wake county social services committee june 7, 2013 agenda ... · action: receive, discuss and vet...

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Wake County Social Services Committee June 7, 2013

AGENDA Human Services Center

220 Swinburne Street, Rm. 2132 **Extended Time: 8:30am – 10:30am**

Purpose: To review progress on current Social Services Committee and related priorities and to begin the process for setting the next group of priorities

Action: Participate in a review and discussion of current priorities and

prepare to make decisions about the priorities and Work Plan for 2014-15.

Purpose: Inform the Social Services Committee about the causes of childhood mortality in Wake County in preparation for informing the Wake County Human Services Board and the Board of Commissioners

Action: Receive, discuss and vet report before sending it to the Human

Services Board

8:30 AM Call to Order - Ms. Angie Welsh, Chair

Approval of Minutes

8:35 AM Prioritization Discussion Starts - Ms. Regina Petteway, Facilitator

10:05 AM Report from Wake County’s Child Fatality Task Force/County Child Protection Team (CFTF/CCPT) - Ms. Lisa Cauley, Presenter

10:25 AM Wrap-Up - Ms. Angie Welsh

10:30 AM Adjournment - Ms. Angie Welsh

Next Meeting Date: **July 12, 2013** NOTE: Date Change!!

http://www.wakegov.com/

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Wake County Human Services Board

Social Services Advisory Subcommittee

Friday, May 3, 2013

9:00 am – 10:30 am

Swinburne Building, Room 2132

Minutes

Board Members:

Pablo Escobar – Chair

John Myhre

Tameko Piggee

Angie Welsh –

Community Members:

Kathryn Johnson

Paul Norman

Lorrinda Michieka

Staff:

Ingrid Bou-Saada

Janny Flynt

Ramon Rojano

Vielka Maria Gabriel

Nikki Lyons

Liz Scott

Warren Ludwig

Agenda Item

Discussion, Conclusions, Recommendations Action,

Follow-up

Responsible

Party

Due

Date

I. Welcome

&

Introductions

The meeting was called to order at 9:09 am by Chair Pablo Escobar.

Pablo

Escobar

II. Review

and approval

of the

minutes

The April 5, 2013 minutes were reviewed. John Myhre moved to approve the minutes,

and Paul Norman seconded. They were approved with no corrections.

Ingrid Bou-

Saada

2

III. Chair’s

Opening

Remarks

• Pablo referred the group to a handout on Community Members’ Terms of Service.

Community members of the Committee were alphabetically assigned staggered

terms of service with 3 members’ terms expiring in 2015, 2016, or 2017,

respectively, in order to ensure continuity and efficiency for the Committee

proceedings. Board members already have assigned terms of service on the

Committee based on their Board appointments. This brings the Committee in line

with the Human Services Board Operating Procedures.

• Pablo announced that this would be the last meeting for which he will serve as

Committee Chair. He appointed Angie Welsh as new Chair beginning with the

June 7 meeting.

Action,

Follow-up

Receive

information

about

Committee

structure and

leadership

Responsible

Party

Pablo

Escobar

Due

Date

IV. Business

Discussion

Work Support Strategies and Division of Social Services (DSS) Transformation

• Liz Scott provided a presentation (handout of PowerPoint slides provided) about

the changes happening at the state DSS, including the transformation of large

initiatives into a new model called Work Support Strategies.

• Discussion Highlights

• Staff will be empowered to try new things in how they interact with clients, but

the majority of the programs are still prescribed by Federal policy.

• Timeline for change in programs and in rolling out NCFAST is aggressive, and

it is driven primarily by the Affordable Care Act, which requires some

marketplace things to be in place by October 2013. Food and Nutrition Services

(“food stamps”) currently transforming, followed by Medicaid and Work First

by late August-early September 2013. Then by early 2014, all active Medicaid

and Work First cases will be converted. Later, Child Care Subsidy and energy

assistance (CCIP and LIEAP) programs will be in NCFAST. Future programs

to convert to NCFAST include Child Welfare, Aging, and Ault Services.

• ePASS (electronic Preasessment Screening Service Tool) is an online system

that will reduce the need for clients to present in person. Ramon suggested

Committee members familiarize themselves with this online assessment,

screening, and application tool.

The Committee

received the

update about

changes in DSS

and engaged in

discussion

about the

information

Liz Scott

(Presenter)

3

IV. Business

Discussion

Director’s Report

• The way the Public Health and Social Services Committees are structured is

changing. Ramon thanked Regina Petteway, Jonica Hinton, Michelle Ricci, and

Ingrid Bou-Saada for working to operationalize this reconceptualization of

committees to begin focusing on one “:main dish” each month, which is primarily

a part of a standard calendar. Meetings will be an opportunity to activate

Committee members and encourage participation, with an emphasis on

articulating public policy for social services.

• The transformation of the Division of Social Services includes ideas for

redesigning space in the main buildings. This is still in budget negotiations and

not yet approved.

Proposed Transformation of Space in Sunnybrook and Swinburne

• Bob Sorrels, Deputy Director, presented information on proposed changes to

physical space in the two main Human Services locations, Swinburne and

Sunnybrook that are occurring in conjunction with the transformation of Work

Support Strategies and the Division of Social Services as well as the change to

more electronic and virtual ways of serving clients.

• These changes will increase interview space, the ability of clients to carry out self-

service, seating capacity. Kiosks will allow clients to scan official documents (like

birth certificates) for their applications. Self-service computers will allow them to

fill out applications.

• Some programs will shift locations such as Medicaid moving from the basement of

Sunnybrook to the first (ground) floor and becoming more of a multi-purpose stop.

• WIC will have consolidated offices on the ground floor.

• Other locations will also see some reorganization with the changes in Behavioral

Health

• Regional Centers will also see some changes to enhance Job Link Centers and to

increase Human Capital Development capabilities.

• Bob will prepare orientation for Board and Committee members and is pleased to

offer future tours to those who are interested.

Action,

Follow-up

The Committee

received

various

updates and

information

The Committee

received

various

updates and

information

Responsible

Party

Ramon

Rojano

(presented)

Bob Sorrels

(presented)

Due

Date

4

IV. Business

Discussion,

cont.

Preparation for Committee Priorities Setting at June Meeting

• Angie Welsh set the stage for the next meeting by summarizing the next steps in

the Committee prioritization process. She referred to the PowerPoint presentation

in the meeting packet.

• Of the 6 current Board priorities, three are assigned to the Social Services

Committee: prevent child abuse and family support, housing for vulnerable

populations, and human capital development. The Committee is responsible for

reviewing the rationale and supporting data for each priority as well as the work

done by the Board/Committee in support of each priority since June 2011. Each

priority will be reaffirmed or rejected, and recommendations will be made to the

Board by July.

• Ingrid Bou-Saada helped Committee members become familiar with the various

handouts in the packet.

Action,

Follow-up

Responsible

Party

Angie

Welsh

and Ingrid

Bou-Saada

(presenters)

Due

Date

V. Next

Meeting Friday, June 7, 2013

8:30 -10:30 am ~ Swinburne Building, Room 2132

VI.

Adjournment

The meeting adjourned at 10:30 am.

Note: the next

meeting is

expanded in

time

Pablo

Escobar

Wake County Human Services and Environmental Services Board Action Planning Worksheet

Date _Dec. 3, 2010__

Priority: Child Abuse Prevention Plan Period: 3 Year Strategy; 1 Year Plan

Objective: Promote collaboration efforts to prevent Child Abuse and support families in Wake County

Strategies/Action Steps Person(s) responsible

Timetable

Start Date Anticipated Completion

Completion

• Identify key community partners, leaders to engage

• Convene the discussion for creating an

comprehensive plan for Child Abuse Prevention

• Develop child abuse prevention advocacy message

targeted toward policy makers and others to

present message.

• Identify key policy makers to inform

• Present advocacy message

Social Service Committee members

Nov 2010 Jan 2011 Mar 2011 Apr 2011 Aug 2011

Ongoing Apr 2011 June 2011 July 2011 Ongoing

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)

• Acknowledgment and support of local Child Abuse Prevention events.

• Additional and/or sustained resources for prevention efforts

• Partnerships Developed

Monthly Reports 6 Month Progress Review Resources leveraged Wake County budget allocations Responsible party maintain list of active partners

• Data regarding Child Abuse, Child Fatality, Incidence

• Data regarding the cost associated with Child Abuse

• Data/evidence of successful prevention efforts (best practice)

• Data of current prevention efforts, gaps and specific opportunities for action

Wake County Human Services and Environmental Services Board Action Planning Worksheet

Date _Dec. 10, 2010___

Priority: Human Capital Development Plan Period: 3 Year Strategy; 1 Year Plan

Objective: Enhance success of Human Capital Development Campaign

Strategies/Action Steps Person(s) responsible

Timetable

Start Date Anticipated Completion

Completion

• Review Metrics (Outcomes & Indicators) of Success

• Ensure accountability for Human Capital

Development efforts

• Develop key community & business partnerships to

advance agenda

• Present Progress Reports/Impacts to targeted

business leaders and policy makers

• Support the statewide HCD efforts of NCACC (North

Carolina Association of County Commisioners)

SS Committee, Human Services Board Members

Oct 2010 Nov 2010 Feb 2011 July 2011

Mar 2011 Ongoing Ongoing Dec 2011

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)

• Agency-Wide Metrics Developed

• Community-Wide Participation Increased

• Bi-Annual Reports to HS Board, BOC

Quarterly Report for SS Committee 6 Month Report for HS Board Annual Report to BOC

• Data regarding community, client, agency trends

• Data on measurable & compelling outcomes & indicators

• Data/evidence of successful HCD efforts

• Data of current development efforts, gaps and specific opportunities for action

Human and Environmental Services Board FY 2011 Community Priorities Page 1

Wake County Human aWake County Human aWake County Human aWake County Human and nd nd nd

Environmental Services Board Environmental Services Board Environmental Services Board Environmental Services Board

FY 2011 FY 2011 FY 2011 FY 2011 PrioritiesPrioritiesPrioritiesPriorities

Community

Priority

Why Is This A Priority (Need)? Strategies

#1 – Child Abuse

Prevention/Family

Support

#2 – Senior

Services (tie)

#3 – Child Care

Services (tie)

Impact on every area of life and

helps break the cycle of

dependency; cost effective

Numbers are increasing; cost

effective way to keep seniors at

home as long as possible vs. in a

facility

Supports ability of families to work,

business development, and human

capital development

A “Community Call to Action”

Education and Awareness

Partnership development and support

Advocacy for policy changes to mobilize

community voices

Advocacy – community; local/state/federal

legislators

Community

Priority


#1 - Access to

Services*

#2 – Obesity and

Nutrition*

#3 – Insurance*

People with no insurance or money

to pay; transportation; language

barriers; unable to leave work to

get health care

Significant and increasing problem

in Wake County

Growing number of people who are

eligible for public health insurance

in the context of possible reductions

in services

Extend health insurance to more patients

Robust public transportation

Week-end and evening clinic hours

Advocacy to maintain and improve

Medicare/Medicaid Reimbursement

Pilot programs in public schools

Support community partnerships and

coalitions (such as Advocacy for Health In

Action, Governor’s Council on Fitness and

Health)

Adequate payment for providers

Educate potential eligible patients and help

them to enroll and stay enrolled or re-enroll

Monitor effects of reductions in

reimbursement

Decentralize enrollment county-wide

*Strategy - Identify & develop a community

plan to address disparities in all priority areas

During the month of March 2010, the Social Services, Public Health, Environmental Health, LME/Behavioral

Health, Housing, Human Rights/Consumer Affairs, and Regional Networks Committees met to develop

community priorities in their committee content area. The committee members used their expertise and

experience to select the specific priorities, that focus on these themes:

� Access to Services (child care, public health, MH/DD/SA

� Protection of vulnerable populations (seniors, children, people living with disabilities)

� Prevention (including health status and disparities, and environmental protection)

The priorities are identified below. Bill Stanford – Board Chairman

SOCIAL

SERVICES

Committee

Priorities

PUBLIC

HEALTH

Committee

Priorities


Community

Priority


#1 - Support ACT

Team Model

#2 – Transition

Services/ Discharge

Stabilization

#3 - Continuum of

Care Facility

#4 - Assure Fluidity

of Consumer/

Provider System

#5 –Crisis Services

Appropriate levels of services to allow

people to step down from levels of care

and live independently in the community

Gaps in the continuum of care

Gaps in the continuum of care between

hospital and outpatient services;

expands capacity for crisis assessment

and detox services

Gaps in the continuum of care

Consumers and providers are in the

midst of system changes

Systemic issues that a facility alone will

not solve

Build provider capacity to support

consumers’ ability to live in the

community

Bridging system

Getting medications

Access to psychiatric services

Address transition from hospitals,

prison, etc.

Open, fund and fully staff facility

Expedite consumer access to care,

coordination and quality services

Maintain capacity/sustainability/

usability of provider network

Smoother transition between steps

in services

Address needs of people now

ineligible for services because they

do not meet the consumer priority

group levels (intent: all ages)

Separate crisis services from the

Continuum of Care Facility; Develop

a crisis management system with

very specific work on access to

critical medical care in times of

crisis, prisons, jails, domestic

violence (intent: all ages)

Community

Priority


#1 – Protect Wake

County’s

Groundwater

#2 - Expand and

Support Animal

Welfare and Control

Initiatives

State and Federal Mandate

Protects quality of life in community

Positive response to reduce (303(d) list of

impaired streams

Septic tank strategies improve water

quality

Animal/pet overpopulation is a public

health threat in Wake County

A - Implement Falls Lake Rules

(Work with Environmental

Management Commission; educate

the public about need; support)

B - Develop self-sustaining Septic

Tank Inspection and Management

Program (Approve self-funding

initiative; educate public about need

and financial impact of inaction)

Report data; educate the public; and

use public education TV channels to

highlight program and successes

LME (LOCAL

MANAGEMENT

ENTITY) AND

BEHAVIORAL

HEALTH

Committee

Priorities

ENVIRON-

MENTAL

HEALTH

Committee

Priorities


WCHS Publication, March 24, 2010 Draft; S:Drive, FY2011 Budget and Business Plan Folder, Board Documents

Folder (RPetteway)

Community Priority Why Is This A Priority (Need)? Strategies

#1 – Housing for Vulnerable

Populations (renters at 0-

40% of Average Median

Income, homeless, special

needs populations –

MA/DD/SAS, seniors and

cognitively impaired)

Lack of rental and housing stock for

these populations at affordable prices

Increase availability of appropriate

and affordable housing options for

these vulnerable populations

(NOTE: This is also the #1 Priority

for the LME/Behavioral Health

Committee. It is listed here as the

area of content is housing). Housing

was also discussed in the Public

Health Committee as a need.


#1 Maintain high quality

services in the current

environment of increased

demand and reduced

revenue

Volume of work is increasing

Complaints are increasing

Staff perceived as non-responsive

Monitor issues

Suggest immediate corrective

actions

Suggest strategies to be conveyed to

management in de-briefings

Follow up on systems solutions to

see if they worked


#1 Define the needs for a

Western Regional Center

and/or Network of Care

#2 Continue to develop and

expand Regional Centers as

a viable service delivery

model to bridge access gaps

and promote integration

among Human Services

programs, County

departments and community

partners

Preliminary GIS mapping analysis

indicates areas of higher need for

economic, child welfare, mental health

and substance abuse services

Need for other County services has not

been assessed in the last 5 years

Current consumers putting a strain on

Southern Regional Center services

Current services in the West need

increased capacity for better

coordination with community partners

Wake County has the largest

unincorporated population of any county

in the state- 186,479 as of 2008

Transportation needs and access to core

Human Services programs continues to

be an issue for the outlying communities

Can tie to the 2010 Community

Assessment process, which is

collecting data by regions and zones

In the next 12 – 24 months, update

the Human Services Master Facility

Plan through the Dept. of Facilities,

Design and Construction

In the next 2 years, identify potential

real estate for purchase, if

assessment deems appropriate

Expand Human Services based on

needs of the regional communities

Leverage resources through

development of partnerships

Continue to offer interdepartmental

services within Regional Centers to

meet the needs of all citizens

HOUSING

COMMITTEE

PRIORITIES

HUMAN

RIGHTS/

CONSUMER

AFFAIRS

COMMITTEE

PRIORITIES

REGIONAL

NETWORKS

COMMITTEE PRIORITIES

1

STATUS UPDATE ON CURRENT SOCIAL SERVICES COMMITTEE AND RELATED PRIORITIES

1. CHILD ABUSE PREVENTION

• In the fall of 2011, the Social Services committee endorsed a plan to hold a Child Abuse prevention summit. A planning committee was appointed, led by committee members Marjorie Menestres of SAFEchild and Anna Troutman of Smart Start. The summit planning committee included:

•Paul Norman, SS subcommittee chair (at that time), Wake Tech

•Dr. Horwitz, SS Committee Member, dentist

•James Williams, SS Committee member, Patient Pathways

•Anna Troutman, SS Committee member, Smart Start

•Angie Welsh, SS Committee member, Triangle United Way

•Marjorie Menestres, SS Committee member, SAFEchild

•Lorrinda Michieka, SS Committee member, Youth Chamber of Commerce

•Maureen McKeon, Prevent Child Abuse North Carolina

•Louse Bannon, Wake County Smart Start

•Jessica Hull, Learning Together

•Giang Le, Wake County Human Services (WCHS) staff

•Genita Burroughs, WCHS staff

•Nikki Lyons, WCHS staff

•Natasha Adwaters, WCHS staff

Many of the people on this list were committee members, but there were also many other partners engaged

• Social services committee meetings in the months leading up to the event included regular updates on the progress of the event and presentations on the Frameworks Institute approach to advocating for child abuse prevention. To oversimplify, the approach states that research shows the most effective way to advocate for public support of child abuse prevention efforts is to focus away from low frequency examples of the most severe abuse, and instead to emphasize the impact of trauma produced by child maltreatment on the developing brains of young children. The committee was receptive to this approach to advocacy and advocacy messaging.

• The actual summit took place in April 2012 and was very well attended by a variety of potential partners including state DSS and multiple local agencies. The state Division of Public Health was also a partner, with Megan Shanahan, the Wake County Child Maltreatment Surveillance Coordinator, as one of the presenters. A primary focus of the forum was to teach how to frame the issue of child maltreatment prevention for effective advocacy as recommended by the Frameworks Institute. (Perhaps Marjorie and Anna could provide information about who attended and partners engaged.)

• In July 2012, Casey Family Programs approached Warren Ludwig about whether Wake County would like to host a Making it Happen--Building a Community of Hope event, an event based on Casey's belief that Child Welfare needs the community's involvement to effectively protect children and support families. Because of the Board's priority and its investment in the summit, Mr. Ludwig asked Casey if the event could also focus on child abuse prevention and was told yes. Later in the summer, he asked the Social Services Committee if members were interested in pursuing a Making it Happen event that would seek to galvanize community support for child welfare families and seek to prevent child maltreatment and support families in general. The Committee expressed interest in going forward.

• Marjorie Menestres, Committee member, participated on the core planning team for Making it Happen. Mr. Ludwig gave several updates to the Committee on event planning.

2

• Several Committee members attended the Making it Happen event on May 23, 2013, and Angie Welsh and McKinley Wooten have both signaled intent to be actively involved in follow-up activities.

• Denise Billman (WCHS staff) reported to the Committee several times on the Child Abuse Prevention event held in April 2013 at Pullen Park.

• Wake County Human Services Family Support and Child Welfare divisions are actively participating with Project Enlightenment in a planning process funded by the John Rex Endowment to propose a community implementation of Triple P, an evidence-based community intervention to strengthen parenting and prevent child maltreatment. Our participating has been influenced by the Board's priority.

3

2. HUMAN CAPITAL DEVELOPMENT (HCD)

• The Social Services Committee has received an official report from HCD staff on an annual

basis since its inception in 2009.

• Each annual report included data on participant enrollment, new partnerships & beginning in December 2011, on specific measures or indicators of progress the agency was considering for tracking client progress towards the attainment of human capital development.

• the Committee heard on three separate occasions updates or reports from staff and were asked to advise regarding development of Youth Thrive (Partnership for Excellence in Youth Development) & the Raleigh Promise (Partnership for Post-Secondary Success).

• Recommendations included such items as reaching out to the faith community to engage grassroots leaders & ensuring that we were inclusive of measuring the attainment of any professional credential rather than solely the attainment of 2 or 4 year college degrees in measuring success.

• Committee members were mindful to recommend alignment with these groups when developing or addressing potential strategies to address other issues related to youth or human capital development coming before them.

• The Committee Chair

• Was present for several presentations between 2009-2012 to the Board of Commissioners

at Work Sessions, where reports were provided, and spoke to the BOC on at least two occasions to introduce the topic on behalf of the Human Services Board.

• Reviewed initial materials drafted to elicit in-kind support from community

organizations & local businesses wishing to contribute to the campaign

• Traveled to Greensboro, NC with the HS Director and Campaign Manager to present to the

NC Chamber Meeting in 2009

• Hosted a meeting of Deans and Academic Department Leaders at Wake Tech to

discuss opportunities for partnership

• Participated in discussion when Wake County hosted the NC Association of County

Commissioners Meeting of the HCD Task Force locally.

• Committee members arranged for presentations to the Employment Security Commission regarding the County's campaign and invited information sharing from community partners trying to help individuals dealing with post-incarceration issues addressing gaps related to rent & employment.

• Committee members framed advocacy agenda for Social Services around the need to

maintain some of the focus of our local discretionary spending to support human capital

development projects where progress was being measured. Social Services Committee strategies related to Human Capital Development largely centered around:

• Advocacy

• Oversight that could be measured & in which client progress could be illustrated

• Engage others (business leaders & partners)

4

3. Accomplishments Associated with the Human Services Board Goal: HOUSING

VULNERABLE POPULATIONS (Submitted by: Annemarie Maiorano, June 3, 2013)

This report covers accomplishments from June 1, 2010 through July 31, 2012. Housing staff

worked closely with the Housing Committee to develop priorities. These priorities were approved

by the Human Services Board:

High Priority: Renters 0-40% AMI, Homeless Individuals and Families, Non-homeless Individuals

and Families with Special Needs

Medium Priority: Renters 41-50% AMI, Homeowners 41-50% AMI

Low Priority: Renters 51-80% AMI, Homeowners 51-80% AMI

Housing staff worked directly with the Housing Committee to develop the 5- year Consolidated

Plan and 3 one-year action plans – these documents were approved by the Human Services Board.

Staff also worked closely with the Housing Committee on processing responses to requests for

proposals. The following is a summary of accomplishments:

Housing Development:

• George’s Mews Apartments. This is a 26-unit apartment complex

• Sandy Ridge Apartments. This is a 45-unit apartment complex

• Mingo Creek Apartments. This is a 76-unit apartment complex

• Water Garden Village Apartments located in Raleigh. This is a 60 unit apartment complex

• Cedar Street – This is a 4 unit complex

• Laurel Crossing Apartments located in Knightdale. This is a 60-unit apartment

• Sunnybrook I Apartments, a 10-unit apartment building located in Raleigh.

• Highland Terrace Apartments. This is a 80-unit apartment complex

• Meadow Creek Commons Apartments. This is a 48-unit apartment complex

• The Woods at Avent Ferry Apartments located in Holly Springs. This is a 64-unit apartment complex

• Poyner Spring Apartments located in Raleigh. This is a 42-unit apartment complex

• 33 single-family homes will be built for low-income first time homebuyers.

Homeless Activities

• Funding was provided for a Coordinator position for the Support Circles Program. The

program has assisted 43 homeless families to obtain permanent housing.

• The Wake County Support Circle subsidies provided rental assistance for 2 families to

obtain permanent housing.

• 135 adults with severe and persistent mental illness have been served with Shelter Plus

Care subsidies.

• 50 chronically homeless individuals/families have been housed using Housing First

Vouchers.

• 65 homeless individuals with mental illness have been assisted with vouchers for housing.

5

• 1,734 men were served at the South Wilmington Street Center.

• 413 homeless participants received services through Project Homeless Connect held in

Raleigh January 24, 2012.

• 190 homeless participants received services through Capital Area Veterans Stand Down.

• 7,143 households received funds to assist with utility bills and avoid disconnection of

services through Wake County’s Emergency Assistance Program.

• HPRP assisted 314 persons in 114 households.

Housing Rehabilitation

• We implemented a new Elderly & Disabled Rehabilitation Program. A total of 87 homes

were repaired through this program

• 6 substandard, owner occupied properties were rehabilitated to meet minimum Housing

Quality Standards (HQS). (5-2010; 1-2011)

• 59 emergency repairs were completed through our Emergency Grant Program (43-2010;

16-2011). Emergency grants are a maximum of $5,000 and address immediate health and

safety risks for very low-income homeowners. Clients for this program are low-income and

typically elderly.

Public Facilities

• Infrastructure improvements for an 18-lot subdivision for new homes to be built and sold to

low-income families were completed.

• 5,070 lf. of sidewalk has been constructed and completed in the Towns of Garner and Apex.

This included road improvements, to provide low-income communities safe pedestrian

access. 2,700 lf. of road improvements are under construction

• Funds have been committed for additional 2,775 lf. of sidewalks along with road

improvements, drainage improvements and water lines throughout Wake County.

• Construction of a playground and restroom facilities in the Zebulon Community Park.

• East Wake Education Foundation was able to purchase and rehab a building and expand

services to children of low income families.

• The Boys and Girls Club of Wake County has a new facility to service the children in the

Zebulon community.

• 1 client received training through the Homeless Employment Program.

• Funds have been committed for a playground in the Knightdale Community Park.

• Funds have been committed for the Salvation Army to renovate a building to provide an

emergency shelter for families.

• Funds have been spent for renovations to a community center in the Town of Wake Forest.

• The HVAC System Upgrade for Cornerstone Building and Electrical & Fire Alarm System

Upgrades for Crosby-Garfield Building were completed with CDBG-R funds.

HUMAN SERVICES AND ENVIRONMENTAL SERVICES

BOARD AGENDA ITEM

Agenda Date: May 3, 2013 – Social Services Committee

May 17, 2013 – Public Health Committee

May 23, 2013 – Human Service Board Meeting

Committee/Item: Social Services Committee

Specific Action Requested: Wake County’s Child Fatality Task Force/County Child Protection Team

(CFTF/CCPT) is required to provide annual reports of activities to the Wake County Board of

Commissioners.

Item Summary: Wake County’s CFPT/CCPT performs regular confidential reviews of representative

deaths of infants and children age 17 or less seeking systematic causes or conditions that might be

preventable and suggesting public policy and programmatic solutions.

This 2012 report reflects infant mortality rates and child mortality rates for 2010 and 2011. State and

County wide data are compiled and reported a full year (or more) after the calendar events and are

unavailable until released by the State Center for Health Statistics. The 2010 child death data were

released Nov. 8, 2011; the 2011 data were released Nov. 8, 2012.

The number of childhood deaths decreased markedly in 2010: 106 children ages birth to 18 years died in

Wake County, down from 132 in 2009. Birth defects and other birth-related conditions (prematurity

and/or low birth weight) decreased in number and rate though continued as the leading cause of infant

deaths, followed by deaths from illness and unintentional injuries. Deaths attributed to SIDS dropped

dramatically, from 10 to 1. Review of sudden infant death (SIDS) indicated that deaths that previously

may have been attributed to SIDS may now be classified as unknown, following extensive death scene

and autopsy review. ‘Roll-over’ and ‘unknown cause’ deaths prompted recommendations to enhance

“back to sleep” awareness, including the risks of infant co-sleeping.

The number of childhood deaths increased in 2011: 137 children age’s birth through 17 years died in Wake County. Ninety-one infants died in the first year of life. As in the previous year, most were born extremely fragile and premature and suffered from immature lungs, or were born with inherited diseases. Two infants died of Sudden Infant Death Syndrome (SIDS). Five children or teens died by motor vehicles, a 50% decrease from 2010. There were three suicide deaths and four homicide deaths (trends are difficult to analyze because of the rarity of these deaths). Twenty-seven deaths were due to illness and sixteen, to unintentional injuries.

Purpose for Action: Inform Wake County Human Services Board and the Wake County Board of

Commissioners of the causes of childhood mortality in Wake County.

Next Steps: Receive, discuss and forward report to Wake County Board of Commissioners

Attachments: 2012 CFPT/CCPT Report

Membership roster, Wake County CFPT/CCPT

Summary of Causes of Childhood Deaths, Wake Co and NC, 2010 and 2011

Representative Case Reviews, 2011-12, ongoing

Opportunities for Advocacy, Policy or Advisory: See recommendations

Connections to Other Committees: Social Services, Public Health

Wake County Child Fatality Prevention Team/County Child Protection Team

2012 (Presented in 2013)

Who are local Child Fatality Prevention Teams/County Child Protection Teams? Local Child Fatality Prevention Teams (CFPT) and County Child Protection Teams (CCPT) are required in each county by statute. Since 1998, Wake County combined the two team review processes. Attachment A lists current team members. This representative group of community based professionals and volunteers meet each month to share confidential and detailed information about children who have died or have been abused or neglected. The team reviews ambulance call sheets, emergency room visits, medical examiners reports, police and sheriff investigations, district attorney and court records, child welfare and public health case notes, mental health visits, academic progress, school attendance, and family dynamics. Together, the team assembles the story of a child’s life and death, looking for systemic issues and interventions that might have prevented the death. Since combining our CFPT/CCPT teams we have been flexible in scheduling timely child protection reviews while continuing detailed child fatality reviews. How does the local team work? Wake County’s CFPT/CCPT can review in detail only a sample of child fatalities. The chair, utilization review nurse, and medical examiner chose 5-6 representative deaths for review each quarter, including all suicides and homicides. The lag between the date of death and the availability of death certificate and other information is such that in a year the team reviews deaths from the previous calendar year. In 2011-12 the team continued reviewing any deaths of children previously or known or currently involved with the protective services system. Child fatality reviews were directed towards suicides, homicides, deaths by motor vehicle accidents, and medical-related deaths. The statute that created the CFPT/CCPT allows teams to request and review any and all materials relevant to the investigation of a child death. The CCPT/CCPT may not contact the family members of a deceased child. CFPT/CCPT deliberations are confidential and not discoverable; recommendations are reported to the State. However, summaries of Child welfare investigations and findings and recommendations of completed intensive reviews involving deaths of children currently or previously known to the Child Welfare system may be requested by and released to the press after consultation with the District Attorney.

The CFPT/CCPT is not performing a forensic review, nor is it determining liability for a death or adverse occurrence. Rather, the team searches for systematic problems that can be remedied by information and training, changes in rules and regulations, and legislation. The CFPT/CCPT is required to review the death of any child reported or investigated by child protective services in the previous twelve months. Though the child may have died for reasons unrelated to child abuse or neglect, a county child protection death review may result in recommendations for improvements in the child welfare system. State statute also requires any such death to be reported to the State Division of Social Services. A more detailed, two day state led local review may be required. One intensive review for 2010 is still pending completion. The team both makes system recommendations and receives system recommendations to decrease the likelihood of untimely child deaths and to improve staff practice, agency performance and community outcomes by better protecting children known to the Child Welfare System or otherwise at risk for untimely death. Why do children die in Wake County? In 2010 Wake County achieved its lowest child death rate ever. One hundred six children ages birth through 17 years died in Wake County. Seventy infants died in the first year of life. Most were born extremely small, fragile, and premature, and suffered from immature lungs or respiratory distress syndrome, or were born with inherited diseases. One infant died of Sudden Infant Death Syndrome – a dramatic drop from ten SIDS deaths in 2009. Death scene investigations have become routine and the medical examiner’s office more often assigns cause of infant deaths as “unknown” or “roll over” if the pathology or scene investigation is inconclusive for SIDS. Ten children or teens died by motor vehicles. There was one suicide death and two homicide death (trends in homicide and suicide are difficult to predict as these are relatively rare events). Twenty-seven deaths were due to illness. In 2011 Wake County experienced an increase in child death rate. One hundred thirty seven children ages birth through 17 years died in Wake County. Ninety-one infants died in the first year of life. As in the previous year, most were born extremely fragile and premature and suffered from immature lungs, or were born with inherited diseases. Two infants died of Sudden Infant Death Syndrome (SIDS). Five children or teens died by motor vehicles, a 50% decrease from 2010. There were three suicide deaths and four homicide deaths (trends are difficult to analyze because of the rarity of these deaths). Twenty-seven deaths were due to illness and sixteen, to unintentional injuries. Attachment B provides 2010 and 2011 Child Death Summary information for Wake County and North Carolina (the most recent year of complete data). Attachment C shows state infant mortality deaths by race, highlighting the disparity between white and non-white deaths. In 2010, Wake County again recorded its lowest infant mortality rate ever -- 5.5 per thousand live births – and the non-white to white ratio narrowed but remains an unacceptably twice the white rate, at 2:2. In 2011, Wake County recorded a higher infant mortality rate than the previous year, 7.3 per thousand live births. This increase was primarily in the African-American Non-Hispanic and Other Non-Hispanic groups. The African-American to white ratio (disparity) rose to 3.1. Attachment D shows the representative case reviews for 2012.

What has Wake County’s CFPT/CCPT accomplished? Wake County’s CFPT continues to perform detailed fatality reviews in hope of providing local and state recommendations that might decrease untimely childhood deaths. Wake County’s CCPT continues to have an open process of receiving, accepting, investigating and substantiating child abuse and neglect including cases referred by the community review and feedback. The CFPT/CCPT met eleven times in 2012. Emergent reviews of childhood deaths or adverse outcomes of child in the child welfare system are always discussed at the most proximate meeting. All team members are welcomed to all reviews. What actions are required of the County Commission? Wake County’s CFPT/CCPT periodically submits to the State case review information and recommendations. Any identifying information that might violate confidentiality is first removed. The CFPT/CCPT is required to provide annual reports of activities to the County Commission. This report covers reviews from January 2012 through December 2012. County Commissioners may appoint members to local teams. Wake County’s CFPT/CCPT will continue to inform the Wake County Board of Commissioners of team composition and will welcome any additional appointments. U:WakeCoCFPTCCPTAnnualReport-12

(D)

Wake County Child Fatality Prevention Team/County Child Protection Team

Representative Case Reviews, 2012 The Wake County CFPT/CCPT meets monthly eleven times a year to review a representative sample of infant, child, and teen deaths. Death certificates, diagnoses and medical examiner reports are used to select cases for review. Time limits the team reviews to only 4-6 deaths each quarter. The CFPT/CCPT must review the deaths of infants, children, and teens reported to Child Welfare services in the 12 months prior to death, including children involved in Child Protective Services investigations, treatment, and foster care. The statutes governing CFPT/CCPT reviews require confidentiality for both death reviews and reviews of active Child Welfare cases. Team reports include demographic information, such as age, sex, race, and cause of death. The reviews concentrate on systems issues identified, recommendations, and actions taken. When system issues are identified the CFPT/CCPT may suggest specific recommendations, including letters of concern and commendation, legislative and community advocacy, and community or professional education. Recommendations can include team sponsored trainings, education, or awareness events. On occasion, the State Division of Social Services requires a two day intensive review of deaths of children currently or previously known to protective services. The team participated in one intensive review in 2011 and two in 2012. Categories of deaths reviewed and representative systems issues identified for 2011-2012 included: Unintentional Poisoning

• The team investigated one death related to overdose of prescription medications that had been prescribed for another individual but were available to the decedent. Our case reviews have informed State efforts to decrease prescription of, access to, and unauthorized use of controlled substances.

Motor Vehicle Deaths

� Review of complicated motor vehicle deaths of minors and teens, both passengers and drivers

� Continued advocacy for increased parental involvement in driver’s education and adoption of a standardized curriculum. The team noted several deaths where the driver was in violation of the State graduated driver’s license (GDL) statutes and also expressed concern that, while progress has been made in education and “stigmatization” of drinking and driving, our culture continues to tolerate excess speed.

______________________________________________________________________ Sudden Infant Death Syndrome (SIDS) and Overlay Deaths

� Continued support of legislative appropriations for enhanced social marketing campaigns for Safe Sleep – an expansion of teaching regarding Back to Sleep

� Parental education on the risks of parent-child co-sleeping and the risks of placing infants to sleep on soft bedding, sofas, or improvised cribs

� Increased awareness not only of the role of alcohol and substance use in overlay

deaths but of the need for increased family support and behavioral health services for at risk families

Homicides

� Two homicides reviewed were of young children who died from non-accidental trauma perpetrated by a parent

Suicides

• Continued concern for suicide by gunshot related to availability of firearms and recommendation to expand safe storage statute to include storage in any house where a child may be unsupervised

Neonatal Deaths (Deaths in first 28 days of life) � A persistence of preterm and very preterm infant births with high morbidity and

mortality rates with a persistent racial disparity gap

� Unsuspected, undetermined, or undocumented use of alcohol, tobacco, and other drugs during pregnancy, labor and delivery

Perinatal Deaths (Deaths associated with labor and delivery) • Review of two deaths presumably related to planned home or birthing center

births where fetal distress and emergent transfer were still associated with infant death. Presented concerns to Joint Oversight Committee of Medical and Nursing Board regarding concern over fetal distress and neonatal resuscitation at out of hospital births.

Cultural and Societal Issues

� Parental awareness of teen mood disorders, e.g., depression and anxiety

� Parental responsibility in preventing under-age drinking and driving

� Parental responsibility and caution in use of ATVs on personal property Administrative Issues

� Continued concern for administrative coding of cause of death in summary

statistics

_____________________________________________________________________ Child Welfare and Adoptions

� Updated information on Wake County’s internal quality improvement program and “mock” chart reviews in preparation of State and Federal Child and Family Services Review (CFSR). In 2013, the State will adopt a continuous quality improvement approach to improvement of child welfare practices.

U:WakeCoCFPTCCPTrecs11&12

(B) 2010-2011 CHILD DEATHS IN North Carolina and Wake County

Child Deaths by Cause in North Carolina Ages Birth through 17 Years

Cause of Death

North Carolina Average Annual

2007-2011

North Carolina

2010

North Carolina

2011

Wake County

2010

Wake County

2011

Birth Defects 216 198 197 18 27

Other birth-related conditions 505 430 458 38 51

Sudden infant death syndrome 87 53 50 1 2

Illnesses 290 297 248 27 27

Unintentional injuries 222 191 202 12 16 motor vehicle injuries 115 100 98 10 5

bicycle injuries 2 2 2 0 0

injuries caused by fire 12 6 7 0 1

drowning 28 37 20 0 0

falls 2 2 1 0 0

poisoning 15 9 16 1 0

other unintentional injuries 48 35 58 1 10

Homicide 48 42 43 2 4

Suicide 26 23 23 1 3

All other 70 77 91 7 7

TOTAL 1,464 1,311 1,312 106 137

Child Deaths by Age North Carolina

Average 2007-2011

North Carolina

In 2010

North Carolina

In 2011

Wake County

In 2010

Wake County

2011

Infant 980 854 866 70 91

1-4 143 153 122 15 16

5-9 86 65 84 8 13

10-14 94 88 95 7 7

15-17 164 151 145 6 10

Data reflect state residents.

Produced by the N.C. Division of Public Health – Women’s and Children’s Health Section in conjunction with the State Center for Health Statistics. U:WCChildDeathsinNC&WakeCo.-11

(C)

INFANT MORTALITY REPORT North Carolina 2011 Final Infant Death Rates (per 1,000 live births)

White Non-Hispanic

Infant Deaths

Af. Am. Non-

Hispanic Infant Deaths

Other Non-

Hispanic Infant Deaths

Hispanic Deaths

Minority Infant Deaths

Total Infant Deaths

White Non-

Hispanic Births

Af. Am. Non-

Hispanic Births

Other Non-

Hispanic Births

Hispanic Births

Minority Births

Total Births

White Rate

Af.Am Rate

Other Rate

Hispanic Rate

Minority Rate

Total Rate

North Carolina 2011

369

367

32

98

866

67,542

28,509

6,135

18,217

120,403

5.5

12.9

5.2

5.4

7.2

Wake County

2011

32

42 8 9 91 6,672 2,846 987 1,953 12,458 4.8 14.8 8.1 4.6 7.3

2010

30 27 3 10 70 6,786 2,838 1,018 2,063 12,705 4.4 9.5 2.9 4.8 5.5

2009

42 57 99 9,242 3,768 13,010 4.5 15.1 7.6

2008

43 37 80 9,630 3,912 13,542 4.5 9.5 5.9

2007

49 48 97 9,603 3,696 13,299 5.1 13.0 7.3

2006

49 41 90 9,264 3,585 12,849 5.3 11.4 7.0

2005

36 49 85 8,941 3,323 12,264 4.0 14.7 6.9

2004

46 36 82 8,572 3,179 11,751 5.4 11.3 7.0

2003

32 40 72 8,300 3,042 11,342 3.9 13.1 6.3

2002

34 26 60 7,959 2,965 10,924 4.3 8.8 5.5

2001 29

37 66 7,824 2,841 10,665 3.7 13.0 6.2

U:WCInfantMortality Report 2001-2011