report
Responsible
Party
Marjorie &
Ann
Warren
3
Follow Up Discussion: Child Welfare – Presented by Warren
• Family Finding –
o Children’s Home Society (CHS) received a Clark Foundation grant for Family
Finding
o 7 staff will be working to support families of children entering into foster care
o The Family Finding Goals
� Decrease length of stay in foster care through reunification and relative
placements
� Safely divert children from foster care
� Provide foster your with family connections and support
� Improve CFSR performance in areas of engaging relatives and
achieving permanence
� Improve compliance with Federal Fostering Connections law
• First Fostering Bright Futures Graduate: Veronica Armstrong is the first to graduate
from Wake Tech through the Fostering Bright Future. Veronica will be attending
UNC Greensboro in the fall.
Action,
Follow-up
Responsible
Party
Warren
HCD Updates:
• PowerPoint presentation attached
Action,
Follow-up
Responsible
Party
Katherine
W.
V. Next
Meeting
Friday, June 1, 2012
9- -10:30 am ~ Swinburne Building, Board Room. –
Action,
Follow-up
Responsible
Party
VI.
Adjournment
The meeting adjourned at 10:35 am.
Human Services Regional Networks Committee Board - Minutes May 10, 2012
1
Committee Charge: Create advocacy, awareness, and community and political support for the need and value of regional networks of care.
Members Present Human Services Staff Present Agenda
Frank Eagles Benny Ridout
Eugenia Pleasants, NRC CAC Rep
Kat Herndon-Lee, SRC CAC Rep
Bob Sorrels Ross Yeager
Darryl Blevins
Kris Ramsundar Rosena West
Andre Pierce
RNC Secretary
Cindy Rice
I. Call To Order/Welcome II. Western Region Advisory Group
III. Western Region Assessment
-Next Steps -Role of Regional Network Committee -
-Role of Staff IV. Southern Regional Center Update
V. Eastern Regional Center Update
VI. Northern Regional Center Update VII. Millbrook Human Services Center Update
VIII. Good of the Order IX. Adjourn
Agenda Item Discussion Conclusions, Recommendations Action, Follow-up Responsible Party
Due Date
I. Call to Order/Welcome
by Chair
Meeting called to order by Mayor Frank Eagles (Chair).
II. Western Region
Advisory Group
Mayor Eagles had a discussion with Ramon Rojano and
shared his thoughts that an Advisory Committee is key for further development of the Regional Network in the
west. Mayors are in favor a regional center but are
fearful of the pushback from town council & citizens.
Bob Sorrels stated that a Community Advisory Committee is needed in the west regardless of having a
building. Services are already there and we have
integrated intentions. Whether it is a storefront, rented space or a new building we need the same concept as
Ross Yeager requested clarification with the next steps, role of the Regional Networks Committee and role of
the staff so he can have a better understanding as to his role in moving forward with the west.
Who would be the key people in recruiting/identifying Community Advisory Committee members for the west? Staff could recommend or identify names of key
stakeholders in the western communities to the
Regional Networks Committee including a Chair that is a community member. The staff members located in
the west could serve as staff support to the committee and assist with keeping the Community Advisory
Committee enlightened and engaged. They currently
have relationships with area non-profits & key stakeholders established.
Darryl Blevins indicated that it is critical to appoint
someone to be lead when working with the Community Advisory Committee. There are many facets to the
committee around available services, keeping the
committee members mobilized as outlined in their work plans, and on-going input into service planning. The
concept maybe somewhat different from other regional centers.
Bob Sorrels reminded the Committee of the “Common Cause”, bringing integrated services to a region (not a
building). We currently have a foundation High House/Cornerstone to build upon. The purpose of the
Community Advisory Committee is to advocate for community needs and let the community know what is
already there.
Should we review the Community Advisory Committee functions and/or bi-laws?
Development Strategies, mentoring, coaching, skill building, financial planning, etc.
Project 100 Service Integration
Southern Regional Center is working to develop a plan to incorporate more HCD strategies into daily service
delivery. A better outcome for families is the ultimate goal.
V. Eastern Regional Center
Update
The Action Plan for the Eastern Regional Center Community Advisory Committee is complete. The plan includes: Marketing Services: Eastern Wake TV will spotlight ERC and the 10 year anniversary to be aired on East Wake TV. (Mayor Eagles suggested for Darryl to contact Mayor Matheny to see if he would be interested in being in a video). Community Advisory members will attend council meeting(s) to promote services. Health Promotions for Seniors: Focus on the safety and well-being of community members. ERC Community Advisory Committee members will partner with Sonya Reid, Health Promotions, to develop strategies. Faith partnership; increase service coordination to address service gaps.
ERC will celebrate and host a 10 year celebration on October 26
th. Committees and sub-committees for this
event have been formed. Save a date cards will be sent out this month. Darryl will be deploying for military duty at the end of June. Sonya Peterkin, Operations Manager will fill in during his absence.
VI. Northern Regional
Center Update
This was the first year NRC was an early voting site.
Three thousand eight hundred thirty-three (3,833) citizens voted.
The April 21st rabies/microchip clinic was extremely successful and is always a popular community event.
Engaging activities with staff (Amazing Grace-a spin off
from the TV series Amazing Race) around Service
Integration. These activities begin Monday, May 21st. Staff will learn about services offered from other
divisions.
VII. Millbrook Human
Services Center Update
LME will be moving out of the Millbrook building.
Millbrook is currently forming their Community Advisory
Committee. Three meetings have been held with community, business and faith partners to recruit
members. Kris will send all completed applications directly to Mayor Eagles for approval.
Forward CAC
applications to Mayor
Eagles directly. Chair (Mayor Eagles) will
endorse.
Kris Ramsundar
VIII. Good of the Order
IX. Adjourn After hearing no further business, Mayor Eagles
adjourned the meeting. The group will next assemble on Thursday, August 9th, 10am, Swinburne 5040.
DRAFT
1
Environmental Services Committee
May 11, 2012
Library Administration – Wake County Office Park
11:30 a.m. Wake County Board of Commissioner
Present
Human Services Board Members
Present:
Leila Goodwin
Frank Eagles
Melissa Jemison
Human Services Board Members
Absent: Clarence (Benny) Ridout
Jeffrey Smith
Kent Earnhardt
Dianne Dunning
Community Members Present:
Donald Haydon
Ed Buchan
Community Member Absent:
Buck Kennedy
Les Hall
Rodney Dickerson
Bob Rubin
Henk Schuitemaker
Phillip White
Bryan Hicks
John Whitson
Suzanne Harris
Julian Prosser
Paula Thomas
Kenny Waldroup
Glenn Harris
Liz Turpin
Julie Wilkins
Staff Present:
Joseph Threadcraft
Matt Roylance
Andre Pierce
Deborah Peterson
Sue Ledford
John Roberson
Ed Duke
Staff Absent:
Britt Stoddard
Sarah Williamson-Baker
Guests/Others:
Shivani Garg (UNC Chapel Hill Intern)
DRAFT
2
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
I. Call to Order
II. Minutes
III. Introduction of
Environmental
Services Committee
Members
Chair Leila Goodwin called the meeting to order at 11:50 A.M.
The April 13, 2012 minutes were approved as written.
Highlights Committee members introduced themselves to Shivani Garg, a UNC
Chapel Hill Intern shadowing Sue Lynn Ledford. Shivani will be
applying to the UNC Chapel Hill Public Health program next year.
Sue Lynn informed committee members that there will be multiple
college interns attending some of the meetings this summer. Interns
will come from East Carolina University, N.C. State University, UNC-
Greensboro, UNC-Winston Salem, Shaw and UNC Chapel Hill. Staff
has been encouraged to allow interns to be a part of their workplace.
Even if this requires some additional time, Sue Lynn reminded
committee members how important it was to cultivate the next Public
Health generation.
Committee
Member
Leila Goodwin
Sue Lynn Ledford
DRAFT
3
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
IV. Public Health
Update
Highlights
• The Ecoli State Fair Report is still being finalized. When
complete Sue Lynn will provide a copy to committee members.
• There is a new Communicable Disease (CD) Nurse. Currently
the CD Program is in a transition period while training is taking
place and if issues arise there is a very stable core team
available to assist client/staff.
• There is an increase in vector borne diseases. Staff is
conducting work in the communities to get educational
information out to the public. Sue Lynn encouraged committee
members to utilize the materials available through the
Communicable Disease Program. If there are any venues that
committee members feel this information could be used, please
contact the Communicable Disease Team.
• There was an issue with a rabid fox in Zebulon. Six people
were exposed. Two of the victims were children. Three of the
people involved received treatment. Because of this incident
staff saw an increase in the number of residents attending the
rabies vaccination and microchip clinic held at the Wake
County Eastern Regional Center on Saturday, May 5, 2012.
Two hundred and fifteen animals were vaccinated.
Sue Lynn Ledford
DRAFT
4
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
IV. Public Health
Update (Continued)
Highlights (Continued)
• There has been an increase in bat exposure. There have been
pets that have been euthanized due to exposure.
• There were several cases of Salmonella in Buncombe County
that was related to tofu and some other unpasteurized
vegetarian products. There were 2 or 3 restaurants involved.
There were a total of over 60 cases related to this incident. One
case involved a Wake County resident. There were six
different states involved. There was a voluntary recall on some
of the products.
• Parrott owned by a Wake County resident diagnosed by
veterinarian to have died from Chlamydophila psittaci (type of
bird flu). Because this is the second bird owned by this
resident to die from this disease, there will be a more thorough
investigation conducted involving staff and a state veterinarian.
DRAFT
5
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
IV. Public Health
Update (Continued)
V. Animal Services
Division Update
Highlights (Continued)
• May 18, 2012 – Symposium/Training held on Mass Fatality
Response (Cultural Issues as it relates to Death and Burial) –
Because of the increase cultural variables in Wake County
there were questions/issues arising that violated the death and
burial laws in the vital records section. Wake County wants to
be sensitive to cultural needs but at the same time the County
must abide by state laws. This training is designed to help vital
records staff, hospitals, funeral homes, etc.
Highlights
• Animal Services Director Position – No candidate chosen from
first set of interviews. 2nd set of interviews conducted. (Since
the May 11, 2012 meeting Dr. Jennifer Federico has been hired
as the new Animal Services Director effective June 1, 2012.
Dr. Federico is a veterinarian with a background in shelter
medicine who has worked as one of the Wake County Animal
Center's veterinarians for approximately one year. She has
tremendous knowledge of animal health and medical issues, as
well as an excellent understanding of how the Wake County
Animal Center operates.)
Matt Roylance
DRAFT
6
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
V. Animal Services
Division Update
(Continued)
VI. Proposed Food
Code Changes
Highlights (Continued)
• TNR Ordinance – Because staff and the Cat Committee could
not come to an agreeable ordinance, the Board of
Commissioners requested staff work with the Cat Committee to
develop two versions for their review. One issue is that staff
would like to have a registered contact should there be issues
with one of the colonies of cats. (At the time of this May 11,
2012 meeting an agreement had not been reached on this
registered contact issue. These draft ordinances were brought
before the Board of Commissioners at their May 21, 2012
meeting. Update to be given at the next meeting.)
Highlights
• FDA prepares a food code every 4 years. The Conference for
Food Protection met this year. During this Conference each
state had 2 votes. North Carolina voted for food codes this
year. North Carolina regulators and industries participate in
this very involved, extensive and technical process.
Andre Pierce
DRAFT
7
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
VI. Proposed Food
Code Changes
(Continued)
Highlights (Continued)
• In 2009, Wake County conducted an assessment of the North
Carolina rules as compared to the 2005 FDA Food Code and
the practices of the North Carolina rules were 50% compliant
with the 2005 FDA Food Code.
• There were some gaps identified in the in the State rules. They
involved:
(1) Barehanded Contaminant
(2) Cold Holding Temperatures
(3) Date Marking
(4) Employee Health Policies
(5) Consumer Advisory
(6) Special Food Processes
(7) Emerging Science
• When North Carolina adopts the 2009 Food Code it will be
used as a model for operating. In North Carolina the rule
making is centralized. Counties do not have the authority to
develop ordinances on food codes. In some States this is not
the case and therefore when going from one jurisdiction to
another there maybe complications in interpreting the rules.
DRAFT
8
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
VI. Proposed Food
Code Changes
(Continued)
VII. Solid Waste 10
Year Plan Update
Highlights (Continued)
Proposed Schedule for FDA Code Adoption:
5/16/12----------Commission for Public
6/21/12----------Rules Review Commission
7/01/12----------Adoption
9/1/12------------Implementation
Highlights
• The Solid Waste 10 Year Plan has been approved by Cary,
City of Raleigh, Fuquay-Varina and Zebulon. Short
presentations are scheduled to be for the other Towns.
• Goal – Submit to the State by June 30, 2012
John Roberson
DRAFT
9
Agenda Item
Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party Due
Date
VIII. Update on Septic
System Subcommittee
IX. Adjourn
Highlights
• The Septic System Subcommittee contains members of the
Public Health Committee and Environmental Services
Committee. They’ve had two meetings thus far. Leila
Goodwin will send copies of the work plan which shows future
scheduled meetings. Currently this committee is in education
mode and has had several experts to come in and speak to the
group. There will be stakeholders input build into this process.
There will be point where the Septic System Subcommittee
will come before the Environmental Services Committee with a
presentation and ideas and start getting feedback on the
direction they may be headed.
THE JUNE ENVIRONMENTAL SERVICES COMMITTEE
MEETING WILL BE CANCELLED. THE NEXT MEETING IS
SCHEDULED FOR FRIDAY, JULY 13, 2012 @ THE LIBRARY
ADMINISTRATION BUILDING, WAKE COUNTY OFFICE
PARK, ROOM 102,
4020 CARYA DRIVE.
Leila Goodwin
Wake County Human Services Board LME Advisory Committee Meeting Community Services Center – 401 E. Whitaker Mill Road, Rm. 210
Mr. Paul Gross and Ms. Beth Nelson presented the LME Monthly Financial Reports as of May 15, 2012. The committee reviewed and discussed the reports. Highlights included:
• Mr. Gross said last month the LME projection for Purchase of Services UCR overspending was $800,000. However, this month, the new projection is $722,956. Mr. Gross estimated the projection at fiscal year end to be between $580,000 - $590,000. Within the next few days, the county will transfer uncommitted LME Systems Administration dollars to cover the overspending.
• HHH inpatient expenditures are on target with FY12 budget projections (under by $1,192). HHH is expected to open additional beds on June 1st, and this could impact the figure during June for the FY12 budget. Demand is high at HHH.
• The state has fixed the glitch in their system for funding drawdown of IPRS UCR earnings in the Child Mental Health category, and the LME has drawn down the earnings at 100%.
Discussion on County Budget FY13: • Ms. Foreman said the county plans to have a funding cap for the MCO and Co./HHH contract. The county, MCO, and HHH
are in re-negotiations with the Co./HHH contract and anticipate having it finalized by June 30.
• Ms. Crystal Farrow said the question will be what to do with unfunded Wake County clients—this is still an unfilled gap in the continuum.
Committee Request: Suggested that the county approach the state for 3-way contracts. Urged to act fast, because State Legislators are considering these contracts now and the opportunity may be gone by next week.
Discussion of Consultant’s Wake County Behavioral Health Strategic Planning Final Report
A Steering Committee with representation from Wake County, the University of North Carolina Health Care System (UNC Health Care), and the North Carolina Department of Health and Human Services (NCDHHS) commissioned a consultant team in August 2011 to analyze behavioral health services in Wake County. The overall purpose of the project was to identify gaps and plan for how best to utilize county resources to meet anticipated growth in the behavioral health population in need of services amidst the challenges associated with federal health care reform as well as local and state changes in the service management and delivery system for this population. Seven (7) key strategic objectives were identified. The full report and the county manager’s presentation can be viewed at the Board of Commissioner’s meeting agenda page: Work Session May 14, 2012. One outcome of the study was a proposed framework for an enhanced partnership between Wake County, UNC Health Care, and Alliance Behavioral Healthcare (MCO). A formal agreement among the parties is being developed with many details yet to be determined prior to consideration by the Board of Commissioners, currently slated for an August 2012 meeting. Discussion: • The county provides $20 million in local dollars for MH/DD/SA services. The county asked UNC to advise them on how to
use the $20 million. UNC has many years of expertise in mental health services.
• The committee discussed the background, overview, key findings, and recommendations of the final report. Ms. Foreman said the report provides good data to help inform decisions. The primary goal is to not have any conflicts of interest in WCBHS as of January 1, 2013. There are opportunities for improvements and partnerships for the spectrum of services. Wake County, UNC and MCO are at the table and will work together.
• UNC will help with the transition. The transition period is 18 – 24 month.
• Ms. Foreman said the county is trying to be transparent and trying to share as much information upfront as possible. There are many details to work out. She pointed out that the county could wait until September when the plan has been developed, but it would not be as inclusive. She said the county preferred to get input first, because we don’t know all of the answers.
• Mr. Tad Clodfelter and Dr. Jim Haryte commented that some oversight is needed to ensure no cherry picking of services. Mr. Rojano said the MCO Board has oversight and that committee members are free to discuss it with them.
New Item: 24-hr. Stay Issue with Crisis Services and Department of Health Services Regulations Mr. Ramon Rojano and Ms. Crystal Farrow
Mr. Rojano and Ms. Farrow gave an overview of a new situation that happened this week.
24-hour Stay Issue at Crisis Services: The new manager of the Guilford Center phoned Department of Health Services Regulations asking if they needed a license to keep people more than 24 hours at the crisis center. This call prompted an investigation and DHSR found that Wake was also holding patients for more than 24 hours in a non-licensed facility (WakeBrook downstairs). DHSR toured WakeBrook on May 1.
DHSR defines stays over 24 hours as a licensed facility.
Ms. Farrow said the single largest contributing factor is the state hospital level of care. The lack of state beds is forcing Crisis Services to hold people longer. Mr. Rojano said this is ten percent of the people served. Ms. Farrow said Crisis Services is near to doubling its budget for overtime and staffing.
If Crisis Services cannot hold people beyond 23 hours, they would need to send the patients to the ED, in which they would start over on the wait list.
Jan.-April, 2012: total visits to Crisis Services total 1,819, of those 734 patients were sent to an inpatient setting. The total number that stayed longer than 23 hours was 181 (or 10%) people, of this group the average length of stay was over three days per person, with the longest length of stay being 16 days.
One out of ten is adolescent. The new PRTF Facility in Garner, opening in September, will help with adolescent services.
Also, on July 1, it will be the Alliance Behavioral Healthcare (MCO) responsibility to make these decisions.
Wake County told DHSR that the solution would need to come from the state.
After the meeting with Wake County, DHSR said they would discuss the situation with the DHHS Secretary to see what route to pursue.
Good of Order • Chair Treadway asked if the MCO would be setting up an advisory committee. The committee agreed that the question for the MCO Board is how do you see the MCO Board staying in touch with Wake County issues.
• Chair Treadway said that she wants the HS&ES Board and BOC to recognize the Mental Health Authority for providing 50 years of services. She has asked Dr. Johnson to prepare a resolution in recognition. Mr. Rojano offered to assist. This item was moved to the June Board meeting agenda.
• Dr. Johnson announced that Alliance Behavioral Healthcare (MCO) will be hosting several Town Hall Meetings to provide information and to answer questions. The meetings are open to providers, advocates, and consumers. He offered to email information about the meeting being held on May 29.
Meeting Adjourned
Meeting adjourned at 2:07 pm. Next meeting is June 19, 2012, CSC 12:00 pm– 2:00 pm
Public Health Committee Meeting Minutes –18 May, 2012
Committee Members Present: Benny Ridout, Leena Mehta, Barbara Ann Hughes, Penny Washington, Sharon Foster, Anne McLaurin, Ann Rollins, Burton Horwitz, Barbara Ann Hughes, Lynette Tolson Staff Members Present: Peter Morris, Randy Marsh, Andre Pierce, Edie Alfano-Sobsey, Michelle Ricci Guests: Kristina Wharton, (NCSU
Agenda Items
• Welcome • Approval of Minutes • Chair’s Privilege • Human Services and Environmental Services Board (Board) Advocacy
Agenda • Obesity/Overweight • Public Health Quarterly Report • Behavioral Health Update
Welcome and Call to Order Benny Ridout
Benny called the meeting to order. Benny welcomed new committee member, Lynette Tolson. Committee members and staff introduced themselves.
Approval of Minutes
Benny asked for a motion to approve the minutes. Barbara Ann Hughes made a motion that was seconded by Penny Washington. The minutes were unanimously approved.
Chair’s Privilege Benny Ridout Update on Wastewater Treatment Systems (Septic Tank) Subcommittee
The first meeting of the wastewater treatment system subcommittee focused on the problem of failing septic systems and where they are located in Wake County. The second meeting was a visit to the NC State farm to observe working septic systems and learn more about how they function. A report was made on the causes of septic tank failures; maintenance is a primary issue. Some homeowners are not aware that they have septic systems. The subcommittee will be discussing ways to address septic tank failures and developing recommendations to move to the Board and County Commissioners. Discussion included:
• Noting individual and community consequences of failed septic systems both
in terms of disease and effects on the drinking water supply.
• Next steps include a review of literature and studies. Edie Alfano-Sobsey and
a representative from the NC Department of Public Health will make a
presentation at the next meeting.
• The benefits of visiting the facility at the NC State were increased
understanding and realization of the quality of the facility. People from
different parts of the country train there.
• The close tie between septic tanks and wastewater management.
• The importance of and venues for education about septic systems. Realtors
do provide information from the County about septic tanks and their
maintenance.
Public Health Committee Meeting Page 2
Advocacy Agenda Sharon Foster
Purpose: Continue discussion on the Board advocacy priority “Decrease disparities in key disease indicators such as infant mortality and chronic disease morbidity and mortality.” Action: Identify strategies to engage stakeholders in this advocacy item. The Board has several priorities in each of the divisions in Human Services. The one that bubbled up from Public Health Committee is “Decrease disparities in key disease indicators such as infant mortality and chronic disease morbidity and mortality.” The Executive Committee has asked that the audience and the specifics of how this will be accomplished be identified. When speaking with the Legislative Committee, the focus was on use of better technology, specifically through NC FAST, as a way to get clients and providers through the Medicaid system expediently. This combined with making reimbursement more competitive will increase the economic feasibility of taking Medicaid clients for both medical and dental providers. Advocacy efforts also support the educational campaigns that increase enrollment. There are many uninsured children who would qualify for Medicaid Health Choice; parents may be unaware they are eligible or have not taken the time to enroll. The enrollment form is 2 pages and the state has been able to enroll more children than any other state.
Stakeholders identified for further education so far are:
• Physicians need to be at the top of the list—especially those practitioners who may not participate in grand rounds types of educational offerings.
• The Wake Delegation. The advocacy work group foresees meeting with the delegation a couple of times a year to educate about disparities and advocate for ways to decrease them.
• Community groups such as community advisory councils. Sue Lynn has been making presentation to the faith community about disparities in heart disease, hypertension, obesity, cancer etc.
Discussion included:
• The North Carolina Council of Churches has partners in Health and Wellness that covers an 8 county district. Poe Center for Health Education partnered with the Council; a registered dietitian wrote a four series health and wellness curriculum for faith based organizations that included the organization as well as the hostess.
• Focusing on 2-3 disease disparities. The number one priority is obesity. Take this as our chronic disease for adults and children. Addressing this impacts other chronic diseases and infant mortality as well.
• STI’s. Addressing this disparity would impact infertility issues as well. Physicians are quantitated on how many of their female patients are screened for STI’s. One of the challenges in screening sexually active females in a pediatric practice is that the test goes on the parent’s bill which affects confidentiality.
• Conversations about Medicaid need to be more specific. While everyone is looking for better Medicaid rates, that may not happen because of the budget. For example, if the focus is on maintaining Medicaid rates for children, for dental Medicaid for dentists who see children, it’s a much easier audience
Public Health Committee Meeting Page 3
than if the focus is on Medicaid rates for providers. • Overhead for the average dental office is 65 to 75%. Participation in Medicaid
has been decreasing; there has not been any adjustment upward in a number of years. The costs of dentistry are much smaller but they are an important part of overall heath. More children are missing school from dental problems than any other reason.
• Medicaid will likely have to make cuts due to lack of money. If Medicaid reimbursements are increased, where will the cuts be elsewhere? That needs to be considered in advocacy.
• Someone needs to advocate for increasing taxes to get more revenue and the health of our population is important to do that
• Ann Rollins offered to send information about HB 503 along with talking points to Michelle to forward to committee members if members want to advocate on something that will have an impact in the next few weeks.
• The talking points address that getting more Medicaid may not be possible; the Board and Committee can advocate for maintaining and making it more efficient and use other means like advocacy in the faith community at the grass roots level without funding to help address issues such as obesity.
• Are there Spanish speaking advocates to work with Spanish churches? The Latino community is impacted by health disparities and there are great educational needs.
• School based health centers were suggested however that may limit efforts as those centers don’t address STDs.
• There was a bill in the legislature recently because of a parent whose child was being treated for an STD without the parent’s knowledge. Advocacy efforts should proceed with care in this area.
• Adult clinics should be able to screen those who are sexually active but the younger population 15-19 with very high chlamydia rates is not being screened because of confidentiality issues.
• Do the schools have wellness policies, are they being implemented and monitored. That may not take additional funding.
• The Legislature may do more with tobacco prevention than previously thought; can address comments to Wake County representatives
• One third of the Child Fatality Task Force’s recommendations are related to infant mortality reduction their agenda could be sent out.
• Additional stakeholders might be Parks and Recreation, the Y, Poe Center, Boys and Girls Club
• The medical home concept is spreading. To become a medical home one must participate in quality improvement initiatives. When initiatives are met, reimbursements increase. That is a positive way to entice physicians into developing strategic plans in client care.
Overweight/Obesity Benny Ridout Leena Mehta
Purpose: Continue discussion from March meeting on Committee activities to address Board and Committee priority of overweight /obesity. Action: As determined by discussion. Leena provided the following outline of the strategic planning process for the Healthy Weight Stakeholders group. The group is ready to move into the gap/analysis and prioritization phase of its work having been successful in the discovery phase. Leena highlighted each phase for the committee. WAKE COUNTY HEALTHY WEIGHT PROGRAM (DRAFT SHELL FOR PLANNING)
I. Discovery Phase
Public Health Committee Meeting Page 4
a. Purpose
b. Vision
c. Possible Assumptions & Barriers
d. Data or Information Gathering
e. Stakeholder Impact Analysis
f. Gap Analysis
g. Prioritization for Approach in Phases
II. Planning Phase (TBD)
a. Determine Phases
b. Taskforce Governance
c. Partnerships/Collaborations
d. People, Process, Technology
e. Communications/Training
III. Design & Development Phase (TBD)
IV. Implementation (TBD)
DISCOVERY PHASE:
PURPOSE:
Prevent overweight and obesity in Wake County by:
• Promoting a healthy living environment
• Build an agenda for community health improvement
• Assess Wake County health status in general
• Making healthy weight initiatives visible in the community
• Tracking behaviors -lifestyle, nutrition, and exercise of people living in Wake
County
• Empower people to assess their health status
VISION:
Build a healthy community in Wake County where all residents are able to live, work,
play in a healthy environment and maintain a healthy lifestyle.
SCOPE OF PROGRAM:
(What is healthy environment and how can it be provided so that Wake County
residents may live, work, and play to create and maintain a healthy lifestyle)
ASSUMPTIONS (possible, depending on the Plan Phase TBD):
• Support from Wake County Schools
• Support from Food and Beverage Industry
• Support from local Hospitals
• Support from local places of worship
• Support from Foundations (business organizations and philanthropic)
• Support from stakeholders mentioned below
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CONSTRAINTS/BARRIERS (perceived):
• Policies at School, Work, and Community
• Accessibility to affordable fruits and vegetables
public school system over the past few months and there is agreement on the part of the school system to participate in part of the YRBSS. Ten thousand dollars is needed for that effort.
• WCHS is developing a 2 year strategic plan for the agency that should be completed by fall. The goals have been approved and the plan is at the point of developing agency wide and program objectives. It is fully anticipated that there will be an agency objective that addresses obesity. One of the problems is lack of data. Another issue is identifying a target.
• Not all stakeholders are using the same outcome data. Consistent collection of data using the same definition for perhaps two data points would save time and effort.
Benny thanked Leena for her work on the planning draft and report to the committee.
Public Health Quarterly Report Edie Alfano Sobsey
Purpose: 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). Action: Accept quarterly report; recommend report to Human Services and Environmental Services Board. Use as needed to inform discussions, decisions, and advocacy efforts related to public health. Edie reviewed the January – March 2012 Public Health Quarterly Report highlighting:
• The Community Health Rankings. Counties were ranked among other counties in North Carolina and rankings are from the community-- not solely public health. Outcome indicators are available nationally and statewide; Wake County’s indicators should be identified as a result of the strategic planning process.
• The differences in each report are due to some data being available annually and some quarterly. The format may change after the strategic planning process with the development of targets so movement toward targets can be tracked.
Discussion included: • Current efforts that impact the physical environment ranking (air quality
program, auto emissions program, mass transit, etc.) • Food violations being reported to Public Health and Environmental Services
Committees. It was noted that the Food Code passed in the Legislature on May 17.
• Current adult obesity data locally is about the same based on behavioral risk factor surveillance study.
Benny asked for a motion to accept the report and recommend it to the Board. Penny made a motion that was seconded by Barbara Ann Hughes. The report was unanimously accepted. It was noted that the Public Health Accreditation process is danger of being eliminated because of budget cuts. The mandate for accreditation will still exist and if funding is cut, counties will have to absorb those costs. Also of concern is that funding will be eliminated and the mandate will be for national accreditation which will cost an estimated $30,000 to $40,000 for a county the size of Wake. Currently it is estimated that the state accreditation process costs about $12,000 for each county. Advocates are asking that the program be funded if the mandate remains or to remove the mandate if funding is removed.
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Behavioral Health Update Randy Marsh
Purpose: Provide committee members with an update on changes in Behavioral Health programs and services. Action: As determined by discussion. Since the last update to the committee, UNC has agreed to work with Wake County. The specifics of what and when are still unknown at this time. Wake County Behavioral Health provided UNC with a large amount of data about its programs and services to UNC’s strategic planning department. UNC has in turn requested additional information to decide how to work with Wake. In the meantime Behavioral Health is building a relationship with the new managed care organization that will begin its work on July 1. There are some areas of concern when considering the integration of behavioral health services in the Human Services agency. One is a conflict of interest statement by the Division of Medical Assistance (DMA) because there are Commissioner appointed Wake County representatives on the board of the new managed care organization (MCO). For that reason Wake County cannot be a provider of Medicaid or federally funded services that are managed through the MCO. If that conflict of interest holds, Wake Behavioral Health will have to stop providing Medicaid services. A question about that conflict extending to social workers in public health providing behavioral health services has been posed --will the new MCO be responsible for managing their Medicaid spending? There’s a DMA clinical coverage policy 8I which is behavioral health services provided in a public health department and all the other number 8 policies are mostly covered by the MCO. The MCO is consulting DMA about that and the outcome is pending. Also of concern is the potential loss of non-treatment behavioral health expertise in the provision of public health services related to tobacco use prevention and substance abuse, as well as in social services. Wake County has been able to totally fund a Master’s level psychologist with expertise in substance abuse and mental health to work in Clinic A through Ryan White funds. She can continue to provide services regardless of the behavioral health transition. At the same time a 2/10 time position (about 8 hours) is being lost. There has been little discussion given to the potential loss of behavioral health services that are integrated into both public health and social services and how those services can be carved out and retained. Discussion:
• Priorities for tobacco/addictions/diseases and obesity are all related to behavioral health.
• The legislature mandated this to save money and managed care saves money by cutting services.
• This is a different time with health information technology. Medicaid is paying based on outcomes—it is time to look how everyone can work together instead of as individuals. As in the case of obesity, there are many in the community working on the same issue. Perhaps Public Health can pull the community together in a convener role. How can the community take care of its needs in a way it has never been done before?
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Benny asked Dr. George Corvin and Jim Bernstein, new Wake representatives to the MCO board, to represent mental health on the public health committee however the board of the MCO board thought it would be a conflict of interest. Dr. Corvin may be able to recommend someone else.
Adjournment Benny thanked committee members for their participation and adjourned the meeting.
Public Health Division Director’s Report
Public Health Committee Updates
Friday, May 18, 2012
Sue Lynn Ledford RN BSN MPA
Public Health Division
1. Cultural Issues Related to Death and Mass Fatalities Preparedness is being conducted today, Friday, May 18, 2012
from 10am to 2 pm. The training is at the WakeMed Andrews Center. The invitees include a variety of people from
public health, hospitals, emergency operations, funeral homes, Hospice, NC PH Preparedness, medical examiners,
faith based groups and law enforcement.
2. BP Zebulon Tobacco Violation. BP Zebulon has filed Petition to appeal the 3/14/12 ruling. This is scheduled for June
and we will keep the Committee informed with status updates.
3. Healthy Weight Stakeholders meeting was held 5/15/12 with good attendance. We heard from the Data and
Marketing Committees. AHA’s new Director, Sheree Vodicka, was welcomed on board and was introduced to the
Stakeholders group. She is off to a great start and has been meeting with many in the community. Leena Mehta
was present and outlined a plan for the next steps in our Strategic Plan. The group has been successful in the Data
and Investigation or Discovery Phase and is now ready to move into the next phase of Gap Analysis Prioritization
Exercises. Leena will update the Public Health Committee on those plans at this month’s meeting. .
4. State Fair Task force on E. Coli outbreak meeting updates
a. Final recommendations have been submitted to Commissioner Troxler and will be released in near future
b. Recommendations will include
i. Logistical changes in layout of Kelly and other buildings to segregate animals from human contact
ii. Will NOT prevent public viewing and access to animal education portals
iii. Increased education and hand wash access points
c. Wake County Public Health Division will be conducting an “Observation Study” of 3 different hand washing
stations during the Got to be NC event May 18-20, 2012. The purpose is to evaluate and compare the
utilization and effectiveness of the various types of stations and inform the State Fair plans.
5. Health Disparities presentations have been conducted in past few weeks to raise awareness and encourage a
community call to action. Presentations have been made to:
a. Strengthening the Black Family
b. N & O (interview)
c. Raleigh Community Advisory Council Leaders
d. Wake Missionary Baptist Church Association and
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e. Latino Faith Initiative
Additional presentations have been planned
6. Multiple interns from ECU, UNC-CH, NCSU, UNC-G, UNC-W, Shaw, etc. are on site for the summer.
7. WCHS Strategic Planning process (next 2 year plan) is underway and there will be request for feedback from the
Public Health Committee as the process moves forward. Michelle and Sue Lynn will be coordinating with Benny.
Epi Team
8. Communicable Disease Update
a. There is a new staff nurse on board in CD Section.
b. Vector borne diseases are seeing an increase as is usual for this time of year. The following items are
available to groups or locations that would have a need for posters or brochures:
• 2012 Lyme disease surveillance memo for health care providers
• 2012 Arboviral disease surveillance memo for health care providers
• 2012 Tick-borne Rickettsial disease surveillance memo for health care providers
• Tick borne illness poster (though developed with the former DENR/PHPM staff, the content
is still appropriate)
• Wake County tick bite prevention poster. Developed last year by Wake County staff, the
poster is good public information and in English and Spanish.
c. There was another rabid fox incident this month involving several people. The incident occurred at Zebulon
park on 5/4/12; 6 people evaluated for exposure (2 were children) and 4 are receiving post exposure
prophylaxis.
d. There has been an increase in bat exposures: 4 positive last week and this warrants public being more alert
and encouraged to make sure household pets are vaccinated even if they are kept indoors.
e. The salmonella outbreak in Buncombe County has been linked to tempeh and tofu consumption. Two or 3
restaurants are involved (there is not a state law for pasteurization for these food items). There are
approximately 60 cases as of last week, 1 was from Wake County and total of 5 states were involved. There
has been a voluntary recall of the food items by the company.
f. Recent case of Chlymdiophilia psittaci (type of bird flu) in a household pet --Senegal parrot. The Wake
County pet owner did have another bird that tested positive in 2007. Carl Williams, State DVM has
communicated to resident regarding the positive test and possible transmission to humans. WCHS- PH
Division will be investigating further to fully trace back information.
g. One hundred and ten people were screened for TB at an area elementary school due to a student exposure.
No disease spread has been detected.
Other
9. Ricin scare in April, 2012 with law enforcement and Wake Med was resolved without further incident. (After action
did yield some recommendations for communication pathways to be better defined.)
10. The Raleigh US Postal Services building is conducting an Anthrax Drill on June 14, 2012. Public Health will participate.
11. Sue Lynn attended the National Public Health Services and Systems Research Conference in April. Speakers
included: CDC Director Dr. Thomas Friedan, Dr. Harvey Fienberg, President of the Institute of Medicine, and Debra
Perez PH.D, Assistant Vice President of the Robert Woods Johnson Foundation, Richard Umbdenstock, President and
CEO of the American Hospital Association, Association of State and Territorial Health Officials Executive Director and
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National Association of City and County Health Officials Executive Director as well as many other distinguished
health leaders. The conference was full of cutting edge Population Health research info and promises to be helpful
to WCHS as we evolve into a more data-driven agency.
12. See advocacy info from the North Carolina Association of Local Health Directors below:
NCALHD North Carolina Association of Local Health Directors
Advocacy Talking Points
Consolidated Governance of Local Health Departments (LHD)
North Carolina can create a public health system that allows integration of local services while protecting the health of
North Carolinians. In order to do so, the public’s health must be the focus of all decisions made by policy makers.
Introduction: Current Environment for counties
1. Counties currently have the authority to physically consolidate local DSS and LHD by:
• Combining local DSS and LHD staff and programs in one building
• Utilizing the same registration area for clients of DSS and LHD
2. Counties currently have authority over LHD budget by:
• Controlling the county portion of the LHD budget
• Bringing LHD financials under the county finance system
• Appointing all Board of Health members
3. Counties currently have authority over LHD staff (local health director) by:
• Appointing all Board of Health members. G.S. 130A-35 (b)
• Board of Health appoints a local health director after consulting with the county board of commissioners. G.S.
130A-40 (a).
What North Carolina needs to do in the interest of the public’s health
1. Preserve Boards of Health –
a. Who bring a level of expertise to the table based on their particular profession - (NCGS 130A -35).
b. Are by statute responsible for protecting and promoting the public’s health – (NCGS 130A – 39).
c. Has the authority to Adopt Rules, including all municipalities – allowing them to take a leadership role in
critical public health issues; providing a buffer between decisions made and the local BOCC’s. – (NCGS 130A
– 39).
d. Serves many functions: i NACCHO 2011 survey of the nation’s 2,568 LHD
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i. (87%) Advise Elected Officials on Policies, Programs, and Budgets.
ii. (81%) Set Policies, Goals, and Priorities that Guide the LPH.
iii. (65%) Hire and Fire the Agency Top Executive.
2. When considering a change in the governance of a local DSS and LHD, county board of commissioners should
collaborate with and have support of local boards of health and local boards of social services. (In current legislation
for multi county authority, G.S. GS 130A-36.) The county board of commissioners should consult with the local
board of health concerning such an important local public health decision.
3. Local Human Services Director should meet the same education and experience requirements as found in G.S.
130A-40 (a).
a. Value of having regulated education and experience requirements for the position (NCGS 130A-40).
b. Who have the legal authority to act when people’s health is in question (NCGS 130A-41)
c. Factors which enable the role and enshrine a duty to serve every person equally and fairly in the
enforcement of laws, rules or policies relating to health.
And which provides a buffer between the Health Department and the County when controversial decisions affecting the
public’s health are made
i NACCHO Research Brief. Local Health Department Job Losses and Program Cuts: Findings from January 2011 Survey and 2010
National Profile Study. Available at
http://naccho.org/topics/infrastructure/lhdbudget/loader.cfm?csModule=security/getfile&PageID=198106; June 2011