County health department update

DENTON – Convening as the Caroline County Board of Health, the three County Commissioners heard an update from County Health Officer Robin Cahall and Jessica Tuel, the county’s local addictions authority and behavioral health director.

Both Cahall and Tuel were pleased with the progress the health department made in fiscal year 2025 and the first quarter of fiscal year 2026.

The update was part of the agenda of the Commissioners’ weekly 9 a.m. meeting Tuesday, Oct. 28, 2025, in Denton.

Cahall said the staff had “some really good success” lately with staffing, with only two open positions currently. The department staff numbers 112. Partnering with the Department of Emergency Services, the Health Department “has actually hired a community health nurse that will be designated to mobile integrated health.” The start date is Nov. 12, and Cahall said, “We're very excited to get them on board.”

Emergency Services Division Chief Kathy Jo Marvel “was instrumental in getting our (mobile integrated health) protocols approved by the Maryland Institute of emergency medical service,” Cahall said. “We have also been awarded funding through the Caroline Foundation to support some of this, because our small-scale effort is being built into our core funding, and we were able to hire that community health nurse with core funding, 50% of it, and then the other 50% is our Babies Born Healthy program.”

“We're looking at taking our first clients on Dec. 1,” Cahall said.

Tuel reported the health department served 1,006 behavioral health clients in fiscal year 2025, including 155 exclusively served by the county’s Mobile Treatment Unit, 36 youth served by the youth substance use program, 269 students throughout five schools served by school-based mental health services, and 48 inmates served at the Caroline County Detention Center.

Since the inception of the Detention Center program, “we've served 208 inmates and we've actually served 52 in just the first quarter of this (fiscal) year,” Tuel said.

The mobile treatment unit served 155 adult clients, and 300 clients received clinic-based services.

During FY 2025, the department began using a measurement-based care program to gather data. In a survey to clients, 127 responded, with 84% satisfied with the services they received and 93% reporting fewer depression symptoms from their first assessment to their most recent.

Tuel’s division is “fully staffed for the first time,” she said. The department can now take private insurance for behavioral health services, in addition to Medicaid and Medicare. That credentialing “has been one of our successes for the last year,” Cahall said.

“Over the last year-and-a-half, maybe two years, we worked really hard for that credentialing aspect so that we can bill private insurance,” Cahall said. “That was a heavy lift for our small organization.”

While responding to the needs of middle and high school students is handled differently, Tuel said she and her fellow therapists “pride ourselves in integrating ourselves into” elementary schools, similar to school resource officers a couple of years ago. “They're not somebody to be afraid of.”

Cahall said, “I also think the effort to remove stigma … has played a big part in that as well.”

The department’s budget shows an increase in core funding, including the county’s required match. The FY2026 budget increased core funding to $2.7 million, an increase of just over $163,000, and accounts for cost of living and salary adjustments. However, an expected decrease in federal, state and some local grants was expected; the grants decreased from just over $6.7 million to almost $5.7 million. “Whatever needs to be sustained, … we’ve built it into something else,” Cahall said. The overall budget has decreased from $9,257,371 in FY2015 to $8,395,834 in FY2026.

Cahall touched on the Rural Health Transformation Program (RHTP) created by the One Big Beautiful Bill Act of 2025. The RHTP’s five key objectives are make rural America healthy again, sustainable access, workforce development, innovative care and tech innovation. In order to meet the state’s Nov. 5 deadline for submitting an application for funding, the Mid-Shore health officers met to quickly assemble information for the Maryland Department of Health, including a focus on nutrition education programs, as well.

“Strong partnerships with our community-based organizations and partner agencies like Caroline County Public Schools and Parks and Rec are going to provide a really good foundation for us,” Cahall said. She said she was “extremely happy to see” a mobile health service expansion regional approach, as well as “funds to improve capacity and a process for improving billing and maximizing revenue generation for local health departments. That is going to be amazing.”

Within the State Health Improvement Plan (SHIP) are five priorities: chronic disease, access to care, women's health, violence and behavioral health. The county health department’s priority “will be chronic disease, and we're really going to focus on, by 2026, reducing the rate of emergency room visits for asthma among children,” Cahall said, providing details about methods and resources the department is planning in order to meet that and other local SHIP goals.

Commissioner Frank Bartz praised the efforts of health department staff, and Cahall and Tuel in particular. “I know you guys care. I've had conversation with you both, and you guys are awesome. Caroline County has been benefited so much. You guys were born and raised here. You’ve stayed here. You do good work.”

“We’re definitely committed,” Cahall said.