Health takes center stage

DENTON – Some key metrics reported by the Caroline County Health Department are improving, according to Health Officer Robin Cahall.

At the May 13 meeting of Caroline County Commissioners, Cahall provided updated information. At the same meeting, two officials from Mid Shore Behavioral Health (MSBH), shared the organization’s annual report and plans for 2026.

MSBH serves as the health department’s core service agency and provides funding for the county’s school-based mental health services, help with gun violence and injury prevention programs, and guidance and assistance with various grant applications, which is “not easy,” Cahall said.

Cahall said the partnership between the health department and Mid Shore Behavioral Health, Inc. has been “huge benefit” in “representing and advocating for providers who are fee for service providers.”

“I value that relationship with them, and I do think it's valuable to Caroline County,” Cahall said.

While the health department’s original funding was reduced by $225,000 in fiscal year 2025, and about $61,000 in federal funding has ended, but most of those grants were expiring anyway, she said. “We managed to mitigate that situation pretty well. We were able to not impact any of our programs significantly.”

However, a potential “significant impact” currently being decided by the courts, is the expansion of a laboratory expansion grant, “which funded our data administration piece of things for the health department,” Cahall said.

For FY26, the department is moving towards being level-funded for a core state match that … is not solidified,” as well as a “proposed allocation for COLAs and salary enhancements,” Cahall said.

The Maryland Family Planning Program budget for FY26, was reduced by 33%, or about $54,000. “Luckily, that has not impacted our staffing level, but may impact some of our activities,” she said.

Environmental Health

Cahall reported a “quite significant” development in a recent letter from the Maryland Department of Environment ensuring the county would maintain its Groundwater Protection Report (GPR).

As provided in the Code of Maryland Regulations (COMAR), the GPR “indicates the sewage disposal system may be installed with less than a 4-foot treatment zone in a coastal plain county – which Caroline County is – if the system complies with the groundwater protection report incorporated in the county's master water and sewage plan,” Cahall said.

“Without that, it would mean that holding tanks would be put in place … a significant economic impact when it comes to building new construction and … repairs for septic systems,” she said.

During FY25, 709 permits, 105 fewer than the previous year, were approved, including 37 perc tests, 144 wells, 117 septic, and 411 other. For the same year, 255 facilities and 55 contractors were licensed.

Commission President Travis Breeding asked whether the 37 perc tests were successful, “because we're talking about housing. Every time a perc is denied, that's a house that's not built on a lot somewhere.”

Cahall affirmed that they were successful, but added that she would research the total number of applications. “We were late to get started because of the lack of rain,” she said. “Essentially, the entire state is seeing some drought conditions.”

Communicable Disease, Family Planning, and Women & Child Health Division

The number of TB skin tests performed dropped from 180 in FY2023 to 87 in FY2024; however, the drop had to do with changes in testing guidance. Individuals treated for Latent Tuberculosis Infection is about even, with 28 for 2023 and 25 for 2024.

Cahall credited the health department’s partnership with Choptank Community Health with the drop in the department’s OBGYN testing and services.

From 2023 to 2024 the department performed fewer pregnancy tests, saw fewer RN office visits, and fewer clients prescribed birth control. However, the number ticked up for both unduplicated family planning and Babies Born Healthy clients served.

“Our continued focus, of course, will be our babies born with low birth weight and our prenatal care in the first trimester,” Cahall said.

The county still has a “pretty decent immunization rate,” she said. “All the diligence that you could possibly put into something is there.”

Wellness Program

In terms of chronic disease prevention, the health department partnered with the Eastern Shore Area Health Education Center to deliver the National Diabetes Prevention Program. It received funding to partner with Greater New Hope Church and Ministries and Aaron’s Place to serve 28 adults.

The department works with the Caroline County Sheriff’s Office to educate retailers and to conduct tobacco compliance checks to ensure no sales to youth younger than 21. Of 118 compliance checks, nine citations were given.

The tobacco prevention and cessation efforts by the department were recently noted by the Maryland Department of Health as “being a stellar program,” Cahall said. Thousands of Caroline adults and students have been helped by the department’s outreach.

State Health Improvement Plan data

Cahall reported improved metrics in key reporting categories, according to State Health Improvement Plan county-level data. “I think that it's important to focus on the metrics and how we're moving that needle, as opposed to the rankings” among Maryland counties, she told the Commissioners.

Depending on the reporting period, metrics have improved in categories of colorectal cancer screenings, persons who have “usual” primary care physicians, school-based health center enrollment, the pre-term birth rate and adults’ physical activity.

However, “areas of focus” for improvement are asthma related emergency department visits, prevalence of diagnosed hypertension, breast and cervical cancer screenings, and babies born with low birth weight, as well as prenatal care during the first trimester. Cahall said other factors could be at play in the numbers, such as the number of poor air quality days, or improved awareness of the need to get testing.

Mobile Integrated Health

The development of policies and procedures for mobile integrated health between the Health Department, Department of Emergency Services and Basic Life Support (BLS) Committee are continuing and will be ready for review by the first week of June. The partnership also includes the University of Maryland Medical System Shore Regional Health.

Built into core funding for the small scale Mobile Integrated Health program are a community health nurse position, a data administrator and support staff. Cahall said the department recently applied for grant funding through the Maryland Department of Health’s Office of Minority Health and Health Disparities for $84,000 for personnel costs.

Behavioral Health

Cahall noted a “significant reduction” in fatality overdoses for 2024. In fact, the “data is suppressed because once you get under 11 you suppress your data.” In 2023, that number was 18.

Another significant set of statistics reported through the state Health Improvement Planwere the number of addictions-related emergency department visits, down 12.4% in 2022, and mental health-related emergency department visits was reduced by 28% in 2023.

A discussion of Mid Shore Behavioral Health’s annual report was led by Chief Executive Officer Katie Dilley and Behavioral Health Coordinator Ann Simpers. They shared highlights of their fiscal year 2026 plan, as well as a letter of agreement to serve as core service agency for Caroline County, both of which the Commissioners approved.

MSBH is celebrating its 33rd anniversary providing behavioral health services for residents of Caroline, Dorchester, Kent, Queen Anne's and Talbot Counties “through effective coordination of care in collaboration with consumers, their natural support systems, providers and the community at large,” according to its mission statement.

The organization’s work with the health departments of the five counties is extensive, including workgroups for children, youth and adults, as well as individuals with autism; the Roundtable on Homelessness; and the Eastern Shore Safe Station Coalition, the Suicide Prevention Coalition of the Mid-Shore, and services for veterans, among several others.

“Another really exciting thing that we've been supporting for the last couple of years is through our assisted living initiative and our state hospital discharge program,” Dilley said. “Mid Shore is supporting that program as one of two sites for the state.”

The state hospital discharge initiative supports people who have been housed and institutionalized in the state hospital systems with “transitioning out into community-based settings through assisted living funding,” she said. “We have successfully placed in the last year 35 individuals out of state hospital systems here on the Eastern Shore and in central Maryland, which is a huge success, so we're really proud to support that project.”

Simpers shared programs and initiatives specific to Caroline County. One of those is developing a resource guide for first responders. Another is Project Chesapeake, an intensive outpatient substance use program which opened in March 2025 in Greensboro. The Hub Pilot Initiative in Caroline County Public Schools, “which is funding to expand our behavioral health services for mental health and substance use for our youth engaged in the public schools,” begins in 2026. MSBH also works with Caroline County’s Problem-Solving Court and supports Caroline Goes Purple.

MSBH initiated a firearms safety and awareness campaign, enabling MSBH to hand out over 2,000 gun locks and provide outreach and training.

MSBH also manages the Mid-Shore State Opioid Response Grant (SOR) which currently funds 12 crisis beds at the A.F. Whitsitt Center in Chestertown, four Safe Stations in four counties, including Caroline, and recovery housing.

MSBH’s annual volunteer day was held in conjunction with Positive Strides, based in Caroline County.

“Through the public behavioral health system, Caroline County has served 1,050 residents for substance use,” Simpers said. For mental health, 2,369 were served, or 7% of the county’s population; for substance use, it was 3%.

The state of Maryland is wrestling with the problem of youth admitted to emergency rooms who experience 3-week delays before being placed in residential psychiatric care facilities.

Breeding said the Commissioners received an email the week before stating that youth “admitted to ERs are waiting up to 20 days for placement in a psychiatric facility.”

Dilley said it was true across the state. “The last residential treatment placement we had on the Eastern Shore (in Cambridge) closed in November of 2016.”

Making the problem more complex is the requirement of “an educational component, which often falls back on the county in which the treatment facility resides,” she said. Further complicating a solution is the current funding climate and workforce.

Over 50% of MSBH’s funding is through the federal government, Dilley said. Funding awarded over a 5-year period from 2021 through the FY25 budget increased from nearly $9.8 million to just under $21.8 million.