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2012-97-Minutes for Meeting February 27,2012 Recorded 3/13/2012DESCHUTES COUNTY OFFICIAL RECORDS 20~2~9~ NANCY BLANKENSHIP, COUNTY CLERK CJ Q y COMMISSIONERS' JOURNAL 0311312012 08:08:49 AM 11111111111111111111111111111 2012-97 Do not remove this page from original document. Deschutes County Clerk Certificate Page - f Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF WORK SESSION DESCHUTES COUNTY BOARD OF COMMISSIONERS MONDAY, FEBRUARY 27, 2012 Present were Commissioners Anthony DeBone, Alan Unger and Tammy Baney. Also present were Erik Kropp, Interim County Administrator; Scott Johnson, Health Services; Nick Lelack and Peter Gutowsky, Community Development; Anna Johnson, Communications; Susan Ross, Property & Facilities; and about a dozen other citizens. Chair DeBone opened the meeting at 1: 30 p.m. 1. Update on Volunteer Connect and Project Connect. Betsy Warriner gave a presentation on the work done by Volunteer Connect and their newest programs, Project Connect, Project Mobile Connect and Project Homeless Connect. They are engaging schools, colleges, businesses and volunteers. Their work is tri-county in nature. They asked for the County's continuing support for the programs in general, but also the newest programs. Shellie Campbell has been overseeing the newest programs. About 350 people showed up for the Homeless Connect event. They are also working with COVO (Central Oregon Veterans Outreach) to provide a variety of services. They appreciate any financial contributions, but also spreading the word about the work they are doing in the region. Commissioner Baney said they are using an `incident approach' structure, which helps them respond more quickly. Erik Kropp asked if the insurance concerns of previous years were addressed. Ms. Campbell stated that they have been able to do so for the entire program and events. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 1 of 13 Pages Commissioner Baney suggested that the group make sure they apply for community grant funding in this year's budget process; and perhaps a portion could be through the economic development grant program. The Board recommended they talk with David Inbody about both programs. 2. Discussion of BLM/USFS Sage Grouse Planning Strategy & Deschutes County's Possible Involvement. Peter Gutowsky introduced Anita Bilbao, Acting District Manager, and Teal Purrington, Planning & Environmental Coordinator, Prineville BLM office. BLM hosted a kickoff meeting in Prineville to talk about Sage Grouse strategy. At a previous meeting, Mr. Gutowsky and the Board talked about the results of this meeting. They are now proceeding with the planning process. Ms. Bilbao said that a new Manager is coming in later in the year from Lakeview, and she is familiar with the issues. Ms. Bilbao stated that she has worked with Deschutes County on other issues in the past. This effort is a bit different, however, since it is a national issue. They are looking at existing land use plans (there are four here), asking questions about whether they are going where they need, and whether the existing plans are adequate or need to be amended. Prineville is not necessarily in the driver's seat, and it is an amendment of an existing plan, as well as being very narrowly focused. There are limiting factors due to the national scope. There is a western set of states, and Oregon is a sub-group. Ms. Purrington stated that Washington is calling this a regulatory amendment, and they will say what needs to be done. Ms. Bilboa added that the Oregon Department of Fish and Wildlife regulates the birds specifically, but the BLM is looking at their habitat. Commissioner Unger asked how well they work with property owners on dealing with the habitat, since they have a stake in this as well. Ms. Bilboa replied that BLM's goal is to have cooperative partners and agencies. The BLM wants early and consistent involvement, and the ODF&W and U.S. Forest Service will be partners. There are tribal and other local governmental agencies involved as well. Local governments have local knowledge of the areas. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 2 of 13 Pages It is valuable to have intergovernmental agreements in place in case there are conflicting issues, and to eliminate duplication of efforts. The BLM can help to reconcile differing opinions. There are other efforts to partner in the future, on issues that may be national in scope, or other more regional issues. The State BLM office has the lead on this particular issue in this area. Commissioner Unger asked for clarification of the roles so the proper person or office can be contacted if there are questions. Ms. Bilboa responded that they would provide details on this. She then referred to a document, the draft memorandum of understanding. The National Environmental Policy Act of 1969 set up the roles, and the BLM has its own version on how this was established. Chair DeBone stated that Deschutes County has some involvement. The Sage Grouse has had the protection of the Endangered Species Act, but evidently has not been high priority up till now. Peter Gutowsky said that in regard to resources, there is a draft MOU to provide context for a legal framework. It would not commit staff or the County to a specific set of demands on staff. The Board can determine the level of participation. Ms. Bilboa indicated that the last page of the draft MOU includes a table showing cooperating agency participation. It identifies the primary stages along the way and the various roles. They are in the scoping and issue identification stage through March 23. In terms of going forward and forming alternatives, that happens through June and July, and that is when they want to hear about planning and zoning on properties adjacent to BLM lands. In terms of estimating the effects and preferred alternatives, agencies may collaborate with the BLM, but this effort is meant to provide information to BLM that they may not have. There is no expectation for anyone from Deschutes County to attend meetings, but it can be beneficial. It is meant to be almost a placeholder for the meetings. Ms. Purrington added that this is nothing like the Upper Deschutes planning process, which required heavy participation from the affected local agencies. Commissioner Unger noted that if something seems of concern to Deschutes County, it is important to address it right away. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 3 of 13 Pages Ms. Bilboa said that the schedule could be extended as necessary if things come up and more information or research is needed. The goal is to make sure they need to do what they should for public lands. Mr. Gutowsky stated that this approach to public lands help avert a listing on the Endangered Species Act, if ways to prevent this are addressed. County Counsel has reviewed the draft MOU and feels it is acceptable. Chair DeBone said that he wants Deschutes County to show support as an eastern county. Commissioner Unger added that they would need to sign on and be engaged in the process. It has big implications for the eastern part of the state, and cooperation can help avoid potential conflicts. Ms. Bilboa stated that if there is no participation at this point, review at a later date would be very limited. Issues can and should be addressed early before they become part of the final draft document. Nick Lelack advised that Harney County is leading the state effort. The goal is to have outcomes by 2014 or 2015. Ms. Bilboa said that the intention is to get MOU's signed by the end of March when scoping is done. Contact information may change, however, and a local contact can be added. Mr. Gutowsky noted that Oregon, when compared to other western states, has the best remaining habitat, and those resources need to be protected. Oregon could very well benefit from the process if some type of mitigation can be developed. - 3. Health Services Update and Review. Scott Johnson explained that there is a lot going on with health reform, locally and beyond. SB 1580 passed and will become a reality. The Health Policy Board has prepared an implementation plan, which will help set the stage. The projection from the State of Oregon is that if they do not institute reform, the Medicaid costs to Oregon will go from $3.2 billion in 2013 to $11.7 billion by 2019. More and more people have come on the Oregon Health Plan and this trend will continue. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 4 of 13 Pages The goal is to save $1 billion in the next three years. This involves mostly Medicaid, but everyone is in the same situation. He added that the use of tobacco products uses up about 10% of Medicaid costs. Most cost considerations are influenced by tobacco, obesity and chronic illnesses. He introduced Anne Pendygraft and Gretchen Rubaloff of Telecare/Deschutes Recovery Center, Brenda Finkle of St. Charles Medical Center, Paul Stell of Bend Metro Park & Recreation and the Public Health Advisory Board and the Behavioral Health Advisory Board. Also present were Kathleen Christensen and Tom Kuhn of Health Services. Draft Health Services Strategic Plan Discussion. Mr. Johnson said they are going through the process to make sure the strategic plan is compatible with current health reform. Tom Kuhn then did a PowerPoint presentation on this item. There were three pages of accomplishments, the health and mental health plans before the merger, and a single strategic plan for the whole department. They want to show what they will do during the next four or five years. If this is funded, it can serve three counties. Both Jefferson and Crook counties are using the same format now. They plan to conduct an annual review, as there are too many factors to just let it run for years. There are a lot of opportunities, and many challenges. The plan includes nine sections and 66 goals. They have been contracting out more services, and hope to find out what the County does best, but also maintain a network of providers. The model is that funding comes to the County from the State, and is disbursed by the County. For greater efficiencies, there might end up being a regional location where this happens through the Health Board. They also have responsibility for compliance to make sure what needs to happen does. Staff did a good job with this document, which is very sweeping and ambitious. It will be a challenge to manage, but they have good staff. Commissioner Baney asked about how they balanced the work. The reply was that they gathered input from employees, so they got a good buy-in. Mr. Johnson said to let him know if there are any concerns or other things to be included. He added that this document will be needed to obtain national accreditation. Granting groups will be looking for this accreditation in the future. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 5 of 13 Pages Tobacco Free Worksites - Discussion of Potential Expansion of Tobacco- free Policy on County-owned Properties David Visiko went through the presentation on tobacco usage, in particular the policy regarding smoking or using tobacco products on county-owned properties. He explained where the funding comes from, and what factors have the greatest or least effectiveness on tobacco use. A comprehensive approach is necessary, from counseling and education to socioeconomic factors. The Tobacco Prevention and Education Program has helped bring down the numbers since 1993. Tobacco use is the leading preventable cause of death in the U.S. Combine all other causes, and they are less than half of what smoking causes. In general, Deschutes County citizens are healthier and about 14% are smokers, as opposed to 19% in the State overall. Tobacco use is the cause of 22% of deaths in the County. It costs $5,600 per smoker per year, factoring in health care, work absenteeism, etc. Of the smokers in Deschutes County, 70% say they want to quit. There are also many who used to smoke and want to stay away from it as much as possible to eliminate smoking triggers. When it comes to health policy, tobacco users tend to honor it and carry it over to their homes and cars. A recent public survey involving 804 people indicated that 84% of the respondents wanted County properties to be tobacco free. To be tobacco free, management support is needed, a policy implementation committee needs to be formed, and sessions with staff need to happen. Adequate time is necessary to be sure everyone is clear on the policy. In terms of enforcement, the idea is that it would be a shared responsibility. Most people will comply. This effort received a letter of endorsement from the Public Health Advisory Board and the Wellness Task Force is pleased with the information. Enforcement is a concern, but it is the right policy. Brenda Finkle from St Charles said they have had tobacco-free grounds there for three years. Signage is critical. They had to educate the management team because of challenges with employees. They offered free tobacco cessation classes and nicotine gum. Enforcement regarding guests at the hospital is difficult and they have to be educated through cards that are handed out, explaining that patients can have allergic reactions to cigarette smoke. Some employees did end up stopping smoking. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 6 of 13 Pages Erik Kropp asked if employees were disciplined for noncompliance. Ms. Finkle responded that there was probably no formal discipline. Caregivers were progressively counseled, and most are compliant. Paul Stell of Bend Park & Rec said that anticipation of the change was worse than the change itself. Implementation has been fairly easy. Usually they are compliant, mostly through peer pressure. Ms. Rubaloff stated that they are already doing this at the homes. No smoking is allowed at either facility in response to a statewide mandate. The most important thing is to be collaborative with everyone. Some have decided to quit because it has been made so difficult for them. They hope to be 100% tobacco- free everywhere, as a suitable response to the mission as health care providers. Staff has been positive. Susan Ross said she supports this from a facilities point of view. Some are smoking in the parking lot, and they have fires in the bark all the time. It would be easier if the policy was consistent throughout the county. There is a duty as representatives of the public to protect the public. Mr. Kropp indicated they made some changes in the county health policy, and anyone can get smoking cessation help free for ten weeks. They can still access the State quit line for two weeks free, and that is open those who are insured or not. Mr. Valisic said they got some funding mid-cycle and can pay for signage with that, but it has to be spent before the end of the year. Ms. Ross indicated that the County has 30-foot policy (from buildings); but the State adopted 10-foot policy, so people were confused. It depends on the entrance or the building in the local campus. Mr. Johnson noted that 37% of people on Medicaid smoke, as opposed to the 14% overall. Mr. Kropp asked for direction on a countywide policy, for all county properties. Chair DeBone said they should not have to ease into it, but should just do it. Mr. Stell stated that they alerted staff and it took a little time. Ms. Finkle added that three months seemed adequate for to educate everyone. There are very few issues now. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 7 of 13 Pages Commissioner Baney said she would like to see a plan to work towards the education piece; something that might incentivize this change. She was advised that they did a kickoff party previously, a wellness raffle with prizes, and focused on wellness rather than having to stop doing something. Commissioner Unger noted that most employees are doing pretty well. Smokers seem to come into the State offices and Courthouse for other services. The policy is the right thing to do, but he is concerned about managing this on site. Commissioner Baney said that you won't get everyone. It is meant to be an engagement and not punitive. They still have personal choice but it does not hurt to try to influence this. They need to have a unified message. Ms. Ross stated that they need receptacles so people don't put out their cigarettes in the bark. It is just a matter of where to put them. Mr. Kropp said that some will ask where they can smoke, and that will be off the property or in their vehicle. Commissioner Baney noted that they need to transition through this as they have with other things, with perhaps phasing, incentive programs and education. Commissioner DeBone said he was ready to just put it in place now. BANEY: Move that County properties be tobacco-free, and that the County move forward with an implementation plan. UNGER: Second. VOTE: BANEY: Yes. UNGER: Yes. DEBONE: Chair votes yes. Potential Closure of the Deschutes County Downtown Health Center. Kathleen Christensen explained that a change is needed. The Center was started in 2006 to provide more outreach to teens and young adults, as part of her Public Health Nurse Leadership Institute project. The original funding came from the Male Advocates for Responsible Sexuality (MARS) program, and some staffing was provided through AmeriCorps volunteers. However, this is the last year for AmeriCorps. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 8 of 13 Pages Visits have been declining over the past few years, and they reduced the open days to two a week. They provide reproductive health and immunization services. About 80% don't have OHP or private insurance. Staff can still be productive, but they don't have a lot of revenue. It started to become a huge STD clinic. About 79% of the clients are female. Approximately 64% of clients are age 18- 24, and 14% age 17 and under. Some were referred from the Courtney facility. The national standard for productivity is 80%, and this is down. It is not an efficient use of staff and there is a lot of maintenance involved for being there just two days a week. Planned Parenthood can provide information on reproductive health and STD's also, but receives federal funding. She surveyed clinic staff and clients. They'd like to expand services longer each day at the Courtney facility. This would shore up the core instead of being spread out. The question is whether the message should go to the public in general or just clientele. Mr. Johnson suggested that they show how this will be more cost-efficient. Health Reform Update, including ABHA Status. Mr. Johnson explained how ABHA fits into the County's services. Medicaid dollars come in to Pacific Source, who sends them to ABHA, and some come to Deschutes County for indigent health services. The new Health Board will include funding from both Medicaid and indigent clients. This is a critical time for ABHA, with possible dissolution. There are five participating counties. The IGA is worded to allow change only with four yes votes. Mark Pilliod is trying to craft the proper document. David Givens said a key component is the financials. Mr. Johnson said that ABHA is trying to market business opportunities, separate from Deschutes County and maybe from other counties. The CCO is emerging soon, and they probably need to move on with some of the changes. Commissioner Baney stated that one option is an amicable separation of duties and financials; a hybrid. However, that may not be the best-case scenario. She indicated that ABHA was setting up private business using public funds. Two other counties, Lincoln and Benton, may not remain with ABHA. Jefferson and Crook may part. Capital and liabilities remain in question. ABHA's efforts may spring into a private company, capitalized by the County. This was never the intention, services versus job security. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 9 of 13 Pages Mark Pilliod added that apart from normal audits, it was discovered that ABHA is sitting on $7 million in reserves. If the County withdraws without a dissolution, that money could be forfeit to the other counties. Most of it has come from Deschutes County. Dissolution is the preferred option, with funds distributed based on how the funds were collected. It is apparent that Lincoln and Benton counties were treating the discussion of withdrawal of Deschutes, Crook and Jefferson counties as the same as dissolution, but it is quite different. ABHA meeting minutes are informal and the agendas very general. Actions taken depend on the quality of the person taking the minutes to know what they are doing. They need a written motion with clarity regarding actions. If a motion requires four votes and fails, it does not mean that the member counties would therefore withdraw. The alternatives are murky, and there is no clear picture of what Lincoln and Benton counties will do if the eastern counties withdraw. They may not be being devious, but just don't know. There might be other options, but it is very unclear. He has worked out a proposed motion. Commissioner Baney said that Crook and Jefferson counties want to see Deschutes County out of ABHA so that dollars can be kept local and keeping goals can be clearer. But, they have little to lose if they pull out. Deschutes County has the biggest burden and would have the biggest financial impact. Mr. Pilliod stated that if this fails, they have to return to their core mission. Mr. Kropp said that they talk of private business that they want to engage in, but that is not core work. Mr. Pilliod noted that this would commit ABHA resources towards new work. With Board approval, he will contact Jefferson and Crook county representatives. With their consent, he would discuss this with Lincoln County counsel, who has been actively involved as a non-voting member of ABHA for a long time. At the last meeting, the Board authorized ABHA legal counsel to engage an auditor to help understand the funds and how they are restricted. Also, to help answer the question of how restricted those funds are, and will those restrictions persist or be distributed. This will go forward anyway. Commissioner Baney said the stakes got higher when it went from $1 million to $7 million. She is not sure what Lincoln and Benton want to do. There are several options. She is trying to find out from Benton County. They are courting other counties to see if they want to join ABHA, and other companies are courting them. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 10 of 13 Pages There are lots of moving parts. During this time, though, the County can't stop providing the work that needs to happen. She voted `no' to continue with some of the work, but she was just one out of five. Mr. Johnson noted that Deschutes County is about two-thirds of the pie, which is significant. Mr. Kropp said that ABHA is looking for future contracts. This is a critical time. Mr. Pilliod added that they need an update to explain the current situation and to answer questions. And the Board needs to assess whether this is the best approach. They have three votes for sure, but need a fourth. If the motion fails, ABHA will continue down the same path and may hold funding hostage. That influences what can be done here. Mr. Givans said that there is supposed to be accounting for reserves by county, not as ABHA as a whole. The language is unclear. Mr. Kropp noted that this is a legal issue, and they need to be able to determine how the funding breaks down. Mr. Pilliod added that employees are entitled to income, PERS, etc., and there are probably potential liabilities. An amount has to be set aside for that. Commissioner Baney said they need to meet in person and get down to work. They need to reduce liabilities and allow for better access to services. 4. Other Items. The Board then went into Executive Session, called under ORS 192.660(2(h), pending or threatened litigation. The following action was taken after executive session (a copy of the letter is attached for reference): BANEY: Move approval of signature of the draft letter regarding LUBA Case #2011-121, REAO Settlement Negotiations UNGER: Second. VOTE: BANEY: Yes. UNGER: Yes. DEBONE: Chair votes yes. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 11 of 13 Pages Mr. Lelack said that they have reached the application deadline for the extension regarding the Historical Landmarks Commission memberships. He suggested they be non-specific as to area. Sisters received no applications. This change requires a text amendment. The applicants seem to be quality but don't fit the criteria as to areas. The Board was supportive. Mr. Lelack said that Mr. Irvine's term as Planning Commissioner ends on June 30, 2012, and he plans to retire and travel. This is an at-large position. The process to find a replacement should begin in April. Commissioner Baney stated that Matt Cyrus is getting pushback regarding the spreading of viridian waste on fields. Tom Anderson explained that the issue is with the Department of Agriculture. If something is designed for farm use, it has to pass muster with the State. A company contracts with breweries to find farmers to take this waste. The company goes to the Department of Agriculture, which approves this as a beneficial agricultural use. The County is out of that loop. This process does not come into play with solid waste issues or land use code. Commissioner Baney said there have been complaints about the smell. Everyone wants the government out of their property rights until it happens to be something they don't like. Some are trying to get the county involved. Mr. Anderson said the Farm Bureau can weigh in, but this should not be political. It is a use issue and the Department of Agriculture would say it is similar to spreading manure. Not all fertilizers smell good. And as a beneficial agricultural use, the conversation stops there. The Board discussed possible dates for an annual retreat. There will not be all three Commissioners in the office on the same days until probably March 26. Commissioner Unger suggested that Mr. Kropp produce a memo detailing anything that needs attention or updating. Commissioner Baney asked if this affects the budget process. Mr. Kropp feels that the budget will be basically status quo, but he can detail which departments are struggling more than others. The goals and objectives need to be reviewed. Commissioner Baney said that it does not need to be as detailed as it has been in the past. She suggested that they might want to look at what to share or consolidate. Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 12 of 13 Pages Chair DeBone wondered about finding out from departments what they think things might look like five years out. They want to talk about the Sheriff's proposal for a training facility, and what other requests or needs there might be for general fund dollars. Commissioner Unger feels that more attention should be focused on the work of the Fair/Expo Center, since they might be missing opportunities there. Mr. Kropp stated that he would like to come up with a few general questions for all departments. The Budget Committee would like to see the basics plus some new things to consider. A tentative retreat date of April 3, all day, was agreed upon. The Board then went into Executive Session, called under ORS 192.660(2(a), to consider the employment of a County Administrator. Being no further discussion, the meeting ended at 4:10 p.m. DATED this qtli- Day of 4 a-A C"k- 2012 for the Deschutes County Board of Commissioners. Anthony DeBone, Chair 6/4,14- U4-t~ ATTEST: UUA-L-,, 6dult~ Recording Secretary Alan Unger, Vice Chair Tammy harfiey, Comm s 'oner Minutes of Board of Commissioners' Work Session Monday, February 27, 2012 Page 13 of 13 Pages Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org WORK SESSION AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS 1:30 P.M., MONDAY, FEBRUARY 27, 2012 1. Update on Volunteer Connect and Project Connect - Betsy Warriner & Shellie Campbell, Volunteer Connect 2. Discussion of BLM/USFS Sage Grouse Planning Strategy & Deschutes County's Possible Involvement - Peter Gutowsky 3. Health Services Update and Review - Scott Johnson Draft Health Services Strategic Plan Discussion Tobacco Free Worksites - Discussion of Potential Expansion of Tobacco- free Policy on County Grounds Potential Closure of the Deschutes County Downtown Health Center • Health Reform Update, including ABHA Status 4. Other Items Executive Session, under ORS 192.660(2) (h), pending or threatened litigation. PLEASE NOTE: At any time during this meeting, an executive session could be called to address issues relating to ORS 192.660(2) (e), real property negotiations; ORS 192.660(2) (h), litigation; ORS 192.660(2)(d), labor negotiations; or ORS 192.660(2) (b), personnel issues. Meeting dates, times and discussion items are subject to change. All meetings are conducted in the Board of Commissioners' meeting rooms at 1300 NW Wall St., Bend, unless otherivise indicated. 1f you have questions regarding a meeting, please call 388-6572. Deschutes County meeting locations are wheelchair accessible. Deschutes County provides reasonable accommodations for persons with disabilities. For deaf, hearing impaired or speech disabled, dial 7-1-1 to access the state transfer relay service for TTY. Please call (541) 388-6571 regarding alternative formats or for further information. o tly- fV v q H ~ O r J ~I Gy ' r ~ rr I~ r ~ . U QE N y s in J V VI? of ca a ~ z fl L fiY I I ILA7e r; 1 ge1t;+A n[~ nn 7 O 5 r _ • Central Oregon's link to volunteer opportunities. Volunteer Connect offers "one-stop shopping" for getting connected with just about every Central Oregon non-profit you can think of. Your employees can help children learn to read through the SMART reading program, restore riverbank habitat through the Upper Deschutes Watershed Council, prepare meals for Bethlehem Inn guests who are homeless, guide after-school activities for the Boys & Girls Clubs, among many other fun - and meaningful - ways to get involved. Make a difference in your community- and for your employees. Volunteer programs turn good workplaces into great workplaces. Volunteer Connect makes it easy. We can: Help your employees find individual volunteer opportunities Help your company find group volunteer opportunities Record employee volunteer hours through our website Provide sign-ups, waivers, and other important forms Volunteer programs area proven way to get employees excited about their work and their community. Volunteering reinforces teamwork and collaboration Volunteering fosters a sense of camaraderie among employees Volunteering helps employees develop leadership, problem-solving and public-speaking skills Volunteering shows the community your company cares Contact Betsy Warriner at 541-385-8977 or email betsy@volunteerconnectnow.org to find out more. 541.385.8977 1 www.volunteerconnectnow.org I 404 NE Norton Ave. I Bend, Oregon 97701 • • • ' Sponsorship Sponsorship that keeps giving. Your sponsorship doesn't just help one non-profit - it helps hundreds of non-profits through a single donation. By connecting individuals with volunteer opportunities, Volunteer Connect leverages the time, expertise and compassion of concerned citizens to make sure that non-profits are able to continue delivering critical services to those who most need them. LEZU SPORSOR - MOO Membership with our Employee Volunteering staff development program Corporate name and logo prominently displayed: On all pages of Volunteer Connect website In Volunteer Connect monthly newsletter for one year At all Volunteer Connect community events CONIC N4 SPOMSOR - M00 Membership with our Employee Volunteering staff development program Corporate name and logo prominently displayed: On Sponsor page of Volunteer Connect website In three Volunteer Connect monthly newsletters At Volunteer Connect community event of choice Who we are and what we do COVIVIECUM 5pOMSOQ-Sg00 Membership with our Employee Volunteering staff development program. Receive information on volunteers connected through Sponsorship. Corporate name and logo prominently displayed: On Sponsor page of Volunteer Connect website In one Volunteer Connect newsletter Volunteer Connect is Central Oregon's link to volunteer opportunities. We connect individuals, families, students and employees with ongoing and one-time volunteer opportunities to help meet important community needs and to promote lifelong civic engagement. We also put on community-wide volunteer events for hundreds of volunteers at a time, including Martin Luther King, Jr. Day of Service and Project Connect, a one-day event that brings vital services to people who are homeless or at risk of becoming homeless. Contact Betsy Warriner at 541-385-8977 or email betsy@volunteerconnectnow.org to find out more. 541.385.8977 1 www.volunteerconnectnow.org 1404 NE Norton Ave. I Bend, Oregon 97701 1000 Friends of Oregon Abilitree After School Buddies American Cancer Society American Red Cross Arts Central Awbrey House Assisted Living BEAT (Bend Experimental Art Theatre) Bend Area Habitat For Humanity Bend Beautification Program Bend Park & Recreation District Bend's Community BikeShed Bend's Community Center Bethlehem Inn Big Brothers Big Sisters Boys & Girls Clubs Breakaway Promotions Camp Fire USA CASA Cascade School Of Music Cascade Youth & Family Center Central Oregon 211 Central Oregon Council on Aging Central Oregon Disability Support Network Central Oregon Land Watch Central Oregon Partnerships For Youth Central Oregon Veterans Outreach Common Table Commute Options Crook County Fairgrounds Deschutes Children's Foundation Deschutes Economic Alliance Deschutes Land Trust Deschutes Public Library Deschutes River Conservancy Deschutes River Woods Neighborhood Association DHS Deschutes Volunteer Services DHS Jefferson Volunteer Services Downtown Bend Business Association East Cascades Audubon Society Family Access Network Family Kitchen Family Resource Center Film Oregon Alliance Four Winds Foundation Friends Of Bend Libraries Friends Of Oregon Badlands Wilderness Friends With Flowers Girl Scouts Grandma's House Healing Reins Healthmatters Healthy Beginnings Healthy Families Heart Of Oregon Corps High Desert ESD - Plaza Comunitaria Human Dignity Coalition Humane Society of CO Hunger Prevention Coalition Icon City Presents Innovation Theatre Works Interfaith Volunteer Caregivers KIDS Center KPOV Community Radio Kurera Foundation La Pine Community Kitchen La Pine Park & Recreation District Latino Community Association Let's Pull Together MountainStar Family Relief Nursery National Multiple Sclerosis Society Natural Areas Foundation Neighborlmpact New Generations Early Childhood Education Center Office Of The Long Term Care Ombudsman Opportunity Foundation Oregon Natural Desert Association (ON DA) Partnership to End Poverty Planned Parenthood Redmond Area Park And Recreation District Redmond-Sisters Hospice River West Neighborhood Association Ronald McDonald House Saving Grace SCORE Central Oregon Serendipity West Foundation Sierra Club Juniper Group Sisters Volunteer Bank Slow Food High Desert SMART SOLV Special Olympics St. Vincent De Paul, La Pine St. Vincent De Paul, Redmond Sunriver Nature Center & Observatory The Bend Spay And Neuter Project The Environmental Center The Heart Campaign The Shepherd's House The Trust For Public Land Think Again Parents Substance Abuse Prevention Teams Together For Children Trout Unlimited Trusted Sports Foundation United Way Of Deschutes County Upper Deschutes Watershed Council VegNet Bend Visit Bend Vital Provisions Program Volunteers In Medicine Westside Village Magnet School 541.385.8977 1 www.volunteerconnectnow.org 1 404 NE Norton Ave. ( Bend, Oregon 97701 Our company is excited to help build a stronger, more connected Central Oregon. We're happy to sponsor Volunteer Connect at the following level: Lead Sponsor 53000 Event Sponsor S1000 Connecting Sponsor SS00 Company Name Contact Person Address Phone 1~dV{z3S J Our check is enclosed Please send us an invoice Email We are donating online at www.volunteerconnectnow.org (Just click on the Donate button.) Volunteer Connect is a 501 (c) (3) nonprofit organization. 541.385.8977 1 www.volunteerconnectnow.org 404 NE Norton Ave. I Bend, Oregon 97701 What is Volunteer Connect? In January 2010, with support from the Deschutes County Commissioners, the Partnership to End Poverty, United Way, and multiple other community organizations, Volunteer Insights became Volunteer Connect and expanded to become Central Oregon's volunteer center. Volunteer Connect is now the region's central resource for potential volunteers to connect with opportunities to make a meaningful difference in Deschutes, Crook, and Jefferson Counties. In 2011, we connected over 1700 volunteers with opportunities to serve our communities through 110 community agencies, primarily in Deschutes County. In the fall of 2011, Volunteer Connect welcomed the opportunity to house and manage Project Connect and Project Mobile Connect, with the prospect of engaging hundreds of volunteers in helping homeless and low-income community members improve their lives. The central objectives of Volunteer Connect are: 1) To connect volunteers with ongoing and one-time volunteer opportunities. 2) To engage volunteers in community-wide volunteer events, including Martin Luther King, Jr. Day of Service and Project Connect. 3) To match corporate employees with volunteer opportunities and service projects, building teamwork, leadership, and community presence. 4) To engage school and college students in service-learning, developing lifelong community engagement and leadership. 5) To help individuals who are seeking employment to connect with volunteer opportunities that build their job skills, community connections, and employability. 6) To lead volunteer management workshops to build community organizations' capacity to utilize volunteers. Request for Funding Support With appreciation for your previous support, we are requesting 2012 funding from the Deschutes County Commissioners for Project Connect, Project Mobile Connect, and ongoing volunteer engagement in Deschutes County, to serve our key objectives. Program: Volunteer Engagement Project Connect("ect Mobile Connect Objectives: 1, 2, 3, 4, 5, 6 2 Re uest: $2000 $5000 vvmw 4ps CENTRAL OREGON PROJECT CONNECT What is Project Connect? Project Homeless Connect (PHC) began in San Francisco in 2004. Volunteers and agencies gathered on one day, in one place, to provide health and human services to the homeless. Since 2004, PHC has become a national event held in more than 100 cities. Portland and Eugene were the first in Oregon to adopt the PHC model, uniting hundreds of volunteers and agencies under one roof to provide health and human service to more than 4,000 community members in need. In 2007, the Central Oregon Community, under the leadership of the Partnership to End Poverty and the 10 Year Plan to End Homelessness, implemented the first Central Oregon Project Homeless Connect. After a successful first event, the name was changed to Project Connect in order to welcome anyone to attend who is experiencing a need for services. In 2011, The Partnership to End Poverty asked Volunteer Connect to take over management of Project Connect. Volunteer Connect is Central Oregon's premier volunteer center. Our mission is to connect volunteers to meaningful volunteer experiences. With over 800 volunteers serving guests at Project Connect, Volunteer Connect was the logical home for the event. The specific objectives of Project Connect are threefold: 1) To help homeless and low-income guests improve their lives by accessing needed services. 2) To involve volunteers and organizations in improving the lives of low-income and homeless populations by providing a supportive environment in which to serve. 3) To inform and educate the region on how our service organizations, agencies and volunteers can help reduce homelessness and to motivate individuals to be involved in the solution. Project Connect is a one-day, one-stop event serving guests who are low-income, homeless or at risk of homelessness. The event is held at the Deschutes County Fairgrounds in Redmond. Guests include low-income and homeless people from Deschutes, Crook and Jefferson counties and the Warm Springs reservation. Services Provided Medical Legal Aid Community Health Veterans/Education Dental Employment Immunizations Social Services Vision Children's Services Housing Nutrition Clothing Addiction Services Haircuts Finance Food Identification/Birth Certificates Project Connect over the years Year Guests Served Volunteers 2007 2008 2009 2010 2011 2012 Key Partners 1200 500 1838 600 2257 662 2597 680 3421 809 September 22! Value to the Community $360,000 $400,000 $535,090 $595,242 $603,967 Project Connect would not be possible without the hundreds of dedicated volunteers who provide valuable services on the day of the event. Many of those volunteers are community partners who work to provide support and develop systems to meet the needs of the fragile population Project Connect serves. It is the support and coordination with our partners that has made Project Connect a success. St. Charles Medical Center Deschutes County Medical Teams International State Of Oregon COVO FAN Neighbor Impact Community Banks Partnership to End Poverty Habitat for Humanity Faith Community Legal Aid Services of Central Oregon Bethlehem Inn COCC Housing Works Abilitree Community Health Agencies OSU - Cascades Project Mobile Connect After evaluating the successful Project Connect, the organizers determined that once a year may not always meet the needs of each community or guest. Project Mobile Connect was introduced in 2011 with support from a grant from the Oregon Community Foundation. In 2011, eight Project Mobile Connect events occurred, serving LaPine, Bend, Deschutes River Woods, Sun River, Redmond, Prineville, Madras, and Sisters. Volunteer Connect will work with volunteers and community agencies to provide five Project Mobile Connect events in 2012. We will offer the events in LaPine, Bend, Redmond, Prineville and Madras. A major goal of Project Mobile Connect is to provide services to those who did not attend Project Connect or who need additional services. Another goal is to have each Project Mobile Connect embraced by the local community in order to provide long term sustainability. Summary Volunteer Connect has welcomed and integrated Project Connect and Project Mobile Connect into the organization's ongoing programs, which connect volunteers with people in need to build stronger communities in Central Oregon. In 2012, Project Connect and Project Mobile Connect will engage more than 800 trained volunteers, including 25 volunteer leaders, and more than 150 service organizations and community business partners in serving more than 3,400 guests experiencing homelessness or are underserved. r_ LZ A) X Community Development Department Planning Division Building Safety Division Environmental Soils Division RO. Box 6005 117 NW Lafayette Avenue Bend, Oregon 97708-6005 (541)388-6575 FAX(541)385-1764 http://www.co.deschutes.or.us/cdd/ MEMORANDUM DATE: February 22, 2012 TO: Deschutes County Board of Commissioners FROM: Peter Gutowsky, Principal Planner MTG: February 27, 2012 Work session RE: Sage Grouse Conservation Strategy / Cooperating Agency Discussions with BLM BLM Presentation The purpose of the February 27 work session is to discuss an opportunity for the Bureau of Land Management (BLM) and Deschutes County to work together in development of the BLM's Greater Sage Grouse Habitat Conservation Strategy. Anita Bilbao, Acting Prineville District Manager and her staff will make a short presentation and be available to answer questions. At the meeting BLM will summarize the schedule for this project, explain BLM and Cooperating Agency roles, and describe the benefits, limitations and time commitment of Cooperating Agency participation. Their goal is to present enough detail that the Board of County Commissioners (Board) can understand the process and make a decision about whether it is in Deschutes County's interest to serve as a Cooperating Agency on this project. Attached for the Board's review are a draft Memorandum of Understanding and a general factsheet. Background In April 2010, the US Fish and Wildlife Service (USFWS) determined that protection of the greater sage-grouse under the federal Endangered Species Act (ESA) was warranted. However, listing the greater sage-grouse was precluded at this time by the need to address other listings facing greater risk of extinction. The sage-grouse is now a candidate species for listing. The primary threats to the sage-grouse across its range are: habitat loss and fragmentation, including wildfire; invasive plants; energy development; urbanization and agricultural conversion and grazing. More than any native species since the spotted owl, the sage grouse sparks direct conflict with traditional industries and emerging, large-scale renewable energy projects, from livestock grazing to the construction of wind turbines and power lines. The status of the sage grouse, both biologically and legally, is important to the state of Oregon because so much of Central and Eastern Oregon consists of sage grouse habitat. If sage grouse is protected as a threatened or endangered species, federal agencies will be required to consult with USFWS on projects and approvals that may affect the sage grouse. "Taking" a sage grouse will be illegal, and the USFWS will be required to designate "critical habitat," resulting in further restrictions upon activities in those areas.' ' The ESA comprehensively defines "take" to encompass any direct or indirect harm to the species, including impacts to habitat modification or degradation that significantly impairs essential behavioral patterns such as breeding, spawning, rearing, migrating, feeding, or sheltering. Quality Services Performed with Pride BLM National Greater Sage-Grouse Planning Strategy What is the BLM National Greater Sage-Grouse Planning Strategy? The BLM National Greater Sage-Grouse Planning Strategy is a planning approach that provides the framework and structure for transparent interagency and stakeholder collaboration on long-term greater sage-grouse conservation and habitat restoration. Under the planning strategy, the BLM will review its principal, existing regulatory framework for sage-grouse conservation-the land use planning process-to determine the development and implementation of new or revised regulatory mechanisms. The focus will be on incorporating regionally-appropriate, science-based conservation measures into BLM land use planning efforts through coordinated, cooperative stakeholder engagement. Greater sage-grouse benefit from and make use of suitable habitat regardless of land ownership and management responsibility, so the BLM planning strategy uses an open and collaborative approach to foster cooperative conservation efforts across the regions and states that make up the greater sage-grouse range. The planning strategy illustrates the Bureau's continued commitment to long-term, rangewide sage-grouse conservation and habitat restoration and acknowledges the added value of engaging all stakeholders in cooperative conservation efforts. Why was a new planning approach developed? In April 2010, the U.S. Fish and Wildlife Service (FWS) found that the greater sage-grouse warrants the protection of the Endangered Species Act (ESA) but that listing the species was precluded by the need to address other, higher-priority species first. decision was an identified need for more adequate regulatory mechanisms to ensure species conservation. The FWS greater sage-grouse decision placed the species on the candidate list for future action, which provided stakeholders such as Federal agencies, states, and private landowners with additional opportunities to continue working cooperatively to conserve the species and restore its habitat. The BLM also used this opportunity to develop the new planning strategy, which is directed toward long-term conservation and habitat restoration on BLM-administered lands rangewide. Domment Reproduces Poorly (Archived) BLM National Greater Sage-Grouse Planning Strategy Highlights • Creates a rangewide approach that allows for improved collaboration and coordination and addresses ecoregional differences by dividing sage-grouse range into an Eastern Region and a Western Region. • Eastern Region will include Colorado, Montana, North Dakota, South Dakota, northeastern Utah, and Wyoming where major sage-grouse threats include habitat loss and fragmentation due to energy development both oil and gas and renewables. • Western Region will include California, Idaho, Nevada, Oregon, and most of Utah, with a small portion of southwestern Montana where major sage-grouse threats include habitat loss and fragmentation due to invasive plant species and wildfire impacts. ♦ Creates several governance teams to ensure ongoing coordination and oversight, both regionally and nationally, using an interagency and multi-state approach that engages all stakeholders. A National Policy Team will provide national policy guidance on sage-grouse conservation and consistent planning objectives. • A National Technical Team (NTT) will use the best science available to derive recommended conservation measures. • Two Regional Management Teams (RMTs) will coordinate planning and strategy implementation efforts across the states and provide direction at specific points to ensure consistency. • Two Regional Interdisciplinary Teams (RIDTs) will coordinate the development of EISs and RMP amendments using policy guidance provided by the National Policy Team. • State-level Interdisciplinary Teams (SIDTs) will conduct the required environmental analyses to transform goals and objectives into regulatory mechanisms for greater sage-grouse conservation. Oregon Implementation of the National Strategy Implementing the National Greater Sage-grouse Planning Strategy allows Oregon BLM the opportunity to fully consider long-term sage-grouse conservation and habitat restoration guidance contained in the Greater Sage-Grouse Conservation Assessment and Strategy for Oregon published by Oregon Department of Fish and Wildlife. To date, an Interdisciplinary Team (IDT) has been formed, a contractor hired and the Resource Management Plan (RMP) process has begun. Historic Sage-grouse habitat encompassed 17.7 million acres in Oregon (prior to Euro- American settlement). Currently, Sage-grouse occupy 14-15 million acres in Oregon which approximately 80% of their historic distribution. About 70% of the current Sage- grouse distribution (about 10 million acres) occurs on lands administered by BLM. Ongoing RMP Efforts in Oregon Oregon BLM will consider new sage-grouse conservation information as part of the following ongoing RMP and accompanying National Environmental Policy Act (NEPA) efforts: Baker RMP revision (Vale) John Day RMP revision (Prineville) Lakeview RMP amendment (Lakeview) Southeastern Oregon RMP amendment (Vale New RMP Amendments in FY 2012 Oregon BLM will be revising or amending the RMPs below and expects to begin a 60-day formal public scoping period on or about Dec. 9 of this year following publication of a Notice c Intent in the Federal Register: Andrews Burns District Brothers LaPine (East) Prineville District Steens Burns District Two Rivers Prineville District Three Rivers Burns District Upper Deschutes Prineville District A lot of good work has already been done by BLM and our partners to conserve and restore sagebrush habitat as evidenced by 80% of the historic range is occupied by sage-grouse. Considering the ODFW strategy and other conservation measures at the planning and regional scale provides an opportunity to continue the good work and adjust plan direction where necessary for the conservation of the species. Updated as of 11/29/2011 ` ' 3~~ ' fr v' er - rat C ~~y M Q r. ~ CO) Z S LCD LLJ N Z ~ m Z r~~ r~ \ J - C4 -oo~ LU > Co ~ C) 00 00 o0100 0000, w a w m 2 J a L) N LL ~ 0) w 11, ljj G m ae w Q g o Q J Y a cis ca ca EL rm co ~ 3 0 _ -0 CC Q) tm In too LL 0 0 ( 0 ~ O I Z y ~ ~ A l0 ~ 'J 8 ~~g 8~ g$gg ~yyy iy N A a Yq ~1 O ~ ~ d m (a CO m= 0 c m (A = 0 c d Q • a e p of C ~1 O m o o ~ _ O1 00 Q ~ 0 0 m e w Fll m MEMORANDUM OF UNDERSTANDING BETWEEN DESCHUTES COUNTY AND THE UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT BY AND THROUGH THE OREGON/WASHINGTON BLM STATE DIRECTOR REGARDING DEVELOPMENT OF THE RESOURCE MANAGEMENT PLAN AMENDMENTS AND ENVIRONMENTAL IMPACT STATEMENT FOR THE PROPOSED GREATER SAGE-GROUSE HABITAT CONSERVATION STRATEGY, WESTERN REGION, OREGON/WASHINGTON SUB-REGION Memorandum of Understanding Between Deschutes County and the Bureau of Land Management For Amendment of the Resource Management Plans and Associated Environmental Impact Statement regarding Greater Sage-grouse Conservation for the BLM Districts With Lands Within Deschutes County Parties to and Purpose for this Document: This Memorandum of Understanding (MOU) is entered into between Deschutes County and the United States Department of the Interior (DOI), Bureau of Land Management (BLM) by and through the Oregon/Washington Director (BLM), for the purpose of coordinating and cooperating in conducting an environmental analysis and preparing the draft and final Environmental Impact Statements (EISs) for the greater sage-grouse habitat conservation strategy. These EISs will be coordinated under two regions: an Eastern Region and a Western Region. The Eastern Region includes land use plans in the states of Colorado, Wyoming, North Dakota, South Dakota, and portions of Utah and Montana. The Western Region includes land use plans in California, Idaho, Oregon, Nevada, and portions of Utah and Montana. Within these Regions, sub-regional interdisciplinary teams (IDTs) will be developing individual EISs. Based on the identified threats to greater sage-grouse and the U.S. Fish and Wildlife Service (FWS) timeline for making a listing decision on this species, the BLM aims to incorporate objectives and conservation measures into Resource Management Plans (RMPs) (for the purpose of this document, the term "RMP" applies to all land use plans) by September 2014 in order to conserve greater sage-grouse and avoid a potential listing under the Endangered Species Act (ESA). Therefore, the BLM will conduct these EISs under expedited timeframes. 1. This MOU establishes Deschutes County as a "cooperating agency" in the environmental impact analysis and documentation process and establishes procedures through which Deschutes County will participate with the BLM sub-regional IDT to conduct the analyses and develop the EIS. Deschutes County has been identified as a cooperating agency because it has special expertise with respect to local land use regulations, laws, and as well as local knowledge of social or political conditions (40 CFR 1508.5). This MOU applies specifically to the lands within Deschutes County in the Oregon/Washington Sub-Region within the Western Region. 2. Authorities: This MOU has been prepared under the authorities for the National Environmental Policy Act of 1969 and federal regulations codified at 40 Code of Federal Regulations (CFR) Part 1500-1508, and 43 CFR Part 46; and BLM's planning regulations (in particular 43 CFR 1601.0-5, 1610.3-1, and 1610.4). 3. Background: In April 2010 the FWS published its listing decision for the greater sage- grouse as "Warranted but Precluded." The FWS identified the inadequacy of regulatory mechanisms as a major threat in the FWS finding on the petition to list the greater sage- grouse. The FWS has identified the principal regulatory mechanism for the BLM as conservation measures in RMPs. Based on the identified threats to the greater sage-grouse and the FWS timeline for making a listing decision on this species, the BLM needs to 2 incorporate explicit objectives and adequate conservation measures into RMPs within the next 3 years in order to conserve greater sage-grouse and avoid a potential listing under the Endangered Species Act. Under the planning strategy, the BLM will evaluate the adequacy of its RMPs and address, as necessary, revisions and amendments throughout the range of the greater sage-grouse (with the exception of the bi-state population in California and Nevada and the Washington state population segment, which will be addressed through other planning efforts). The BLM has determined that the proposed strategy is a major federal action which requires the preparation of an EIS in accordance with the National Environmental Policy Act (NEPA). The BLM will seek public and agency input to identify issues to address in the EISs, and BLM will coordinate with other federal, state, and local government agencies in preparing the EISs. The BLM will conduct detailed environmental studies on the proposed and alternatives, and analyze how implementation of these alternatives may affect the quality of the environment. Under the authorities of the NEPA and its implementing regulations (40 C.F.R. § 1501.6), and federal regulations promulgated by the Department of the Interior (DOI) for NEPA (43 C.F.R. 46.220, 46.225 & 46.230), the BLM is the lead agency and Deschutes County is a cooperating agency for this EIS process. Cooperating agency status may be offered to other federal agencies, tribes and local government agencies as well. All EISs will consider both federal and non-federal lands in its analyses. However, any decisions that would result in implementation action would apply ONLY to federal land and minerals and may be subject to additional NEPA process. 4. Term of MOU: This MOU will commence upon the date of the last signature made by the duly authorized representatives of the parties to this MOU, and will remain in full force and effect until terminated as described in item 9i, below. 5. Responsibilities of Deschutes County: Based upon the expedited time frames for this initiative, Deschutes County will participate in the environmental analysis and documentation process by providing information regarding environmental issues for which or where Deschutes County has special expertise. Deschutes County has special expertise regarding local laws, regulations or County land use plans as well as knowledge of local conditions. A schedule and preliminary timeframe for the respective stages of EIS development where Deschutes County may participate in the planning process is included in Attachment A. Deschutes County will have one representative appointed to represent its interests and work with the Oregon/Washington sub-regional IDT and as its point of contact (see Section 9k.). At the BLM's discretion the Deschutes County representative may be present, as available, at IDT meetings and provide supporting documentation and information as necessary. Information provided by Deschutes County may be at its discretion or upon request by BLM IDT members or the BLM's third party NEPA contractor through the sub- regional IDT leader and within the IDT leader's specified time frames. If the County has special expertise available for the plan amendment process, the BLM may ask the County's appointed representative to participate in the interdisciplinary team process. 3 Through its representative, Deschutes County will have the opportunity for input to preliminary draft documents prepared during the EIS process. The IDT leader may, at any time during the effective term of this MOU, request records by contacting the Deschutes County point of contact identified in Section 9(k) below. Prior to release, all records or information requested of or provided by Deschutes County pursuant to this MOU will be subject to review by Deschutes County. Under this MOU, Deschutes County may be expected to assist the BLM by identifying key issues, developing reasonable alternatives, providing timely information, and reviewing preliminary environmental documents, in accordance with the schedule for preparation of the EIS set by the IDT leader. As a non-Federal agency, Deschutes County agrees to maintain the confidentiality of all documents and information it acquires through the processes and deliberations covered by this MOU, during the period prior to the public release of the final EIS. 6. Responsibilities of the BLM: In accordance with 40 C.F.R. § 1501.5 and 43 C.F.R. § 46.220, the BLM is the lead agency. The point of contact for the preparation of this EIS is as designated in Section 9(k) of this MOU. The BLM will keep the Deschutes County representative apprised of current events and timeframes in relation to this EIS. The BLM will consider and may use input and proposals from the Deschutes County representative to the maximum extent possible and consistent with responsibilities as lead agency as described in 40 CFR 1501.5. BLM may incorporate information provided by Deschutes County into the draft and final EISs as appropriate. The BLM is solely responsible for any decisions made in relation to the planning effort. Any BLM decisions made associated with the EIS apply only to BLM-administered lands and federal mineral estate. 7. Mutual Responsibilities of the Parties: Deschutes County and the BLM agree to cooperate by informing each other as far in advance as possible, of any related actions, issues or procedural problems that may affect the environmental analysis and documentation process or that may affect either party. The parties listed under provision 9.k. below will serve as the MOU core team. The purpose of the MOU core team is to ensure that timely and coordinated communication and exchange of information between the parties to the MOU occurs throughout the planning process. 8. Payment: No payment will be made to either party by the other as a result of this MOU. Each party will pay its own costs. During the course of the planning process, should it become necessary for one party to purchase from or make payment or reimbursement to the other party, such arrangements will be covered in a separate agreement. 9. General Provisions: a. Amendments. Either party may request changes to this MOU. Any changes, modifications, revisions, or amendments to this MOU, that are mutually agreed upon by and between the parties to this MOU, will be incorporated by written instrument, 4 executed and signed by both parties to this MOU, and are effective in accordance with the terms of paragraph 2 above. b. Applicable Law. The construction, interpretation and enforcement of this MOU will be governed by the applicable laws of the United States and, where not inconsistent, the laws of the State of Oregon. c. Entirety of Agreement. This MOU, consisting of pages, with Attachment A, represents the entire and integrated agreement between the parties and supersedes all prior negations, representations and agreements concerning the parties' environmental documents, whether written or oral. d. Severability. Should any portion of this MOU be determined to be illegal or unenforceable, the remainder of the MOU will continue in full force and effect, and the parties may renegotiate the terms affected by the severance. e. Sovereign Immunity. Deschutes County and the BLM do not waive their sovereign immunity by entering into this MOU, and each fully retains all immunities and defenses provided by law with respect to any action based on or occurring as a result of this MOU. f. Third Party Beneficiary Rights. The parties do not intend to create in any other individual or entity the status of third party beneficiary, and this MOU must not be construed so as to create such status. The rights, duties and obligations contained in this MOU will operate only between the parties to this MOU, and will ensure solely to the benefit of the parties to this MOU. The provisions of this MOU are intended only to assist the parties in determining and performing their obligations under this MOU. The parties to this MOU intend and expressly agree that only parties signatory to this MOU will have any legal or equitable right to seek to enforce this MOU, to seek any remedy arising out of a party's performance or failure to perform any term or condition of this MOU, or to bring an action for the breach of this MOU. g. Exchange of Information. All records or information requested of either party by the other will be reviewed by the party generating the record prior to release. To the extent permissible under law, any recipient of proprietary and/or pre-decisional information agrees not to disclose, transmit, or otherwise divulge any such information without prior approval from the releasing party. Any breach of this provision may result in termination of this MOU. The BLM and Deschutes County recognize that applicable public records laws will require release of non-exempt documents. h. Administrative Considerations. Pursuant to 204(b) of the Unfunded Mandates Reform Act of 1995, responsible Federal Agency officials may meet or enter into project level MOUs with officials of State and local Governments or their designees. During such meetings and development, implementation and monitoring of such MOUs, views, information and advice are exchanged, or input relative to the implementation of Federal programs is obtained. Such meetings and MOUs will further the administration of intergovernmental coordination. 5 The meetings or MOU referred to include, but are not limited to, meetings called for the purpose of exchanging views, information, advice or recommendations, or for facilitating any other interaction relating to intergovernmental responsibilities or administration. Nothing in this MOU will be construed as limiting or affecting in any way the authority or legal responsibility of Deschutes County or the BLM, or as binding either Deschutes County or the BLM to perform beyond the respective authority of each, or as requiring either to assume or expend any sum in excess of appropriations available. It is understood that all the provisions herein must be within financial, legal, and personnel limitations, as determined practical by Deschutes County and the BLM for their respective responsibilities. This MOU is neither a fiscal nor a funds obligation document. Nothing in this MOU will be construed to extend jurisdiction or decision-making authority to BLM for planning and management of land and resource uses for any non- Federal lands or resources in the planning area. Similarly, nothing in this MOU will be construed to extend jurisdiction or decision-making authority to Deschutes County for planning and management of land or resource uses on the Federal lands or mineral estates administered by the BLM. Both Deschutes County and BLM will work together cooperatively and will communicate about issues of mutual concern. L Termination: Either party may terminate this MOU upon 30 days written notice to the other party of their intention to do so. During the 30-day period, the parties will conduct negotiations to resolve any disagreement(s). If the disagreement(s), if any, have not been resolved and the party initiating the termination has not rescinded its termination notice in writing by the end of the 30-day period, the MOU will terminate. In the event negotiations are progressing but are not concluded by the end of the 30-day period, the party initiating the termination notice may request in writing that termination be postponed for an additional 30-day period or longer while the negotiations continue; upon such request, the termination shall be postponed for the specified period. j. Dispute Resolution: Disputes between the BLM and Deschutes County concerning the content of the RMP Amendment/EIS shall be resolved through good-faith efforts between the cooperators themselves. The parties recognize that BLM has the delegated authority to make final decisions regarding public land management in the RMP. This MOU does not preclude Deschutes County, notwithstanding cooperating agency status, from pursuing relief through any applicable administrative or judicial review or litigation. Nothing in this MOU shall compromise or affect the rights of the County to contest the results of the planning process through any means available to Deschutes County. 6 k. Contacts: The primary points of contact for carrying out the provisions of this MOU are: DESCHUTES COUNTY NAME ADDRESS BLM Sally Sovey Oregon/Washington Bureau of Land Management 333 SW First Avenue Portland, Oregon 97205 ssovey(n,blm.p,ov (503) 808-6625 7 10. Signature: The parties hereto have executed this Memorandum of Understanding as of the dates shown below. The effective date of this MOU is the latest signature date affixed to this page. Deschutes County by and through: NAME TITLE Date U. S. DEPARTMENT OF THE INTERIOR, BUREAU OF LAND MANAGEMENT, by and through: NAME Date Ed Shepard, Oregon/Washington BLM State Director 8 Attachment A Cooperating Agency Participation in the National Sage Grouse Planning Strategy BLM RMP/EIS Stage Proposed Completion Date County Cooperating Agency O ortunities to Engage Conduct scoping and identify March 23, 2012 May identify issues for issues consideration. Formulate alternatives June 30, 2012 Provide information regarding local land use plans or zoning on lands adjacent to or immediately vicinity of BLM lands. May suggest themes or land allocations for potential alternatives. Estimate effects of alternatives September 30, 2012 May collaborate with BLM to Select the preferred alternative; December 31, 2012 review portions of preliminary issue Draft RMP/EIS alternatives / Draft EIS. This may include review of the socioeconomic section. May collaborate with BLM to review portions of preliminary alternatives / Draft EIS. This may include review of the socioeconomic section. Respond to comments May 31, 2013 May participate as the general public does in providing official comments to the Draft EIS. Issue Proposed RMP/FEIS November 30, 2013 Governor's Consistency Review January 31, 2014 May contribute to Governor's Consistency Review. Resolve protests; modify May 30, 2014 Limited Role. Proposed RMP/FEIS if needed; sign ROD Deschutes County Board of Commissioners Work Session Agenda - February 27, 2012 Department: Health Services A. Overview -Scott Johnson, Director B. Tobacco Policy -Jock Pribnow MD PHAB vice chair, Tom Kuhn, David Visiko 1. Overview 2. Letter from PHAB and Rich Fawcett MD, Health Officer 3. Other public input: Bend Parks, St. Charles Health System, Telecare, Susan Ross 4. Discussion - Board guidance C. Downtown Health Center -Tom Kuhn, Kathy Christensen 1. Overview 2. Discussion - Board guidance D. Strategic Plan draft -Scott 1. Overview 2. Discussion - Board guidance E. Health reform -Scott 1. SB 1580 passage - CCOs to form 2. Dissolution of ABHA - Board guidance a. Proposed dissolution motion draft (handout) - Mark Pilliod b. Proposed financial plan draft (handout) - David Givans 3. Health Board operation a. Retain health authority roles at County level b. Manage resources regionally if more effective and efficiency c. Tools: consent agenda; annual meeting; can call for regional meeting if concern d. Formal policy guidance will be brought to you later Thank you! A~ Deschutes County Tobacco-free Policy Talking Points February 2012 Tobacco-free policies are important for the health of Deschutes County residents: • Tobacco is highly addictive, including smokeless tobacco, and carries serious health risks. • Tobacco-free policies offer more comprehensive protection (than smokefree policies) for people and property. o They reduce maintenance needs and costs. Less money is spent to clean up cigarette butts and chew spit on sidewalks and other surfaces. Tobacco-free policies encourage smokers and smokeless tobacco users to quit. o In Oregon, nearly 69% of smokers want to quit' but struggle to do so. A tobacco-free environment helps remove the temptation and supports people kicking the habit. o Sixty-one percent of smokers in Deschutes County attempted to quit for at least one day (highest prevalence in the state; statewide average is 48.3 percent).2 • Tobacco-free policies increase productivity, as employees take less sick time and smoking breaks. • Tobacco-free policies ensure equal access to all. Secondhand smoke is an access barrier for people with asthma and other chronic conditions. • Tobacco-free policies help show kids that tobacco is not part of a healthy life. o The Centers for Disease Control recommends tobacco-free policies as a comprehensive youth tobacco prevention tool.3 In 2009, tobacco cost Deschutes county $80 million in lost productivity and medical expensee Direct costs due to media expenditures (2009): $41.9 million • Indirect costs due to lost productivity (2009): 38.1 million • Total economic costs (2009): $80.0 million • Source of data: Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC). http://apps.nccd.cdc.gov/sammec/index.asp. The statewide productivity losses were recomputed using 2009 smoking prevalence numbers, overall mortality rates for 2004-2007 for tobacco-related cancers, and current population data. The smoking-attributable expenditures are expressed in 2009 dollars.5 1 Oregon Tobacco Facts, 2011, page 17. 3 Oregon Tobacco Facts, 2011, page 18. 2 http://www.cdc.gov/tobacco/data-statistics/fact-sheets/secondhand_smoke/protection/reduce-smoking/index.htm 4 Oregon Tobacco Facts, 2011, page 6. 5 ham.//public.health.Oregon.gov/PreventionWellness/TobaccoPrevention/Documents/countvfacts/technotedf Our community wants tobacco-free policies and they recognize the dangers of secondhand smoke: [71 of people surveyed said it is very important and [13%] said it was somewhat important to them that Deschutes County established tobacco-free buildings and grounds. • [51 of people surveyed said they were bothered either a little or a lot by tobacco smoke while visiting a Deschutes County building. • [86%] of people surveyed try to avoid secondhand smoke when out and about. • [68%] or people surveyed believe breathing secondhand smoke is very harmful to one's health and [23%] believe it is somewhat harmful to one's health. Enforcement • Tobacco free policies are easier to enforce than those with designated smoking areas, demanding less staff time for enforcement. • 100 percent tobacco-free policies are easier to enforce because there are no gray areas, and such policies reduce costs associated with cigarette litter and tobacco damage to facilities. • Tobacco-free policies work best when compliance is viewed as the shared responsibility and the right of all in the community-smokers and nonsmokers alike. Concerns can be mitigated by emphasizing the goal of ensuring a safe and accessible space for all, and by encouraging open discussion and airing of any questions. • Clearly communicate the tobacco-free policy by developing an internal and external communication plan to ensure everyone understands what the policy entails and the proper steps for enforcement. This will need to be mapped out after a more detailed planning session with the decision makers. Deschutes County Tobacco Control can offer to help in that process and also help develop the internal and external communication plan]. o Sample language: ■ While X is ultimately responsible for enforcing the new policy, we encourage everyone to politely ask others to refrain from using tobacco while on X property. ■ For those who absolutely have to smoke, we ask that you step off of the property to do so. Please be courteous of neighbors and area businesses by keeping the noise volume down and picking up your cigarette litter. Bark dust fires: • During 2005-2009 there were almost 6,400 cigarette fires in Oregon, which were responsible for 34 deaths, 133 injuries, and an estimated $20 million in property loss. 6 Trend in businessestworksites going Tobacco free 6 hftp://www.oregon.gov/OSP/SFM/docs/Data_Services/Reports/2005- 2009_Oregon_Cigarette_Fi res_in_S ing le-And_Multi-Fa mily_Hou sing. pdf?ga=t Business, organizations and institutions across Oregon are implementing smokefree and tobacco-free policies, including: o Housing Authorities o Hospitals o City and county campuses o College campuses o Parks, Farmers Markets and other outdoor spaces o Events, such as fairs and powwows o Hotels Emissions of cars versus secondhand smoke • Cigarette smoke has a higher concentration of carbon monoxide than exhaust from a clean, well-maintained vehicle.' Oregon Quit Line • The Oregon Tobacco Quit Line is available to anyone, regardless of income or insurance overage. Call 1-800-QUIT-NOW or 1-877-2NO-FUME for Spanish, or visit www.oregonquitline.org • The Oregon Tobacco Quit Line also offers an online, live chat coaching service for those who would prefer to receive help to quit via their computer. 7 http://facuity.washington.edu/djaffe/ce3.pdf Deschutes Coun Public Health Advisory Board February 27, 2012 Public Health Advisory Board 2577 NE Courtney Drive Bend, Oregon 97701 February 27, 2012 Deschutes County Board of Commissioners Anthony DeBone, Chairperson Alan Unger, Vice Chairperson Tammy Baney, Commissioner Re: Support of 100% Tobacco Free County Properties Dear Board of Commissioners: The Deschutes County Public Health Advisory Board (PHAB) would like to request that you take the lead in protecting the health of Deschutes County residents. Specifically, expand the current restriction on the use of tobacco products to include the entire campus of all Deschutes County properties. PHAB asks for your formal support to better protect the health of clients, visitors and employees who frequent our properties. With this request, PHAB is aligning with the Triple Aim framework; by improving the health of our population, and reducing or, at minimum, controlling the costs of care, major benefits will be realized by our visitors, our county residents, and our employees. With your leadership, we could remove second-hand smoke and other tobacco in and around our public spaces. This would reduce health safety risks for all who access our campus and ensure equal access to the facilities for those who are medically sensitive to the effects of tobacco smoke, such as people with asthma and pregnant women. This would achieve an exponential effect: motivating current smokers to quit smoking and safeguarding visitors, clients and staff-86 percent of whom are nonsmokers-from the toxic effects of secondhand smoke. It is our understanding that county dollars would be saved, by a reduction in county staff time utilized in cleaning up litter created by cigarettes and putting out landscaping bark fires. Research further shows that any exposure to secondhand smoke, even outdoors, has harmful biological consequences. Further, removing all smoking cues facilitates quitting, and research demonstrates that 70 percent of smokers wish to quit. Tobacco is the leading cause of preventable death in the world today and in Central Oregon. Smoking-related deaths from cancer, heart and lung diseases, and other conditions account for more than 440,000 premature deaths each year, about one in five deaths in the United States. Let's make Deschutes County a key stakeholder in the statewide tobacco free movement by being proactive in our policies. Sincerely, Public Health Advisory Board Kim Curley Reynolds, Chair DCHS Health Officer Dr. Richard Fawcett E✓` Deschutes County Board of Commissioners Anthony DeBone, Chairperson Alan Unger, Vice Chairperson Tammy Baney, Commissioner Re: Support for 100% Tobacco Free County Properties Dear Board of Commissioners: With mounting evidence of the consequences of tobacco use including negative health, social, economic and environmental effects, Deschutes County's Wellness Task Force respectfully requests that you support a comprehensive worksite policy designating all County Facilities as 100% tobacco free. Currently, Deschutes County policy states that every County facility shall prohibit tobacco use within thirty feet of all doors in each building. State law mandates that Deschutes County Health Services be a completely tobacco-free campus. In addition, the Fairgrounds, Community Development Department and the Mike Maier Building, have all voluntarily adopted tobacco free buildings and grounds. Tobacco free policies are not just designed to protect employees, clients, and visitors from the negative health effects of secondhand smoke. They are also intended to improve the overall work environment and support tobacco users who are interested in quitting. Examples include provision of tobacco cessation resources, promoting a cleaner worksite environment, containing health care costs, and establishing a positive organizational image. A January, 2012 public opinion survey indicated that 84% of over 800 respondents believed that it was 'Very/Somewhat Important' for Deschutes County to establish tobacco-free buildings and grounds. County employees mirrored these findings in an October, 2008 survey that asked, "In your opinion, how important is it for Deschutes County to establish tobacco free grounds?" Over 87% answered 'Very/Somewhat Important'. The trend toward tobacco-free environments continues to grow. St. Charles Medical Centers, Mosaic Medical Clinic, Bend Park and Recreation District, the City of Bend, and all State-owned buildings now have tobacco free grounds. As county government officials, it is important to set an example for the community and send a clear message that Deschutes County is committed to the health and safety of all residents. Thank you for your consideration. Deschutes County 'Wellness Task Force A team of representatives from every County Department 2/27/2012 DOCument Reps-dukes Poorly (Archived) CHANGE IS IN THE AIR: TOBACCO FREE WORKSITES David Visiko M.S. Tobacco Prevention & Control Coordinator Deschutes County Health Services Deschutes County History • Smoking prohibited 30 feet of any county building entrance or facility. • Smoking and tobacco use is not allowed in any County building, facility or automobile • October, 2009: OAR requires addiction outpatient programs to be 100% tobacco free facilities and grounds. • Health Services Campus, Courthouse Annex, Downtown Health Center, and Wall Street Services Building affected. • Community Development Building and Mike Maier County Services Building (proximity to child care center and health services). 1 2/27/2012 smanost Impact Impact Factors that Affect Health A Examples dt Sourw Dr. Tomas R FciedaS Direchm U.S. Cent= for Disease C"itid & Pirmlim 100 90 80 N 70 60 50 e~ 40 aL 30 20 10 In 1996, Oregonians pass Measure 44, raising the tobacco tax and funding the Tobacco Prevention and Education Program TPEP shut down for six months & TPEP funding restarted with fundin restored to voter- approved Measure 44 level Orzechowski and walker (2011). The Tax Burden on Tobacco. 2 Oregon vs. rest of United States, FY 1993 - 2010 Tobacco is the Leading Preventable Cause of Death in the U.S. ■ AIDS 500,000 ❑ Alcohol 400'000 ■ Firearms '300,000 ■ Illegal Drug use 200,000 ■ Motor vehicle 100,000 ❑ Poor DletlPhysical Inactivity 0 ❑ Passive Smoking Tobacco Diet & Inactivity Other Causes Related ■ Active Smoking JAMA, March 10, 2004 Vol 291, No. 10 Tobacco's toll on Deschutes County in One Year 14% of adults regularly smoke • 4,471 people suffer from a serious tobacco related illness • 22% of all deaths in Deschutes County • $42 million is spent on medical care • $38 million in productivity lost 2/27/2012 3 2/27/2012 Cost Impact of Tobacco Use $5,600 per smoker per year when you factor in: -Greater health care costs -Increased absenteeism -Work time spent on smoking rituals -Higher life insurance premiums -Greater risk of occupational injury Costlier disability -More disciplinary action 86% of Deschutes County Adults Currently Do Not Use Tobacco 133,924 Adults in Deschutes County EL J+ - 18,883 145,U41 J ; 14% 86% 70% of Deschutes County tobacco users want to quit 4 2/27/2012 Positive Impacts of Proposed Policy Can positively impact 95% of our adult population • Can positively impact Deschutes County residents who do not smoke by reducing their exposure to secondhand smoke and eliminating smoking triggers. AND • Can assist tobacco users who want to quit, reducing chronic disease and its impact on health care costs. Adult Quit Patterns Deschutes County smokers have the greatest desire to quit smoking in the state. • 47% of Oregonians stopped smoking for a day or longer in the past year in an attempt to quit • 61% of smokers in Deschutes County attempted to quit for at least one day (highest prevalence in the State; ).Oregon Tobacco Facts, 2011, pop 18. 5 2/27/2012 Deschutes County survey shows support for tobacco free policy More than 800 people completed a survey fielded by Deschutes County Health Services to determine the level of support for establishing a 100% tobacco-free policy at some or all of Deschutes County properties. 84% of survey respondents were in favor of 100% tobacco- free county properties. Public Opinion Survey Results Feb.2012 Respondents' views on importance of establishing tobacco-free buildings and grounds in Deschutes County N=803 ■ Very important Somewhat important Ei Not very important ■ Not important at all 6 2/27/2012 Survey Results at a Glance: • 91 % visit Deschutes County Offices • 86% try to avoid Second Hand Smoke • 91 % think Second Hand Smoke is harmful • 84% think tobacco free buildings important 804 survey respondents Where do we go from here? • Recommendation to go 100% tobacco free • If supported, next steps: • Obtain management support • Establish policy implementation committee • Information & Input Sessions with staff 7 2/27/2012 Compliance of Proposed Policy Internal and External Communication Plan. • Clearly communicate the policy to staff and public Compliance with this policy is the shared responsibility of all Deschutes County personnel. • Any person who observes a violation of the policy is authorized and encouraged to communicate the policy with courtesy and respect. Management and supervisory staff are responsible for ongoing compliance with this policy within their respected work areas. • Management and staff are expected to adhere to standard practice in resolving any issues of noncompliance with employees. 8 A Document Rear uses Poorly (Archived) Downtown Health Center Closure February 27th, aoia Kathleen Christensen Clinical Supervisor 1 .t ®THC Opened March 2006 M.A.M Ne Male Advocates for Re~onslble Semallty o Served teen and young adults up to age 25 o Housed the MARS program o Partially staffed by AmeriCorps volunteers ®THC Visits Declining o 2011- 6,348 RH Visits / 9,728 Total Visits o Main Office- 3492 RH visits/ 6141 total visits ~ o Redmond Office- 1911 RH visits/ 2478 total visits A o LaPine Office- 263 RH visits - 309 total visits op o Downtown Health Center- 682 RH visits- 801 total visits C~ o 2010 - 6,375 RH Visits / 8722 Total Visits - u Main Office- 3352 RH visits / 5122 total visits o Redmond Office-1832 RH visits / 2218 total visits o LaPine Office-240 RH visits / 308 total visits o Downtown Health Center- 951 RH visits -1073 total visits 2 i" DTHC Statistics o Age of clients 0 15 and under 14% 0 18-24- 64% 0 25 and over 22% o 79% Females, 21% male o Lower Clinic Productivity at the DTHC o Bend and Redmond RN Schedules are at 85%, DTHC is at 50% o Bend and Redmond NP Schedules are at 100%, DTHC is at 80% o Averaged 5 clients/day in 2011 Concerns o Not efficient use of staff time. o Ratio of support staff to clinician is 1:1. o Large amount of maintenance time for a two day a week clinic. o Not serving the teen population very well- 14% of clients 17 and under. o Staffed by an RN 1 day a week. o Decreased scope of practice compared to NP. o Decreased revenue from billing if client has insurance. o More clients are coming in for STD services than Family Planning services. Access for Family Planning services are available at PPH on the west side of town. 3 A o If implemented, Staff will be reassigned. o Main office currently open Mon - Fri 8-5. o Will be open until 6pm two days/wk and 7pm 3 days/wk. 0 open at lunch hour 5 days a week. o Have reviewed this plan with staff and advisory board. o Will residents be underserved? o Results from client survey. o Where can they get services? Next Steps - News Release, Setting Closure Date To assure clients are aware we will have signage, forward phones, and have health educators create new promotional materials. 4 A J • Accomplishments: a look back Page 26 • More service for more OHP members • First State demonstration site for ■ More contracted agencies integration ■ Significantly more residential options ■ Integration with Mosaic Medical (3) ■ Less hospitalizations thru ACT, • More school-based centers (6) Wraparound, AMHI, EASA • County health rankings positive #7 ■ 2009 Health Report and update; key role in health assessment ■ My Future My Choice; Cuidate ■ First beta site in nation for Public • First Or. LAUNCH program 5-yr grant Health accreditation • Regional Nurse Family Partnership ■ 2009: State BH certifications ■ Health Council - Health Board 2010: State PH triennial review 2/27/2012 1 2/27/2012 E Plan Construction Page 21 a. Table of Contents same as regional Health Improvement Plan b. Mission - Vision - Values - SWOT analysis c. Regional Health Report & health assessment data d. Meaningful DCHS staff involvement e. Advisory Board work sessions & reviews f. BOC work session February 27, 2012, feedback g. R Fawcett MD, Health Officer M Williams, MD sign off h. Advisory Boards adoption March 21, 2012 i. Board of Commissioners adoption April 2012 j. Regional Health Improvement Plan (CO Health Council) k. Annual reviews and updates each fall • Environmental Scan Opportunities 1. Our County staff 230+ 2. We value collaboration 3. Progressive, we want to improve 4. Better care thru integration 5. A focus on best practice 6. State health reform 7. Change as opportunity Page 7 Challenges 1. Need is greater than resources 2. The economy 3. Complex regulatory environment 4. State agencies as silos 5. Measuring results 6. Can we streamline 7. Change as risk and ambiguity r1 I~ 2 ~J I • Highlights: 9 sections, 66 goals A. Increase Access (Page 9): meet OHP access standard, open Redmond Service Center, South County future, school-based health centers B. Improve Health (Page 10): Living Well expansion, prevent childhood obesity, improve maternal mental health C. Improve Care (Page 11): electronic health record systems, quality councils, Early Learning Council work, public safety preparedness (several areas) D. Reduce Costs (Page 12) : less hospitalizations- Assertive Community Tx. (ACT), children's wraparound, Early Assessment & Support Alliance (EASA) E. Increase Integration & Collaboration (Page 13): Primary care and behavioral health (at least 10 locations, PH internship program with OSU • Highlights continued F. Pursue Excellence (Page 15): National Public Health Accreditation; Environmental Health to meet national FDA standards; behavioral health outcomes tool across all providers G. Expand Regional Efforts (Page 15): Central Oregon Health Board; Health Information Exchange; regional Nurse Family Partnership H. Strengthen Our Organization (Page 16): Staff development actions; behavioral health emergency preparedness 1. Promote Sound Health Policy (Page 17): 13 policy directions including the Triple Aim, Regional Development; Recovery & Resiliency; county-operated behavioral health services, integration, tobacco policy etc. Board suggestions and direction on the Plan are welcomed • 2/27/2012 3 Deschutes County Health Services Strategic Flan 2012-2015 Docuffwnt ReProduces Poorly (Archived) Summary This Strategic Plan outlines a vision and set of goals to improve the health of our residents, strengthen our organization and promote community collaboration. It is a plan for action that capitalizes on national, state and regional reform. It is both ambitious and a realistic portrayal of our focus and capability over the next four years. It is rooted firmly in goals that will lead to better community health, better care and work that will promote health and lessen society's burden for unnecessary human and financial costs. This new plan carries forward a commitment of Deschutes County Health Services to use public health assessment practices and community guidance to frame a clear agenda, mobilize our resources and act. Through this effort, we will continue to ensure County government is accountable and helpful to our County's residents and that we fulfill our mission to promote and protect the health and safety of our community. In the past five years, we've acted on past plans, sponsored many new projects, expanded our services and improved access to care. A sampling of those accomplishments is listed in Appendix iii. In 2009, our Department was formed as a consolidation of the County's Health and Mental Health Departments with Environmental Health added in 2010. In 2012, we will help thousands of residents, offering health and human services at more than 40 locations including schools, clinics, agencies and a variety of outreach efforts. We will also continue to increase our investment in our economy and the workers at many local helping agencies. While we are optimistic and excited by the promise of health reform, a difficult road lies ahead. All signs point to reductions in public funds and rising costs as well as a need to push forward with difficult changes in the way we work and the way people are served. Each fall, with the help of our community boards and the Central Oregon Health Board and Health Council, we will review our progress, reassess health reform and our community and regional needs and update our priorities to remain current and relevant to the work at hand. With this in mind, we look forward to a healthier Central Oregon in the years ahead. We hope you will take the time to review the 67 goals in this document, to ask difficult questions and to join us in this effort. With adoption of the plan we will move forward immediately on a number of these actions. We do this with gratitude for the work of a talented and dedicated staff, the thoughtful guidance of our community boards and volunteers, the help of community partners and the commitment of our Board of County Commissioners to community health and well-being. In partnership with our community and region - Scott Johnson, Director Deschutes County Health Services Deschutes County Health Services Strategic Plan 2.24.2012 Page 2 of 32 Endorsements and Adoption Adopted this _day of March, 2012, by the Deschutes County Public Health Advisory Board. Kim Curley-Reynolds, Chair Deschutes County Public Health Advisory Board Adopted this day of March, 2012, by the Deschutes County Behavioral Health Advisory Board. Darrel Wilson, Chair Deschutes County Behavioral Health Advisory Board Adopted this _day of March, 2012, by the Deschutes County Health Officer and Medical Director. Dr. Richard Fawcett, Health Officer Dr. Marc Williams, Medical Director Adopted this _day of , 2012, by the Deschutes County Board of Commissioners. Anthony DeBone, Chair Alan Unger, Vice Chair Tammy Baney, Commissioner ATTEST: Recording Secretary Deschutes County Health Services Strategic Plan 2.24.2012 Page 3 of 32 Table of Contents 1. The Triple Aim Page 5 II. Our Mission, Vision and Values Page 6 III. SWOT Analysis Page 7 IV. Strategic Plan Domains A. Increase Access Page 9 B. Improve Health Page 10 C. Improve Care Page 11 D. Reduce Cost and Increase Cost Effectiveness Page 13 E. Increase Health Integration and Collaboration Page 13 F. Pursue Excellence Page 15 G. Expand Regional Efforts Page 16 H. Strengthen Our Organization Page 16 1. Promote Sound Health Policy Page 17 Appendices i. Membership the Strategic Planning Group Page 21 Accreditation Measure 5.3.1 A 1. a ii. Strategic Planning Process Accreditation Measure 5.3.1 A 1. b. Page 22 ii a. 2012-2015 Strategic Plan Timeline ii b. Annual Strategic Planning Cycle iii. Accomplishments in Recent Years Page 27 iv. Ten Likely Environmental Changes in 2012-2015 Page 29 v. Community Health Assessment for Public Health Accreditation Page 30 vi. Regional Health Improvement Plan: Ten Priority Areas Page 31 Deschutes County Health Services Strategic Plan 2.24.2012 Page 4 of 32 L The Triple Aim* Our Vision for a Healthy Central Oregon BETTER HEALTH Improve the health of people in Deschutes County & Central Oregon BETTER CARE Improve our service quality, access, reliability, safety and satisfaction LESS COST Contain per capita cost; undertake preventive care and health education *The "Triple Aim" is a health reform concept developed by the institute for Healthcare Improvement, an independent, nonprofit organization helping to lead the improvement of health care throughout the world. Triple Aim thinking is intended to improve health and health care. Triple Aim is now part of Oregon law and a founding concept for the Oregon Health Authority. It has been adopted by the Central Oregon Health Council and Deschutes County Health Services. Deschutes County Health Services Strategic Plan 2.24.2012 Page 5 of 32 II. Our Mission, Vision and Values ti "T ~M Our Mission To promote and protect the health and safety of our community. Our Vision Deschutes County residents experience excellent health and the highest quality of care. Costs of health care gradually decline. We successfully advance public health policy, health assessments and health solutions as well as affordable, accessible and coordinated services. As an organization, we adapt effectively to health reform, focus on our strengths and areas where we are most needed for the region's success. We offer a capable workforce and a commitment to excellence. We succeed by joining with other counties, the health care system, the business and nonprofit communities and a responsible citizenry. Oux Values Advocacy The pursuit of community health, healthy lifestyles and access to health care. Collaboration True partnership with our customers, community agencies and coalitions. Cultural competence Awareness and responsiveness to the diversity in our community. Excellence A commitment to best practice and high quality service to the public. Innovation A willingness to try new approaches to better serve our community. Professionalism The highest level of personal integrity, conduct and accountability. Stewardship The wise, effective and efficient use of public resources. Workplace health Work sites that promote respectful interactions and healthy lifestyles. Deschutes County Health Services Strategic Plan 2.24.2012 Page 6 of 32 III. SWOT Analysis Strengths, Weaknesses, Opportunities, Threats... Winter 2012 The development of this Strategic Plan has included an analysis of data on health needs and trends in our County and region (see Appendix v: Health Assessment) as well as this assessment of our agency and the conditions in our County, region and state. We have used this information to frame our long-range goals and fulfill our mission to promote and protect the health and safety of our community. Summary of critical considerations: Our strengths: Opportunities: 1. Our workforce: talented, energetic, professional. 1. State, regional, local support of health reform. 2. Our innovation and a commitment to improve. 2. Better care for our clients through integration. 3. Our partnerships and community providers. 3. Regional work with the Health Council & Board. Challenges / weaknesses: Threats: 1. Complex regulatory requirements. 1. A down economy: impact on community, funding. 2. Management in a changing environment. 2. The impact of any opposition to health reform. 3. Measuring the impact of our work (outcomes). 3. The impact of the social determinants of health. Within our organization... Our Strengths: Dedicated, passionate and highly professional staff; staff stability; a high value placed on teamwork and support for one anothers' efforts; a progressive organization that values innovation in our programs and services; promotion of creativity; use of evidence based practices and programs; willing to explore new opportunities, to continually strive to expand our benefit to the community; we value community involvement and partnerships, we benefit from the help of several community advisory boards; we prepare for change rather than react to it; actively participate in many community partnerships; we work to shape our environment, our reputation with the State of Oregon is very good, client-focused in a client-centered community; we manage limited resources responsibly; open to looking at outcomes; Deschutes County and the County Commissioners are very supportive of our work; diversified, providing wide range of valuable services; developing a greater commitment to quality improvement throughout the organization; forward thinking, undertaking a number of strategic efforts that take time to develop and grow; a long range financial approach, using our reserves wisely to limit program crises. Our Weaknesses: It is challenging to manage effectively in a changing environment; learning to adapt and adjust to new opportunities while managing busy daily operations; our technology (electronic record system) needs an upgrade, improvements are under way but are taking time and resources and will be difficult to implement; at times, we have been resistant to change and to integrating our services and staff support although this is Deschutes County Health Services Strategic Plan 2.24.2012 Page 7 of 32 changing on many levels; we need to become more adept at managing based on performance measures, outcomes and the Triple Aim (better health, better care and less cost); unable to help everyone who needs assistance, particularly the uninsured; many client issues are more complex than in the past, particularly with health and economic issues for clients; administrative support services have not kept pace with our program development; like similar agencies in Oregon, with all the Federal and State regulations and complexity, we vulnerable to a State or Federal audits and are working hard to improve in this area; need to strengthen our planning processes and health assessment capacity, using health, demographic and economic data; need effective internal and external communication during a time of change; can be guilty of "silo thinking"; at times it is difficult for staff to understand the big picture; need to improve our billing practices by strengthening our Business Office, linking to clinical records; have lacked an agency-wide commitment to quality improvement; need greater client voice and involvement in our work. In our environment... Opportunities: Oregon is well positioned for Federal and State health reform, especially with the new Oregon Health Authority and recent Coordinated Care (HB 3650) and Health Exchange (SB 99) laws; innovation will be highly valued in the next several years with Federal, State and regional health reform; the formation of the Central Oregon Health Council (community-wide) and Health Board (counties) is well regarded so far; potential to increase County involvement in community health; potential to increase focus on prevention and population health; County Commission likely to place a high value on collaboration and community involvement; strengthening public health work through national public health accreditation; potential success of LAUNCH (Linking Actions for Unmet Needs in Children's Health) and early childhood health and education; prevention (especially in public health) will be important to "bend the cost curve" in health care; State Health Improvement Plan calls for strengthening public health infrastructure in Oregon; the number of insured Oregonians will increase significantly in 2014, requiring a more robust workforce; federally qualified health clinics (e.g. Mosaic Medical, La Pine Community Health Clinic) are likely to expand to meet an increasing need; new Behavioral Health Organization (BHO) through the Central Oregon Health Board will help integrate mental health and addictions and the work among our three counties; contracting OHP behavioral health through PacificSource helps integrate with physical health, makes sharing health information easier as we seek better health for our clients and community; improving quality assurance; ability to lessen bureaucratic requirements; peer services in behavioral health; new community health worker concept. Threats to our services and success: Public resources are very limited; the Oregon economy is likely to remain difficult for several years and could negatively impact funding and reform, increasing the need for our services but creating instability in the Oregon budget; the State's budget shortfall is resulting in a loss of critical community services for vulnerable populations, it will require reducing health costs $329 million in 2011-13, County contributions not likely to grow significantly; State cuts will impact our clients and our ability to keep up with greater need for people with and without insurance coverage; Department services and staffing levels; will our provider network be able to shoulder a greater responsibility to serve people in need; increases in costs of our services exceeds our likely revenue; at times, a consensus must be reached before we can make the changes that are necessary, that can slow us down; Medicaid regulations are complicated and the focus on fraud and abuse is difficult and threatens our resources and programs; for behavioral health, the capitated system requires service to everyone eligible with a need; the recent Administrative Rules in behavioral health require work force education and change in our processes; national and global environment and economy will impact the State of Oregon and our future. Deschutes County Health Services Strategic Plan 2.24.2012 Page 8 of 32 iv. Strategic Plan Domains Key: CO HIP: Goals aligned with the Central Oregon Health Improvement Plan OR HIP: Goals aligned with the Oregon Health Authority Health Improvement Plan Note: The Goals listed in this plan are not listed in priority order. Items listed in red represent the final edits requested by our Advisory Boards A. Increase Access Definition: Improve access to health education, preventive services and health care. Provide timely care to achieve the best possible health outcomes. Cultural Competency: Reflect our community profile in hiring policies and service practices. Cultural Competency will be accomplished through the following actions: a) Conduct a health assessment of the ethnic and cultural profile(s) of Oregon Health Plan members and other service populations by October 2012. b) Reassess current program offerings and assure all programs are able to address the cultural needs of Hispanic clients and other groups as warranted by February 2013. c) Reassess the composition of our community boards. d) Quantify specific personnel needs in each program to assure a capacity to serve clients needing help. e) In priority areas, assign additional weight to bilingual candidates, recruiting workers or volunteers who are bilingual and bicultural by July 2013 or with next available opening(s). OR HIP Dual Competencies: Develop behavioral health staff expertise in priority population areas. a) Staff knowledgeable and skilled in behavioral health practice and service to people with developmental disabilities. b) Staff knowledgeable and skilled in behavioral health practice and service to veterans who fall into our priority population groups (as well as improved coordination with the veterans' service system). c) Staff knowledgeable and skilled to serve clients with health issues related to both mental illness and chemical dependency. d) Involvement of staff or partner agencies to address chronic disease issues and general physical health. 3. Translation Services: Assure that Health Services Spanish interpreters meet State of Oregon qualification criteria for healthcare interpreters by January 2014. Qualification criteria will be tracked through the Oregon Health Authority's Office of Multicultural Health and Services. 4. Hours of Operation: Offer additional hours of operation and services. Expand hours of operation to evenings and Saturdays, piloted at the new Redmond Service Center by September 2012. a) Clarify potential need for variable work hours at time of hire. b) Assure needed support staff for such operations. 5. Redmond Service Center: Open the Redmond Service Center as a comprehensive health and human service center by January 2013 with tenants to include State of Oregon Department of Human Services, Deschutes County Health Services and Mosaic Medical. 6. School Based Health Centers: Strengthen the school based health center system in Central Oregon. a) Open Sisters School Based Health Center (new building) by July 2013. b) Complete Long Range Plan to recommend the full complement of centers for a comprehensive County and regional system by July 2014. Deschutes County Health Services Strategic Plan 2.24.2012 Page 9 of 32 c) Complete a comparative business analysis of the best option(s) for system management and oversight by July 2014. CO HIP - OR HIP 7. South County Healthcare: Work with provider groups to increase access to healthcare for La Pine and South County residents. a) Participate in 2012 task force with providers who share the same vision for increased access to primary, urgent care and behavioral Health services in South County. b) Assist in educational campaigns to reduce the amount of ambulance transports and emergency room visits. 8. Reproductive Health: Assure quality, timely access to reproductive health services within our community as we move toward health care reform. Access can be measured through collaborations formed, identifying access and monitoring it. In 2010, an estimated 609 unwanted pregnancies were averted in Deschutes County, saving the health care system $5 for every $1 spent. 9. Behavioral Health Access Standard: a) Meet OHP access to care contract requirements for members in need of behavioral health services, reporting quarterly. b) Increase use of community behavioral health network and outpatient services: Increase the percentage of unique OHP members served by panel providers by 100% by July 2013. Measurement: baseline of 694 unique people served in FY 2011. CO HIP 10. Access to Geriatric Behavioral Health Care and Consultation: Seek resources to expand the Health Services Seniors Program as a resource to the health system, care facilities, families and seniors in need throughout Central Oregon. CO HIP B. Improve Health Definition: In collaboration, seek to assure the health of County residents through processes, activities or the services of our organization(s). Health outcomes include morbidity and mortality; physical, social and mental well being; nutritional status and quality of life. 1. Living Well Program Expansion: Improve the health of adults with chronic conditions in the region through expansion of the Living Well program. Program enrollment of 1,700 people, with 1,100 completing the course, saves an estimated $2 million in health care costs. Increase enrollment in the program annually 25% from a baseline of 242 clients in 2011; measured each July through 2015. OR HIP - CO HIP 2. Wellness Marketing Campaign: Develop and promote Worksite Wellness tool kits to regional organizations in order to achieve adoption and implementation from 2012 through 2015. Toolkits would assist organizations in developing wellness policies, promoting Commute Options, creating smoke-free campuses and referring to Chronic Disease Self-Management. Success measured by the number of tool kits distributed and implemented. The purpose of worksite wellness programs is to reduce the costs of health insurance claims by improving employees' health and subsequently maximizing the return on investment. OR HIP 3. Partner Violence: Create a prevention plan to address intimate partner violence at the individual, community, department and policy levels by 2015. The plan will be developed through convening an intimate partner violence committee, developing the plan and advocating for the plan at the community level. The Centers for Disease Control and Prevention has recently identified intimate partner violence as widespread and a major public health problem in the United States. The term "intimate partner violence" Deschutes County Health Services Strategic Plan 2.24.2012 Page 10 of 32 describes physical, sexual, or psychological harm by a current or former partner or spouse. Create a linkage to Behavioral Health. 4. Childhood Obesity Prevention: Expand capacity and provide support to community activities that focus on reducing childhood obesity. Needed research will be supported and best practices will be implemented in Central Oregon. a) Participate with the Kids @ Heart Program in developing an action agenda by December 2012. b) Identify opportunities to engage with local and state partners, including hospital systems, school based health centers and schools. Seek funding and/or other support as needed. CO HIP - OR HIP Create a linkage to Behavioral Health. 5. Maternal Mental Health: Using the Substance Abuse & Mental Health Services Administration's model, collaborate with community partners to develop a maternal mental health system which provides prevention, screening and treatment for women at risk. a) Conduct a survey of behavioral health, medical and community providers; identify gaps, and report to Public Health Advisory Board by July 2012. b) Conduct maternal mental health trainings and grand rounds for physicians by September 2012. c) Facilitate a community taskforce to develop integrated plan of care, funding sources, and method of evaluation. d) Conduct on-going assessment of need through standardized community screening, reporting and tracking by September 2015. CO HIP - OR HIP C. Improve Care Definition: Improve the care people experience and our associated practices and processes. Identify areas for improvement, monitor compliance and manage risk. A premium is placed on connecting staff to the performance of the organization. Early Learning Council Development: As the public health and mental health authority and as a health provider, participate in the Central Oregon Health Board's development of a regional Early Learning Council system. Integrate public health and behavioral health services with this new Oregon child development model. Measurement: Role definition and measures by July 2013. CO HIP Create a linkage to Behavioral Health. Information Technology: Electronic Health Records: Utilize electronic health record software throughout all clinical programs of the organization. a) Behavioral Health: launch system by July 2012. b) Public Health: launch system by July 2013. Measurement: Short-term, utilize electronic health record software as an organization to meet "meaningful use" requirements to qualify and receive American Recovery and Reinvestment Act fund incentive payments. Both divisions should be ready to apply for "meaningful use" payments within the first year after software implementation. Long-term, assure interoperability with the regional Health Information Exchange and Early Learning Council. OR HIP 3. Quality Councils: Assure organizational commitment to quality improvement through Quality Councils. Roles will include quality priorities and standards, workforce knowledge, use of improvement processes and tracking and reporting performance. a) Public Health Quality Council and Behavioral Health Quality Council in the organization or regionally with the Central Oregon Health Board by July 2012. b) If formed, participate on a comprehensive Regional Quality Council with other health stakeholders. c) Develop organizational competencies in use of the Plan Do Study Act improvement model through training by July Deschutes County Health Services Strategic Plan 2.24.2012 Page 11 of 32 2013, and each division will undertake at least two such projects by July 2014. Measured through quarterly reports to Central Oregon Health Board and Central Oregon Health Council. CO HIP - OR HIP 4. Focus County Behavioral Health Operations: Place County's emphasis for county-operated services on specialty programs, safety net services and integrated services for community members with complex care behavioral health needs. Expand points of service to increase access. 5. Holistic Services to Improve Health: Within billing regulations and feasibility, develop fully integrated health services (for behavioral health clients across the age spectrum) that are family-centered, evidence-based, recovery oriented and outcome driven. Promote access by removing barriers to holistic services (i.e., wellness services and activities, healthy eating, nutrition, exercise, parenting, budgeting) by July 2015. 6. Public Safety Preparedness: Sustain and continue to report on essential public safety programs and services supported by Health Services including a) 24/7 crisis services; b) co-sponsorship of Crisis Intervention Training (growth expected); c) coordination, service or support to treatment courts; d) shared investment with the Sheriff's Office in chemical dependency treatment; e) the civil commitment process; and f) public health roles in emergency preparedness and response. From time to time, additional public safety work will be considered in consultation with the Local Public Safety Coordinating Council and its members. 7. Housing for People with Mental Illness: a) Update the Deschutes County Housing Continuum to a regional framework by July 2013 in collaboration with the Central Oregon Health Board, Housing Works and the Oregon Health Authority. b) Identify target population(s) and project(s) for development. c) Increase access to rental assistance for our clients in supportive housing and independent living. 8. Client Engagement and Reduction in No-Show Rates: For clients seeking outpatient services, establish a standard of three appointments in the first thirty days of service to increase engagement in the therapeutic process. Measurement: Set baseline by January 2013. CO HIP Ensure appropriate training for staff who are first contacts? Streamline of handoffs following initiation. D. Reduce Cost and Increase Cost Effectiveness Definition: Reduce the cost of health care through better health and care options. Increase efficiency and effectiveness. Invest in strategies that best accomplish this goal. Billing and Coding Audit: Utilize an external certified coding consultant to review and revise billing practices and annually audit provider coding for accuracy. Annual, ongoing. Preferred Provider Contracts: Gain preferred provider contracts with the major insurance carriers by annually assessing the department's top 15 most commonly billed commercial payors. Execute contracts to increase reimbursement rates and reduce patient out-of-pocket costs by July 2013. 3. Assertive Community Treatment: a) Strengthen the Assertive Community Treatment (ACT) team including 1) determining the necessary staffing level, and 2) expanding the use of peers to coordinate care. b) Meet the ACT Program fidelity standard by December 2013. CO HIP Deschutes County Health Services Strategic Plan 2.24.2012 Page 12 of 32 4. Children's Intensive Treatment Services (Wrap Around): Improve intensive treatment services for youth through wrap-around services, while reducing associated hospitalization costs. Create County team to respond in collaboration with St. Charles Medical Center to serve high acuity youth in need of emergency services. Reduce the number of youth under 18 requiring hospital admissions to 1.5% (per 1,000 enrollees) or lower annually. Nate that this is a local initiative. 5. Early Assessment and Support Alliance (EASA): Reduce symptoms of psychosis, mental health crises and hospitalizations by expanding the EASA program throughout Central Oregon. Meet the Triple Aim objective of better health, better care and reduced costs. a) Screen and refer a minimum of 18 clients quarterly; and b) maintain a minimum caseload of at least 28 clients while growing program service capacity. c) Continue a reduction in state hospital admissions. Maintain level of EASA hospitalizations under 25% of total enrolled clients. CO HIP E. Increase Health Integration and Collaboration Definition: Improve health practice and care by combining activities, services and care. 1. Communications with Clients: Create a program to implement secure texting (e.g., breastfeeding support, appointment reminders) with clients by July 2012. 2. Information Technology: Remove barriers to communicating electronically with clients and community providers. Develop or purchase information technology resources which allow electronic communication via email, phone texts, electronic health records. Contract with external provider to offer secure webmail with encryption that allows communication with clients. This will allow clients better communication, ease of access, and ultimately better access. Policy developed July 2012. OR HIP 3. Communication with the Community: Better utilize traditional and new social media outlets to ensure broad dissemination of public health information. Measured by creating Facebook and Twitter accounts for Health Services as well as a seasonal calendar of media releases and public service announcements by July 2013. CO HIP 4. Health Communications: Develop and implement a three-year communication plan for Health Services that includes strategies and resources to enhance public awareness of our programs and services by July 2013. Meet with program leaders to identify communication needs and priorities. Increase media outreach and dedicate resources implement the communication plan. 5. Community Health Workers: Expand use of community health workers (including peer support) to better coordinate care. a) Establish short-term measurement tools for behavioral health peer positions by December 2012. Begin tracking and reporting to Quality Councils and management. b) Develop an operating model agency-wide including financing and effectiveness measurement, in consultation with the Central Oregon Health Council, by December 2012 for implementation in FY 2014. c) Finalize a development plan by February 2013 for our organization including targeted program areas. Reflect the improvement plan in the FY 2014, FY 2015 and FY 2016 operating budgets. Measurement: 2011 DCHS baseline: 2 peer specialists in behavioral health. CO HIP - OR HIP Deschutes County Health Services Strategic Plan 2.24.2012 Page 13 of 32 6. Coordinated Care for Health Services Clients: In an effort to better serve our clients, establish a coordinated care model that provides easy engagement of our clients in multiple services we offer. Track clients served by multiple programs, complaints and care experience. a) Convene an interdisciplinary team to construct a policy, protocol and training plan by December 2012. b) Prioritize clients for needed services across Health Services programs to assure a "warm hand off." c) As a specialized need, develop internal staff capacity (e.g., health worker position(s) to offer health services for specific client groups by July 2013; this will include but may not be limited to clients with developmental disabilities. 7. Integrate Primary Care and Behavioral Health: Create integrated health homes throughout Deschutes County to include primary care and behavioral health services. Improve access for Medicaid, uninsured and safety net populations. a) Measure the health and care benefits of integrated services in the school-based health centers. b) Complete 2012 expansion to include 1) primary care services at Health Services' Bend specialty behavioral health clinic (the Annex) for people with a serious mental illness, 2) co-location and care coordination (Mosaic and Health Services) at the Redmond Service Center, and 3) investment in behavioral health services at Mosaic Medical's Bend Greenwood clinic. c) Improve collaboration with primary care physicians when managing Health Services' behavioral health clients. OR HIP Linkage to Developmental Disabilities. 8. Consulting Psychiatrist: Through leadership of the Health Services Medical Director and behavioral health team, develop a capacity and model to offer short-term consultation to primary care practices (children and adults) by July 2013. Critical considerations include viable funding model. CO HIP 9. Maternal Child Health: As a partnership between maternal child health and behavioral health developmental disabilities teams, implement an integrated transition process for CaCoon clients transitioning from adolescence to adulthood by January 2013. OR HIP 10. Living Well: Continue to improve and sustain relationships with Central Oregon community partners to improve access and availability to the Living Well program. Through 2015, regional referrals made by providers and other partners will increase annually by 20%, from a baseline of 271 referrals in 2011. OR HIP 11. Immunization Exemptions: Collaborate with Bend - La Pine School District (or other school districts with high exemptions), pediatric and family practice clinics, hospital birthing units, and parent education classes to decrease the kindergarten immunization religious/philosophical exemption rate. Provide education and targeted outreach to these groups by July 2013. Become more aligned with State immunization rates. Baseline 2010-11 kindergarten religious exemption rates: Deschutes County: 9.0%; State: 5.6%. OR HIP 12. Internship Program: Establish a formal collaboration with the Oregon State University Master of Public Health Program and OSU Cascades Extension Office by September 2012. Establish a Master of Public Health Internship program with regular student rotations at Deschutes County Health Services. Expand program to include at least one additional institution no later than September 2014. Note: Any direct service activity will require assurance of ability to serve, document and bill for such service. CO HIP - OR HIP 13. Parent-Child Interaction Therapy: Increase capacity for Parent-Child Interaction Therapy throughout Deschutes County in conjunction with LAUNCH. Collaborate with community partners (Department of Human Services, Family Access Network, KIDS Center, Mtn. Star Relief Nursery, etc.) to identify at-risk families and youth ages 2-8 to actively participate. Provide training for minimum of eight therapists within Deschutes County Health Services Strategic Plan 2.24.2012 Page 14 of 32 County and in practice in community 2014. Increase positive interactions between family members with a measurable baseline by July 2012. F. Pursue Excellence Definition: Maintain standards of practice and performance that ensure accountability and peak performance to operate effectively and keep our communities safe and healthy. 1. Health Assessment Capacity: By July 2013; a) Create the capacity to serve as the regional hub for the collection, analysis, interpretation and dissemination of primary and secondary health related data to guide programmatic decisions, resource distribution and gauge outcomes. b) Launch a web-based regional and community health data site with shared investment and public health leadership. Note: Recommended as an initiative of the Central Oregon Health Board. CO HIP - OR HIP 2. National Accreditation: Receive accreditation from Public Health Accreditation Board for all three Central Oregon public health agencies by July 2014. CO HIP - OR HIP 3. Environmental Health: Assure that Deschutes County's Environmental Health Program meets seven of the nine standards of the Food and Drug Administration Voluntary National Retail Food Regulatory Program by July 2015. 4. Behavioral Health Outcome Tools: Measure therapeutic outcomes and increase diagnostic expertise. Through the Central Oregon Health Board, identify specific outcome tools to be used by all behavioral health providers in the Central Oregon provider network by January 2013. CO HIP G. Expand Regional Efforts Definition: Collaborate with local and State governments, our hospital system, local providers, private insurers, health collaboratives, our community and the people we serve. 1. Regional Health Coordination Among Counties: Provide leadership in the development of the Central Oregon Health Board. Develop and expand regional services offered through our three counties. a) Complete an inventory of regional programs shared by Central Oregon counties by December 2012. b) With our Coordinated Care Organization, help create a Health Board unit to coordinate and improve the Central Oregon behavioral health system to benefit all communities in the region. Emphasize service to Oregon Health Plan members and indigent residents of the region. To include tracking of core metrics at least semi-annually. Form by October 2012. c) Through the Central Oregon Health Board, adopt (by March 2012) and implement a regional 2012-14 work plan to improve health and care as well as increase efficiency. Measurement: Quarterly reports. Measurement: Track of work plan deliverables; new resources and successful project completion. CO HIP - OR HIP 2. Health Information Exchange: Within HIPAA guidelines and Exchange protocols, include County client data by June 2015. Benefits include public health analysis of population data, individual access to personal health information and an ability to meet Federal "meaningful use" requirements. Health Information Exchange is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system. CO HIP - OR HIP Deschutes County Health Services Strategic Plan 2.24.2012 Page 15 of 32 3. LAUNCH: The LAUNCH Program will implement and evaluate an early childhood wellness media campaign to help unify the early childhood wellness service community and to educate and mobilize the public and policy makers around the issue, reporting to the Public Health Advisory Board by July 2012. CO HIP - OR HIP 4. Emergency Preparedness: By July 2013, develop regional liability protections for activation of Public Health Reserve Corp volunteers when mutual aid is requested in an emergency. Note: Includes Central Oregon Health Board, local health departments and tribal governments. CO HIP 5. Regional Nurse Family Partnership: Implement regional Nurse Family Partnership home visiting program, serving at-risk families with young children. Maintain caseloads (2012: 138 clients for Deschutes, Jefferson and Crook), establish a regional Advisory Council and identify diverse funding streams. Expand capacity to meet the demand for service. Measurements: a) perinatal outcomes for the three Central Oregon counties posted on web site annually, b) number served. CO HIP H. Strengthen our Organization Definition: Build the internal infrastructure necessary to create a robust, healthy and flexible organizational environment which fosters teamwork, progressive thinking and cutting-edge programming. 1. Organizational Structure: At least biennially, evaluate our organizational capacities and structure to assure that we are efficiently and appropriately staffed and organized to accomplish our goals. a) Hire a Behavioral Health Division Director to manage day-to-day direct service operations related to mental health, chemical dependency and developmental disabilities by July 2012. b) Reassess the organization and structure with Department leadership by December 2013 and December 2015. Integration: Annually, offer integrated activities for public health, behavioral health and support personnel (e.g., joint staff meetings, collaborative program discussions, cross-training or presentations between programs). Includes but is not limited to: Charter and convene periodically a "Support Staff" Team to strengthen Department processes and communication as well as help execute special projects by July 2012. 3. Emergency Preparedness: In conjunction with the public health preparedness program, develop a behavioral health preparedness capacity including: a) Train essential staff serving vulnerable populations (e.g., teams serving people with a serious mental illness, crisis personnel) by December 2012. b) Name a behavioral health preparedness team and leadership position by November 2012. c) Incorporate the team into the Incident Command System Structure through requisite training by July 2013. 4. Streamline and Strengthen Staff Development: In an effort to strengthen our work force and their ability to perform their work, a) Develop and implement a new employee orientation for new Health Services employees by July 2013. Include attention to documentation required, licenses, system access, team orientation, payroll, etc. b) Develop and implement a supervisory orientation for new managers and supervisors by January 2013. c) Develop and implement an employee exit interview process complementary of the County's process; analyze results annually during the fall Strategic Plan review and work plan development process by January 2014. L Promote Sound Health Policy Deschutes County Health Services Strategic Plan 2.24.2012 Page 16 of 32 Definition: Advocate and support clear, overarching policy interests and expectations for population health and the region's health care system. 1. The Triple Aim: Health Services will promote and advance the Triple Aim. We will support programs, services, practices and activities that lead to "better health, better care and less cost" across the health system. Note: The Triple Aim is now part of Oregon law and a founding concept for the Oregon Health Authority. It has been adopted by the Central Oregon Health Council and Deschutes County Health Services. 2. Regional Development: Deschutes County, through Health Services, will use a regional approach to program development, direct services, resource management and advocacy when the Department determines that the benefit to our County and our residents outweighs any associated costs. Criteria for assigning benefit to a regional project include a) a tipping point where we can accomplish something as a region that is less likely to be accomplished when done by a single County, b) an ability to increase resources and expand services, c) better coordination with regional organizations, d) greater efficiency, and/or e) improved education and advocacy. These initiatives will most often focus on Central Oregon counties through mutual agreement of all parties. Whenever Deschutes County takes a regional approach to its health work, we will identify the benefit of regionalization. Strategic Plan and Regional Health Improvement Plan as Core County Documents: As a matter of policy, the Strategic Plan and the Health Improvement Plan provide a set of principles, policies, priorities and positions that reflect the direction of the Deschutes County Board of Commissioners. Within State or County guidance, Health Services will advance the principles, policies and priorities contained in these plans, subject to any further direction or guidelines set forth by the Board. A progress report on our success in implementing the Strategic Plan shall be provided to the Board at least biennially. 4. Adherence to Policies: Health Services will operate within statutory, administrative rule and grant requirements as well as County and Department policies. Additional guidance for our work will also be established, when helpful, at the division and program levels. Policy guidance will be posted for staff, and supervisory staff will work to assure staff are aware of and operating within these policies. 5. Public Health Policy Approach: Through 2015, Health Services will collaborate with local agencies to reduce the burden of chronic disease in Deschutes County by way of policy, systems and environmental change. We will: a) use data to develop and implement health related policies to address priority population health needs and disparities; b) inform decision makers and stakeholders about potential health impacts of proposed plans, projects or policies wherein health is not a consideration; c) promote no- and low-cost community resources that support health related policies; and d) collaborate with land use and transportation agencies on projects that impact population health (e.g., Health Impact Assessments, membership on Regional Transportation Planning steering committee and active transportation initiatives). OR HIP - CO HIP 6. County-Operated Behavioral Health Services: Health Services will continue to focus County-operated programs and services in areas where the Department has particular skills and expertise and where the Central Oregon Health Board determines our work is most beneficial. By policy, we will also work with the Health Board to advance a network of agencies and services for outpatient care and treatment when such options are a) of high quality, b) more cost effective and/or provide for consumer choice. In such instances, Health Services will serve as one of several agency options or will refrain from offering such services, based on the direction of the Central Oregon Health Board and/or the Deschutes County Board of Commissioners. Deschutes County Health Services Strategic Plan 2.24.2012 Page 17 of 32 7. Resiliency and Recovery in Our Behavioral Health Practice: Health Services will promote resiliency and recovery for people of all ages who experience developmental disabilities or psychiatric and/or substance abuse disorders. Policies and procedures governing service delivery will attend to factors known to impact individuals' resilience and recovery. This work will include: a. A high quality of life for each individual or family; b. An ability to develop and maintain social relationships; c. Inclusion as a member of the community; d. Participation in community activities of the individual's choice; e. Improved health status and function; f. Success in work, school or living situation; and g. An ability to measure our success in implementing this policy. This will be achieved by providing services that are: a. Client directed. The provider will work in partnership with the client. The client will identify personal goals and have control of the resources to achieve these goals. b. Individualized and client centered. The plan for reaching goals will be designed to meet the specific needs and strengths of each individual. c. Empowerment. Services will be delivered to support and educate the individual to be able to plan for and direct his/her own services. d. Holistic. Services will encompass all the aspects of an individual's life. Services will address client identified needs such as housing, employment, community participation, transportation, family involvement, education and treatment for health, mental health and addiction issues. e. Strengths based. Providers will work with clients to identify the inherent strengths of each individual and build on those strengths to achieve the identified goals. f. Peersupport. Services will be designed to encourage peer support including sharing of experiential knowledge and social learning. g. Respect. Respect will be the basis of all relationships with clients. We will treat each individual with respect. We will work to ensure that the individual's rights are protected, to eliminate discrimination and stigma, to assist the individual to regain or maintain self-respect and to encourage the individual's participation in all aspects of life. h. Hope. Services will convey the motivating message of a better future. Both the client and the provider believe that things can get better, barriers can be overcome and goals can be achieved. Visually move this up in list 8. Inteerate Primary Care and Behavioral Health: Through the Central Oregon Health Board and Central Oregon Health Council, we will develop integrated behavioral health and primary care settings. We will evaluate various models including care through a) co-location of County personnel, b) contracted behavioral health providers, and c) primary care employment of behavioral health personnel. Note: all three models are under development in 2011-12. OR HIP 9. Tobacco Cessation Billing: Health Services will work with the Central Oregon Health Board and PacificSource to establish an approved method to bill for tobacco cessation treatment for behavioral health clients. With a viable billing option, we will begin offering tobacco cessation groups for mental health and alcohol and other drug clients by December 2013. CO HIP - OR HIP Deschutes County Health Services Strategic Plan 2.24.2012 Page 18 of 32 10. Tobacco Policy: Exposure to second-hand smoke can lead to heart disease, cancer and many other diseases, Bans on smoking in public places, including all indoor workplaces, protect people from the harms of second- hand smoke, help smokers quit and reduce youth smoking. a) Implement a 100% tobacco-free campuses policy at all Deschutes County facilities and all local government properties. b) Assess the desire for downtown tobacco-free campuses in Bend, Redmond and Sisters. c) Coordinate a regional approach to collect data on tenants of multi-unit housing and their preferences toward smoke-free housing and smoke- free multi-unit properties. d) Work toward implementation of smoke-free multi-unit housing properties. e) Assist in implementation of tobacco-free policies where people connect with physical and mental health services or support. OR HIP 11. Breastfeedine Policy Advocacy: a) Collaborate with community agencies to strengthen place-based (e.g., child care facilities) obesity prevention policies and practices that address nutrition, physical activity, screen time (e.g., computer, television) and breastfeeding. b) Advocate that a mother's infant feeding decisions be supported and protected in a variety of settings. c) Through WIC program investment, promote the Baby Friendly Hospital designation at St. Charles Bend and Redmond by July 2013. d) Educate the public and at least ten employers about Oregon's breastfeeding laws and regulations by July 2014. OR HIP 12. Nutritional Guidelines: Assure availability of healthy foods in Health Services' worksites. Develop and implement nutritional guidelines for foods and beverages available to Department staff, clients and visitors through 2015. a) Adopt a healthy vending machine policy that sets nutrition standards for foods sold in vending machines in Deschutes County agencies. b) Create guidelines for healthy foods and beverages at County sponsored meetings and events. c) Expand the Farm to Work program to include additional drop sites, a comprehensive outreach campaign and more educational opportunities related to healthy nutrition. OR HIP 13. Community Based Service Options: Deschutes County supports the concept of a community system of care through which County residents have local access to a wide range of health services. On a case-by-case basis, it is understood that an out-of-area placement for some health services may be necessary though it is not usually as beneficial as an effective local option that allows continued family and community involvement and a smooth transition to local services and supports. Deschutes County Health Services Strategic Plan 2.24.2012 Page 19 of 32 Appendix i. Membership of the Strategic Planning Group Public Health Accreditation (Measure 5.3.1 A 1. a.) We are grateful for the support and contributions of our Department leadership and staff in the development of this Strategic Plan. Participating leaders included Dana Bennett, Kacy Burgess, Cherstin Callon, Kathy Christensen, Jim Denman, Kathy Drew, Jeff Emrick, Shelly Falconer, Barrett Flesh, Lori Hill, Kathe Hirschman, Scott Johnson, Tom Kuhn, Maggi Machala, Tim Malone, Virginia Mayhill, MaryAnne McDonnell, Jean Mendenhall, Eric Mone, Kate Moore, Sherri Pinner, Travis Sammon, Terry Schroeder, Elaine Severson, Laura Spaulding, Martha Steigleder, Karen Tamminga and Patricia Thomas. Both our Advisory Boards also contributed to this plan, offering feedback and suggestions throughout the construction and approval process. These individuals included: Advisory Board Participants Public Health Advisory Board Behavioral Health Advisory Board Kim Curley-Reynolds, Chair Glenda Lantis, Chair (2011) Commute Options Central Oregon Community College Jock Pribnow, Vice Chair Darrel Wilson, Chair (2012) Retired Physician Anthony Rosenthal Retired Physician Keith Winsor Academy Medical Systems Cynthia Barnes OHSU Dentistry School Mike Bonetto Health Policy Advisor, Governor Kitzhaber Eric Alexander Partners in Care Jane Dey Retired RN (Public Health) Blake Drew Family Dental Care Charles Frazier Retired Pharmacist Holly Remer Healthy Beginnings Katrina Wiest Bend La Pine School District Opportunity Foundation of Central Oregon Pat Croll Retired Geriatric Specialist, Provider Jay Harris Telecare Mental Health Services of Oregon Chuck Hemingway Deschutes Family Recovery Marty Miller Bend-La Pine Schools Special Education Roger Olson NAMI of Central Oregon Kristin Powers St. Charles Health System Lee Ann Ross Retired Economist Julie Rychard Full Access Brokerage Lindsay Stevens Vocational Rehabilitation Counselor Marianne Straumfjord Retired Psychiatrist Susan Keys Bert Swift Inspire USA Foundation Retired Professor of Healthcare Administration Aylett Wright Patricia von Ried) Community Volunteer, COCC Peer Specialist, Deschutes County Health Services Deschutes County Health Services Strategic Plan 2.24.2012 Page 20 of 32 Appendix ii. Strategic Planning Process (Public Health Accreditation Measure 5.3.1 A 1. b.) Introduction: Strategic planning in Deschutes County was launched in 2011 during a time of rapid change in a dynamic health reform environment. With an application for Public Health Accreditation on the horizon, we are collaborating with the community on a Regional Health Assessment, an update of our 2009 Health Report and a Regional Health Improvement Plan for Central Oregon. The strategic planning became a final step to guide Deschutes County's work in public and behavioral health. A more detailed summary of the process follows: 1. Accreditation Beta Site: In May 2010, Deschutes County hosted the nation's first site visit from the Public Health Accreditation Board, an important step in a major effort to strengthen our nation's public health system. The goal of public health accreditation is to improve and protect the health of the public by advancing the quality and performance of all health departments in the country, so that residents can feel confident that their public health department is providing the highest quality services possible. Deschutes County was one of the 19 local health departments chosen to beta test the accreditation process in 2009 through 2010, and the first site in the nation to go through a beta accreditation site visit. Participation in this process has positioned Deschutes County Health Services to be better prepared for the official accreditation process through the identification of deficiencies and proficiencies. 2. 2009 Health Report: In 2009, a private consultant was contracted to begin assembling a health report specific to Deschutes County. The purpose of this report is to provide region-specific data that can be used by local government and community agencies, health care providers, school districts and other interested community members and groups to help identify and better address the health needs of Deschutes County residents. The health indicators examined in this report are used to represent trends by tracking measureable changes over time. The report identifies health areas where Deschutes County has met or improved in state or national health objectives, as well as areas in need of improvement. This report was utilized as a starting point for staff in creating goals to work toward in the current planning cycle. Also, this serves as the foundation for the current Regional Health Report which is being developed concurrently with the 2012-2015 Strategic Plan. 3. Central Oregon Regional Health Assessment Advisory Group: -Regional planning began informally in late 2010 when regional stakeholders formed a Regional Health Assessment committee in order work toward the common goal of having access to health information needed to guide programming decisions. This group formed to accomplish multiple tasks including identifying a web-based health indicator tool to be used by all health systems and the community, helping to guide the development of a Regional Health Report and preparing for the creation of the Regional Health Improvement Plan. The focus and direction of these initial meetings has evolved into a core group of regional partners working together toward common goals and serving as a committee of the Central Oregon Health Council. 4. Regional Health Report Update: In the fall of 2011, hours were secured for an in-house Research Analyst to update the Deschutes County 2009 Health Report and create a Regional Health Report using funding from the Accreditation Support Grant. The Analyst has presented updated health report data at regular intervals to our Behavioral and Public Health Advisory Boards, the Regional Health Improvement Plan Committee and Deschutes County Health Services Strategic Plan 2.24.2012 Page 21 of 32 to County Commissioners. Feedback received from these interactive presentations led to identifying ten top priority areas to be addressed by the Regional Health Improvement Plan as well as for Deschutes strategic planning. Although work is often driven by available funding streams, it is important to look at local health data to guide the future direction of service. S. Regional Health Improvement Plan: In 2011, the Central Oregon Health Council began driving the formal process of creating a Regional Health Improvement Plan (RHIP) to be utilized by Crook, Deschutes and Jefferson counties. The development of the RHIP took place concurrently with the Deschutes strategic planning process, making it possible to effectively align priorities and target areas between the two plans. This document was completed in March 2012 and effectively links regional goals with County-specific goals. The Regional Health Report update data was used to develop the ten priority areas in the development of the RHIP. 6. Strategic Planning Process: a. Process i. Mission. Vision and Guiding Principles - Deschutes County Health Services Director Scott Johnson created the mission, vision and guiding principles for the plan. ii. SWOT Analysis - During a retreat with Department management staff in the fall of 2010, an agency SWOT Analysis was conducted. This analysis was examined as another guiding point for management when looking at which goals best met the community and agency needs. The document in the appendix entitled "Ten Likely Environmental Changes in 2012-2015" further examines external factors that will affect future public, behavioral and clinical health care delivery. iii. Domain Creation and Development - Health Services management selected and then defined nine domains which they felt brought together the elements of the Triple Aim concept in addition to the essential components needed to successfully position the agency for health reform. These domains serve to broadly classify the working elements of the plan to ensure that gaps do not exist globally. iv. Staff and Workgroup Input - Using the Deschutes County 2009 Health Report and the current Regional Health Report Update as initial data, strategic planning work began with staff input. Staff worked in small groups to brainstorm and identify agency priority areas to focus on from 2012-2015. These workgroup sessions began to populate the nine domains with goals that they felt would benefit the community and agency over the next four years. Some goals were specific to behavioral health, some to public health and some to both. At times, work sessions took place during meetings of management staff, program staff and at a combined meeting of our Behavioral and Public Health Advisory Boards. v. Workgroup Process - Workgroups met in two designated "planning rooms," where the nine domains were written on poster boards on the walls of the meeting rooms. Staff wrote out potential goals on "Post-It" style papers and adhered the goals to the poster boards under the specific domains under which their goals most appropriately fell. Following approximately four weeks of time to allow staff to populate the domains, the domains were collected and goals typed into the template of the Strategic Plan. Staff participation and response to this open process was very positive and produced an overabundance of goal areas to incorporate into the plan. vi. Stakeholder Input - Once the draft template was completed, a process of vetting the information through the Behavioral and Public Health Advisory Boards, regional partners, County Commissioners and Department leadership teams began. The Advisory Boards are comprised of area health professionals, partners and community members, which provided a broad spectrum of expertise and experience to contribute to the plan. Minutes were taken during each review by the various groups, and feedback was incorporated into the plan. Simultaneously, previous and current health Deschutes County Health Services Strategic Plan 2.24.2012 Page 22 of 32 data was provided to stakeholders by the in-house Research Analyst to assist in identifying gaps in the plan. b. Oregon Regional Health Improvement Plan -The Oregon Regional Health Improvement Plan was examined in detail and compared with the goals of the Strategic Plan to identify where there was alignment and where gaps existed. There was a reasonable amount of overlap; however, there are areas which the Oregon Health Authority has the capabilities and resources to address which are not feasible locally. This comparison document is available for review. c. Timeline -The 2012-2015 Strategic Plan Timeline (Appendix ii.a.) contains the complete macro level agenda specific to strategic planning including the groups of staff, community groups and regional partners who participated in the process. Minutes for these meetings were recorded to document input and feedback utilized to develop the plan. d. Annual Planning Cycle -The Annual Strategic Planning Cycle (Appendix ii b) visually demonstrates the annual process that Health Services will engage in throughout the duration of this plan. To be successful the plan must be examined annually to align the annual work plan with goals and budgets, review and compare with legislation, examine new emerging health data and evaluate progress of the plan. This diagram also contains a long-term timeline which will designate when final evaluation of the plan will take place along with planning for the next strategic planning cycle. Deschutes County Health Services Strategic Plan 2.24.2012 Page 23 of 32 Appendix ii a. 2012-2015 Strategic Plan Timeline Deschutes County Health Services Date Item/Meeting Outcome Sept 16 Deadline for program areas to submit goals for Strategic Plan -Mission/Vision/Values -9 Strategies & Goals Sept 20 1't Draft completed (rough) Sept 20 PH Leadership Team Review of 2008-11 Strategic Plan Sept 21 BH Advisory Board -Review of Strategic Plan Sept 26 Management Team -Health Assessment update Sept 28 PH Advisory Board -Review of 2008-11 Strategic Plan Oct 12 Board of County Commissioners -Health Assessment update BH & PH Leadership Meeting -Review Draft Oct 26 Combined BH & PH Advisory Board Meeting Review & Edit Strategic Plan Oct 31 Management team retreat -Review & Edit Strategic Plan -update SWOT Analysis Nov 4 2"d Draft completed Nov 8 PH All staff BH All staff Share with staff Nov 15 Review by Kuhn & Emrick Detailed Editing Nov 16 BH Advisory Board Review if needed Dec 07 PH Advisory Board -Strategic Plan update Dec 21 BH Advisory Board -Health Assessment update Dec - Mar Central Oregon Health Council Health Improvement Plan 2012 Jan - Feb BH & PH work on FY 2013 Work Plan 2012-13 Work Plan Draft Jan 3 Regional Health Improvement Plan Committee Health Assessment Review and input (top 10 priorities) Jan 18 BH Advisory Board Health Assessment Review and input (top Jan 25 PH Advisory Board 10 priorities) Feb 7 Final Draft completed (all input due) Feb 15 BH Advisory Board -1St Read of Plan Feb 22 PH Advisory Board Feb 27 Board of County Commissioners Work Session to present Strategic Plan and review Mar 21 Combined BH & PH Advisory Board Meeting -Adopt Strategic Plan -Adopt 2012-13 Work Plan Mar Central Oregon Health Council Health Improvement Plan completed Mar Sherri - budget Actions & Measures to Dave Inbody Mar Board of County Commissioners Adopt Strategic Plan Deschutes County Health Services Strategic Plan 2.24.2012 Page 24 of 32 Annual Strategic Planning Cycle Fall 4Evaluate Strategic Plan Progress 4Review Health Report Data no Appendix ii b. Winter Create Annual Work Plan Review Regional Health Improvement Plan Make Adjustments to Strategic Plan a Central Oregon Health Board County Commissioners Public & Behavioral Health Advisory Boards Community Partners t Summer +Review Legislative Session Outcomes +Begin implementing Work Plan Spring Budgets Aligned with Plan Priorities Adoption of Plans and Priorities Regional Health '09 Health Strategic Regional Health Strategic Accreditation Strategic Assessment ReportAnalysis Planning Health Improvement Plan Application Planning Planning & Update Process ReportComplete Plan Complete Adoption Process 2011 2012 2013 2014 2015 2016 Strategic Plan Updating as needed Deschutes County Health Services Strategic Plan 2.24.2012 Page 25 of 32 Appendix iii. Accomplishments in Recent Years Over the past eight years, previous Strategic Plans, grant applications and program development efforts have resulted in considerable growth in our services and our contributions to our communities and our region. "Better Access to Help" for People in Need a. Increased community behavioral health services for Oregon Health Plan members through employees and contracts as members increased 211% from 8,134 (2004) to 25,340 (2012). b. Increasing mental health options by end of 2012 by certifying and funding six more mental health agencies since 2004. Authorized help for 649 people in 2011 alone. c. With Building Services, secured State and Mosaic Medical commitments to open an extensive integrated Redmond Service Center in the summer of 2012. d. Expanded Health Services school-based health centers to six centers, opened new centers in Sisters and Redmond (High School). Note: Includes Gilchrist center in North Klamath. e. With Deschutes County grant writer, secured a Federal grant application to construct a new multi-purpose, integrated health center in Sisters to serve children and seniors. f. With the support of the Klamath County Board of Commissioners, assumed responsibility for helping Oregon Health Plan residents in Gilchrist, Chemult and Crescent. "Better Health" for County Residents a. As the County's public health agency, contributed to favorable county health rankings. Deschutes County ranks 4th of 33 Oregon counties in health factors; 7th in health outcomes. b. Deschutes County ranked first of all Oregon counties in "health behaviors" (measures of smoking, diet and exercise, alcohol use, and risky sex behaviors). c. With all area school districts, became the first Oregon County to develop new policies and implement My Future My Choice (sexuality education) in middle schools countywide; secured a regional grant to implement Cuidate, a prevention program for Latino youth. d. Expanded immunization capacity with local private and public clinics, helping to assure access and education about vaccine. In 2010, added Mosaic Medical's Bend Clinic as a delegate clinic; increasing free vaccine for people at high risk. e. Promoting worksite wellness in the community; sponsored an agency Health Improvement Committee. Continuing to pilot a farm to work program and offering other improvements. "Better Care and Safety" for Our Community a. Beginning in 2011, co-sponsoring a best practice, regional Nurse Family Partnership program, improving maternal and child health for high-risk families in Central Oregon. b. Created our first Community Health Worker positions; employed two peer support specialists in our Behavioral Health Division, preventing ill health and coordinating services. c. Beginning in 2011, created a new Quality Improvement Program addressing access, critical incidents, client concerns; sponsoring projects focused on better health and care. d. Successfully transitioned Deschutes County Environmental Health to Deschutes County Health Services, integrating the staff and services with our Community Health team. e. In 2010-11, completed the largest increase in residential options for people with mental illness in the County's history (48 more units/slots), preventing homelessness, hospitalizations, improving health and safety and reducing costs. Deschutes County Health Services Strategic Plan 2.24.2012 Page 26 of 32 f. Providing key health role in County emergency preparedness; staged successful emergency preparedness exercise with the U.S. Postal Service, health providers and law enforcement with a health site at DCHS for affected workers. g. Offering a best practice Parent Child Interaction Therapy program, improving parent child interactions and preventing abuse and neglect. "Less Cost" for Our Health Services in Oregon and Nationwide a. Continuing to expand Living Well, a regional, evidence-based chronic disease program, helping Central Oregon residents of manage chronic conditions and lessen hospital stays. b. Sponsored and expanded our regional early intervention Early Assessment & Support Alliance program; helping transition age youth experiencing psychosis for the first time. Offers better care and reduces hospitalizations. c. Helping people return to the community from the State Hospital; participating in Oregon's new AMHI (Adult Mental Health Initiative). Reduces hospital stays and improves care. d. Developed a new best practice Assertive Community Treatment team, improving care with 24/7 behavioral health service for people with severe mental disorders. e. Developed and strengthened our Children's Wrap Around team, offering intensive community services to high-need children with serious emotional disorders. Assures better care and reduces hospitalizations and out of community placements. "A Better Community and Regional System" During a Time of Health Reform a. Implemented a five-year federally funded Linking Actions to Unmet Needs in Children's Health program, enrolling more than 100 at-risk children and families. Integrated services are provided by a multi- disciplinary team with a nurse practitioner, mental health therapist and Family Access Network advocate. Strengthens families and prevents abuse. b. With the Commissioners, formed a regional Health Board to replace Accountable Behavioral Health Alliance (five-county Behavioral Health Organization); developing regional services among counties for greater efficiency, an increase in resources and better services. c. Helped pass SB 2004, forming Central Oregon Health Council to serve as community governance over State required Coordinated Care Organization (HB 3650 2011 session). d. Recognized as a State of Oregon demonstration site for service integration in partnership with the hospital system, insurance groups and health providers. e. As a region, lead organization(s) for health assessment; launching community web site with health assessment data by January 2013 to increase community awareness and response. "A Stronger County Department" with a Focus on Accountability a. First county in nation to participate as a beta site for public health accreditation through the Public Health Accreditation Board; improving our operations through this process. b. Successfully completed the State Public Health Triennial Review. Addressed all findings and recommendations, completing the process in September 2010. c. Continuing improvements and integration in our business services area with greater emphasis on billing systems and processes, critical business functions as part of health reform. d. Improving our health record system with new technologies; implementing Unicare system in behavioral health in 2011; preparing to select and implement the OCHIN system in public health in 2012-13. Deschutes County Health Services Strategic Plan 2.24.2012 Page 27 of 32 Appendix iv. Ten Likely Environmental Changes in 2012-15 Regional development. The C. O. Health Council, a new Coordinated Care Organization (CCO) and the C. O. Health Board (counties) as well as limited funding and the numerous other regional groups in Central Oregon all point to an expansion of collaborative work across the three-county area. 2. A shared goal of care coordination' with clients and between providers. Integration of primary care and behavioral health care throughout Central Oregon and a close working relationship with Federally Qualified Health Clinics (Mosaic Medical, La Pine Community Health Clinic). 3. Formation of a Coordinated Care Organization in our region. Our CCO will manage all Medicaid and Medicare-Medicaid funds. This role may expand in the future to more public and commercial business including PEBB and OEBB 2 PacificSource may become a major player in this work. Our Medicaid behavioral health work will transition to the Central Oregon Health Board. 6. Outcome based systems and greater accountability required. The State plans to move to a global budgeting model with payment made based on outcomes achieved. Fee for service payments may go by the way side. Failure to perform (evidence of measurable outcomes) may result in lost funding. 7. Health insurance coverage for 95% of Central Oregon residents in 2014. Federal reform and the national movement toward health insurance exchanges (see SB 99 in Oregon) will provide coverage to most uninsured. Working poor could still struggle for access. A potential crisis in health care. While 4. National accreditation of the Three Public Health agencies in Central Oregon. This will improve our practice and make us more competitive for grants. It will require ongoing improvement and reporting efforts. Oregon Health Authority Addictions & Mental Health Div. system change. Beginning in July 2012, State General Funds for behavioral health will require a common statewide system of core services, global budgeting, a new statistical reporting platform and accountability for outcomes. Service Elements will end. 1 Coordination will particularly focus on improving our DCHS clinical work with primary care practices and the hospital as well as between public health, public health clinical and behavioral health. 2 Public Employee Benefit Board and Oregon Education Benefit Board. Deschutes County Health Services Strategic Plan more people will be insured, we may lack the primary care provider capacity to serve people. If new payment systems are difficult for providers, people could be excluded from service. Access will remain a critical issue in our County. We must assure timely access to quality care. 9. Changes in professions and the need for work force development. We will see a continuing push for people to work at the top of their licenses and the emergence of a new work force: "community health workers" (i.e., para- professionals (including peer support specialists) who help to coordinate care. 1o. Unknown changes in the roles of County government (in the areas of health and human services). The roles as the "local mental health authority" and the "public health authority" are increasingly uncertain over the next several years. Work on safety net issues will remain as the community continues to turn to County government to help with social, health and safety issues that must be addressed. 2.24.2012 Page 28 of 32 Appendix v. v a ~a a COMMUNITY HEALTH ASSESSMENT for PUBLIC HEALTH ACCREDITATION Conduct and disseminate assessments focused on population health status and public health issues facing the community *Focus: Systematic monitoring of health status; collection, analysis, and dissemination of data; use of data to inform public health policies, processes, and interventions; and partici- pation in a process for the development of a shared, comprehensive health assessment of the community. DOMAIN INCLUDES FOUR STANDARDS: 1. Participate in or Conduct a Collaborative Process Resulting in a Comprehensive Community Health Assessment. 2. Collect and Maintain Reliable, Comparable, and Valid Data That Provide Information on Conditions of Public Health Importance and On the Health Status of the Population. 3. Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors That Affect the Public's Health. 4. Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Intervention. *Public Health Accreditation Board (2011). Standards & Measures, V 1.0, May 2011. http://www.phaboard.org/ pg. 9. Appendix vi. In conjunction with the Central Oregon Regional Health Improvement Plan, ten priority areas were identified from the Regional Health Report. They will serve as a driving force in planning and community action. The complete Central Oregon Regional Health Report, with all indicators and data elements, will be available at http://www.deschutes.org/Health-Services.aspx in late March 2012. Regional Health Improvement Plan: 10 Priority Areas (The following items are not listed in order of importance)) 1. Disparity/Inequity Comparative mortality ratios in areas of Southern Deschutes County and Northern Jefferson County are significantly higher than state average, and are considered a health disparity (or difference) in health. Mortality in this case is related to geographic area. But the disparity is also inequitable because it is avoidable and unjust. It is no surprise to many Central Oregonians that our rural areas have high rates of poverty, less access to services, greater distances to travel for needed care, and many individuals struggle to meet basic needs. These systematic barriers needlessly impact individuals' health. This is one example of disparity and inequity in our region. Many other disparities exist, warranting investigation to determine if these differences are equitable and just or not. Improving public health will require work toward health equity-aiming for communities where all individuals have the opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential because of socially determined circumstance. 2. Access to Resources The ability to access resources, services or assistance is impacted by numerous factors including transportation, travel distance and time, finances, social and cultural barriers, waiting time, and the systems of care in place. An elderly person living alone and unable to drive may have financial means, but limited access to care. Similarly, a working single mother with no car may have access to public transportation, but cannot afford the cost of unpaid leave from work to access resources. Central Oregon's rural and urban population: More than 41% of Central Oregonians live in unincorporated areas and towns with less than 2,500 people. 3. Early Childhood Wellness A child's growth begins in pregnancy and continues into adulthood. Many factors impact childhood wellness: social, environmental, physical, cognitive. Children in environments unable to meet their needs have increased risk for poorer health, safety, development, and ability to learn. These unmet needs during childhood pose threats to health long into adult and later life. Early childhood wellness is a short-term investment for today and a long-term investment for the business, health, education and social sectors in decades to come. Deschutes County Health Services Strategic Plan 2.24.2012 Page 30 of 32 4. Food Insecurity Crook and Jefferson counties were among the top five Oregon counties with highest food insecurity. Deschutes County has the largest total number of food insecure individuals in Central Oregon. In Crook County, the average cost per meal is nearly $1 higher than in Deschutes County and the rest of Oregon. It is estimated that more than 37% of children in Jefferson and Crook counties may be food insecure. In Deschutes County, of all the food insecure adults and children, 45% are not eligible for SNAP (Supplemental Nutrition Assistance Program) or other federal food programs-a sizeable number of children and adults who may not be able to access much needed assistance. 5. Oral Health Though frequently identified by providers and community members as a problem in Central Oregon, there is little recent data to estimate total burden of poor oral health in the region. Poor oral health can cause pain, discomfort, and disfigurement; it can affect an individual's quality of life, ability to eat and to speak, and can interfere with opportunities to learn, work, participate, engage and contribute. What's more, poor oral health is related to chronic disease in later life. 6. Safety, Crime and Violence Central Oregon counties have higher rates of abuse and neglect victims (confirmed cases) than the state of Oregon. This may be due to differences in reporting and resources in the system of care, or an actual higher rate of abuse/neglect. In 2009, Deschutes and Crook counties were ranked in the top ten Oregon counties with highest crude rate of total violent crimes reported. In the same year, Jefferson County was in the bottom ten Oregon counties for number of police per 1,000 of population. Last year, more than 1,450 individuals in Central Oregon called an emergency crisis line about domestic violence alone. 7. Chronic Disease In the past 65 years, adult chronic disease has grown into the main health problem for industrialized nations. Cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease account for at least 50% of the global mortality burden. In Central Oregon, chronic diseases are the leading causes of death for each county. Crook County's age-adjusted prevalence of adults with high blood pressure is 46.2%, significantly higher than 25.8% of adults for all of Oregon. Exposures, modifiable behaviors, and risk factors all play a role in the development of chronic disease in later life. 8. Alcohol, Drug and Tobacco Use In 2009, more than 19% of adult males reported binge drinking in the past 30 days. In Central Oregon, adults age 18-25 years old report higher rates of alcohol dependence in the past 12 months than individuals over 26 years old. Heavy drinking, drug use and tobacco use is associated with higher rates of all-cause mortality, chronic disease, violence and abuse. Deschutes County Health Services Strategic Plan 2.24.2012 Page 31 of 32 9. Behavioral Health In Deschutes County today, suicide claims nearly as many lives as motor vehicle accidents. It is estimated more than 9,000 adults in the tri-county region have serious mental illness. Roughly 1/3 of Central Oregon 11th graders reported having a depressive episode in the past year. High depression scores are associated with poor academic achievement, anxiety, poor peer and teacher relationships. The extent of the need for behavioral health services and the capacity to provide services should be looked into. Early risk factors and prevention data also need to be investigated. 10. Healthy Environments There is much to learn about the specific environmental health characteristics of Central Oregon's communities. The ecological surroundings of individuals, families, communities and regions impact the options available to individuals to reach their full potential for health. Environments-on any scale- simultaneously impact and are impacted by those within them. Built and natural environments directly impact human health, and humans directly impact the built and natural environments. Current and relevant data on all scales of environment is lacking in the Central Oregon region. Locations of stores to purchase affordable fresh fruits and vegetables impact healthy choices. Safe and affordable alternative commute options impact the behaviors of individuals to choose alternatives to driving, thus impacting the environment. Safe and easily accessible places to play outdoors impact the ability of children to play outside. - END - Deschutes County Health Services Strategic Plan 2.24.2012 Page 32 of 32 C Z 0 -C February 27, 2012 Jason Miner, Mary Kyle McCurdy and Pam Hardy 1,000 Friends of Oregon Main Office 133 SW 2"d Ave, Suite 201 Portland, OR 97204 Board of County Commissioners 1300 NW Wall St, Suite 200 • Bend, OR 97701-1960 (541) 388-6570 • Fax (541) 385-3202 www.co.deschutes.or.us board@co.deschutes.or.us Tammy Baney Anthony DeBone Alan Unger Richard Whitman Governor's Natural Resource Office State Capitol building 900 Court Street NE, Suite 160 Salem, OR 97310 Jim Rue, Rob Hallyburton, and Tom Hogue Oregon Department of Land Conservation and Development 635 Capitol Street NE, Suite 150 Salem, 97301-2540 RE: 1000 Friends v. Deschutes County, LUBA Case No. 2011-121 Regional Economic Opportunity Analysis Settlement Negotiation Dear Negotiation Partners, The Deschutes County Board of Commissioners (Board) appreciates everyone's willingness to openly discuss the Regional Economic Opportunity Analysis (REOA) and opportunities for a settlement. As you know, the purpose of the REOA has been to provide a clear, efficient path for Central Oregon cities, utilizing county statutory coordination authority, to identify, entitle, and serve large-lot industrial sites with traded sector employers. At the present time, the Board remains committed to the current bifurcated approach in the existing REOA that relies upon county statutory coordination authority and the adoption of the REOA, followed by the obligation of Central Oregon cities to initiate any urban growth expansion under OAR Chapter 660 Division 24. The Board, however, is certainly open to additional or alternative approaches that offer a legal framework for implementing a large-lot industrial program for Central Oregon in 2012. In that spirit of openness, on Monday, February 27, 2012, the Board unanimously agreed to delay the submission to LUBA of the record in the above listed case until the end of March in order to continue negotiations with 1,000 Friends of Oregon, with the direct assistance of Richard Whitman and Oregon Department of Land Conservation and Development (DLCD). The Board also directed the Community Development Department and Legal Counsel to continue negotiations until March 23, 2012. The agreement to continue negotiations, however, is contingent upon the following written commitments: Enhancing the Lives of Citizens by Delivering Quality Services in a Cost-Effective Manner DC-2012-148 + DLCD will commit that, should the parties continue to agree that it is necessary, DLCD staff will initiate by Summer 2012 the LCDC rule making process for narrowly crafted amendments to OAR Chapter 660 Division 24 (Urban Growth Boundaries) that will allow cities to utilize a regional large-industrial lands analysis and its identified short-term need for sites, subject to a regional governance structure, without the requirement to determine a 20-year need for the land. • 1,000 Friends of Oregon will commit to collaborating with the County and Regional Advisory Committee (RAC) to refine policies addressing 6 short-term sites, a replenishment of at least 2-3 sites, a review period, and a large-lot industrial overlay zone; and, as a partner during the rule making process, to support a narrow amendment to OAR 660 Division 24 in 2012. • The Governor's Office will commit to continue facilitating negotiations and, if necessary, collaborate with the County and 1,000 Friends of Oregon as a partner during the rule making process in 2012 to support a narrow amendment to OAR Chapter 660 Division 24. If Deschutes County can obtain the written commitments described above by March 23, the intervenors will be convened later that month, prior to checking-back with the Board, to assure that our regional partners are supportive of the settlement approach. If there is consensus by the intervenors, the Board will withdraw for reconsideration Ordinance 2011-017, which adopted the REOA and several regional industrial lands policies. If however, negotiations and/or rule making unexpectedly cease, the Board reserves the right to readopt the REOA as it is currently written. Sincerely, Z4~_441~ Anthony DeBone Deschutes County Board of Commissioner Chair a&t, uUnger Deschutes County Board of Commissioner Vice Chair C MW Tammy Baney Deschutes County Board of Commissioner