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2015-330-Minutes for Meeting May 26,2015 Recorded 7/16/2015 DESCHUTES COUNTY CLERK W 415.330""��V NANCY COMMISSIONERS ' JOURNAL 07/16/2015 08'12'40 AM IJj II I 1 1111111111111 III 2 1 -3 Do not remove this page from original document. Deschutes County Clerk Certificate Page 0 444.11k1 G�JT co 2� 0 r Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 yito (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF BUDGET MEETING—HEALTH DEPARTMENT DESCHUTES COUNTY BOARD OF COMMISSIONERS MONDAY, MAY 26, 2015 Allen Room, Deschutes Services Building Present were Commissioners Anthony DeBone, Alan Unger and Tammy Baney. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; Mike Maier, Clay Higuchi and Bruce Barrett, Budget Committee; Wayne Lowry, Finance Director; Loni Burke, Financial/Budget Analyst. There were no members of the media present. Meeting minutes were taken by Kathe Hirschman, Health Services. Chair Bruce Barrett opened the meeting at 3:23 p.m.. Present from Health were Jane Smilie, Health Services Director, introduced Health Services staff present: DeAnn Carr, Behavioral Health Deputy Director; Sherri Pinner, Business Manager; Melissa Rizzo, I/DD and Intensive Youth Services Program Manager; Michael Ann Benchoff, Systems Performance Pro g ram Manager; Dave Inbody, O p erations Manager; Thomas Kuhn, Community Health Program Manager; and Barrett Flesh, Child & Family Behavioral Health Program Manager. Ms. Smilie presented a graphic depicting a conceptual framework for governmental health services, showing foundational capabilities of most public health departments and "extra" functions provided by Deschutes County Health Services. She noted that it is very important for us to be attentive to those foundational capabilities and the data used to track how we are doing in order to inform planning. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 1 of 9 Highlights & accomplishments over the past year: • Achieved national public health accreditation; • Certified by the State of Oregon in mental health and addictions services for three years; • Certified as a regional Early Learning Hub; • Met increased demand for K Plan services for individuals in the intellectual/ developmental disabilities community; • Enhanced operational services; • Improved the department's budget development process; • Modified facilities, staffing, and processes to gear up to be ready to receive the increase in behavioral health clients due to Medicaid expansion. Mr. Higuchi asked whether public health accreditation would help leverage federal funding. Being accredited will help leverage such funding. In future, we believe state and federal funding will be tied to accreditation. It is also very exciting that there are now national standards for public health. The department has almost doubled the amount of billable OHP encounters from 2014 to 2015. There was a slight downward trend in meeting timelines for route appointments in the first quarter of 2015, so the department has formed a "touchpoints" work group to look at all forms and points of access to improve access and bring the 85% number back up to target. In response to a question from Commissioner Baney, Ms. Carr explained the process for a routine request for service. The caller will be scheduled for an assessment as quickly as possible; it may be two weeks before an assessment appointment is available. While doing the assessment, the clinician will schedule an appointment with the primary clinician. This appointment will be as soon as possible, and the timeframe depends on the type of service needed, whether for an adult or a child, and where the service is requested. Appointments in Redmond take a bit longer due to higher demand at that site. Consumer satisfaction surveys were conducted in two separate surveys—one for public health and one for behavioral health. The response rate was about 100 clients for each survey; and results were good in both areas. Overall, the comments in each survey were very positive about their experience at DCHS. The surveys will be repeated on a regular basis. The department is also evaluation non- traditional business hours in order to provide better customer service. A question will be added to future surveys asking clients their preferences on non-traditional hours. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 2 of 9 Integration is another area of success with healthcare reform. Partnership with Mosaic Medical at the Harriman Health Center, located within the Deschutes County Downtown Health Center, has increased the show rate for medical appointments by over 400%. We are also working with Mosaic Medical to co- locate County behavioral health staff at Mosaic's Bridges Program, which serves people with complex health care needs. Ms. Carr noted that in December 2013, approximately 20,000 new OHP members were anticipated in Deschutes County. Based on that estimate, we anticipated 5,333 new OHP clients during 2014. By December of 2014, there were approximately 40,000 new OHP members, and the department saw a 43% increase in OHP membership within that year. Ms. Can noted that we received most of these new OHP members in January. Commissioner Baney noted that the behavioral health customer base has exceeded our capacity to provide services and the response rate was still high impressive. Ms. Smilie then described the department's budget development process and work done try to make the department's complicated budget more understandable. She and Ms. Pinner spent a lot of time with Mr. Lowry peeling back the layers to better understand how the funding plays in this budget. A lot of time was then spent with program managers collectively looking at data and planning. OHP funding is the department's largest source of funding; it is very difficult to get an answer when asking what OHP funds can be expected for the coming year. Ms. Smilie feels this question may get more difficult in future as funding streams blend and allocations are more and more tied to performance. PacificSource was able to provide actuarial data that was used to estimate OHP funding for the coming fiscal year. An official indirect rate was calculated, which allows the County to take as much administrative cost as possible from grants. This is very important as we are bringing in so many outside dollars. The department is requesting 7.05 new FTE, which is a net increase of 3.1 FTE from the last budget. The department prioritized FTE requests, putting them where we knew we can increase productivity/service; commitments to partners; and those not requiring general fund. The department is also requesting a one-time investment in facilities, and in the children's mental health service continuum to help a gap in needed services in our community. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 3 of 9 The department uses County general funds to serve segments of the population who are uninsured or underinsured; as matching funds to leverage additional federal funds; with other funds to provide essential services or to enhance the level or quality of service; to ensure services are available throughout the county; and to fulfill our responsibility to protect the health and safety of citizens. Ms. Saraceno gave a brief history of the regional Early Learning Hub and noted. that our application to be a Hub scored the highest in Oregon for our sophisticated use of data. We became certified as a Hub in October 2014 and have recently moved from the planning phase to the action phase. The scope has changed from a county approach to a regional approach. One key role of the Hub is resource development, and we have brought in nine grants for a value of almost $700,000 to address needs that have been identified in our region. The County's two Early Learning Division FTE are working on projects specific to Deschutes County but are also doing regional work with the Early Learning Hub, ensuring D es chut es County's s needs a re add r essed in the regional work. A time study of Early Learning Division staff shows 60% of their time is spent on regional work and 40% spent on work specific to Deschutes County. It is important to keep in mind that 80% of tri-county residents are in Deschutes County. Mr. Higuchi asked what matrix is being used to measure success. Ms. Saraceno explained that we are working with education, health and social service safety net programs, all of which have metrics; and each of the strategies has metrics tied to it. There are milestones that are measured as a child proceeds from kindergarten to high school graduation such as third grade reading scores and eighth grade math scores. Commissioner DeBone asked about Healthy Beginnings Head Start and whether we are aligned well and everyone working together well in Central Oregon. Ms. Saraceno replied that key partners are working together and work is ongoing to develop those relationships with other counties, partners and with the Tribes. The department is not requesting more County general funds that what was contributed in FY 2015 for Early Learning Hub at this time but is proposing a conversation with the Commissioners about County general funds in October, when the State Early Learning Hub funding appropriation should be finalized. Mr. Maier and Commissioner Unger do not want to see the general fund being used to balance the budget in the event the State does not step up with funding. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 4 of 9 Commissioner Baney asked if Crook and Jefferson counties are contributing their general fund dollars to support the Hub. Ms. Saraceno answered that Crook County is definitely making general fund contribution, but in Jefferson. County, it is debatable. Crook and Jefferson each have one employee and Deschutes has two employees working in collaboration. We do have a regional approach and. partnership that is working well. Commissioner Baney wants us to be mindful that we will be receiving state funds for the Hub; in the past, we received no state money but are being asked for the same general fund contribution. If we receive other funds from the state in October, how will that offset? Mr. Maier stated that this is a decision that cannot be made until we know about the State funding. He went on to say that he is happy that the department in general is not increasing the general fund cost because of all the other pressures on the general fund. Ms. Saraceno noted that approximately $89,000 of the general fund contribution is earmarked for Alternatives to Incarceration. If we take that out, then we have the real number of subsidization by general fund. Mr. Higuchi asked whether the department would add the seven new staff if OHP funding does not come through. Ms. Smilie answered that the funding for new staff will come from what the department has. Mr. Higuchi noted that there was a point when they were concerned about what things were moving when folks went away. It is important that you say this is what we get, this is what our staff is, and don't make the parts moving. He complimented the work done by department staff to simplify the department's budget. Ms. Pinner noted department funds would be even easier to track if the department were able to move to one operational fund. There has been concern over the past few budget cycles about the amount of general fund support given to the School Based Health Centers. Ms. Smilie explained that we have been able to carry on with the support of our medical sponsors. We have moved some of the staffing and funding directly to the sponsors to hire staff. We will continue to look for efficiencies and do the best we can—this is a movement in right direction. Mr. Bishop asked if we had a sense of how many individuals we see at the School Based Health Centers. While we do not have the numbers at hand, Ms. Carr noted that the department billed $120,000 for behavioral health services to OHP members in the School Based Health Centers during the first quarter of the fiscal year. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 5 of 9 Commissioner Baney pointed out that this highlights her concern. The Commissioners were asked to support $50,000 for grants to match a state grant to stand up the School Based Health Centers. When that request was made, no one ever said it would come to this. If we are going to start up a project that is going to require ongoing support, we need to know in advance. When we bring on grant- funded positions her confidence in not having a request down the road for ongoing FTE is wavering. Ms. Smilie understands the concern. She noted that some general fund does go to support foundational capabilities. She also noted that the County system does not have a way to adjust to the continuing increase in the cost of doing business. Property & Facilities' estimate of cost the upgrading the department's Wall Street Services Building and. South County Services Building is about $1 million. Mr. Inbody explained that we had an opportunity to combine intensive services for youth ages 18-25, to include reproductive health, at the Wall Street Services Building location. The ability to serve this population with all services at one location has a huge impact. He also noted that the department facilities had been in poor shape—dark, dingy, no space available and not safe. The space the department previously used in Redmond had little security and no privacy. Once we get a decent facility in Redmond, we had a large increase in the number of individuals coming in for services. Ms. Smilie noted that the department plans to use OHP funds for the bulk of the improvements. The proposed remodel projects will add a front desk/reception area at each site to improve safety and security. Ms. Smilie explained that the department is working closely with WEBCO, St Charles, Crook County, Jefferson County and PacificSource, to much needed bring children's intensive services to our region. We are trying a different way—to incentivize a provider to come to Central Oregon to provide a level of service that falls between our intensive services and acute care. We are planning to put OHP funding toward this. Our region is big enough to see the kids who need these services but not big enough to sustain a provider agency through the first years of ramp-up. In response to a question from Mr. Maier, Ms. Smilie explained that the proposed provider agency provides services in many states as well as in many counties in Oregon. The agency is a nonprofit with a good track record. Department staff has made a site visit and are very impressed with their work. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 6 of 9 The department is requesting the following new FTE: • 0.5 new health educator position to be paired with existing 0.5 FTE suicide prevention coordinator we have through federal funds; • 0.05 new health educator position to be added to existing 0.95 tobacco prevention • 0.5 peer counselor for breast feeding support—service is currently provided by an on-call employee and demand for the service has been high enough to warrant a regular, part-time position • 2.0 new peer specialists for DCDC/Harriman health clinic at the request of Mosaic Medical because the service provided by these peers is instrumental in the success of this project • 1.0 new behavioral health specialist to be co-located with Mosaic Bridges Program and • 1.o new behavioral health specialist for Redmond because of the increase in demand • 1.0 scheduler to increase productivity by moving scheduling away from the therapists Commissioner Baney asked if these are all grant-funded positions. Ms. Smilie explained that a combination of funding will be used for all the new positions and that no general funds are being requested for these positions. For example, OHP funding will be combined with the federal Garrett Lee Smith funding to increase the suicide prevention position. Commissioner DeBone noted that OHP is sizing the funding to the population, which is very different from a three-year grant for a specific project. In response to a question from Commissioner DeBone, Ms. Smilie explained that adding an epidemiologist position is an effort toward building foundational capabilities and that the position would be cost allocated across the entire department to provide support to all our programs. Epidemiology is the study of distribution and determinants of conditions of public health importance—chronic disease, health behaviors, suicide, social determinants—and is important to understanding what the needs are in a very targeted way. In response to a question from Commissioner Unger about the conceptual framework for governmental health services slide, Ms. Smilie explained that services within the box are mandated services and those above the line are "optional," or more robust services. She noted that there are some services within the box that the department could not provide without County general fund support. Handouts explaining where the department uses county general funds were distributed. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 7 of 9 Commissioner Baney asked why, with all the funds coming in from OHP, would we put general funds toward access. Ms. Smilie explained that OHP funds can be spent only for OHP members and that general funds are used for access to build the safety net and serve those who are not insured or underinsured. If someone is on Medicare and gets limited coverage, it was pointed out that the County serves those who are seniors and disabled populations as well. Medicare covers counseling in general but not intensive services that will keep the client out of the hospital. If the person ends up in the hospital, indigent funds are used. If the County can instead provide those intensive services, that can help avoid the high cost of hospital care. Commissioner Baney pointed out that there are policy choices in all of this that are being made or have been made for the County, versus decisions the County may want to make that might be different. She is okay leaving things as they are this year, but wants an opportunity to make choices for the County at some point. Mr. Anderson stated that the County is only able to fund 80% because of OHP funding, but the County wants to provide the same level of service to those not on OHP. This means a general fund contribution. Ms. Smilie noted that in Behavioral Health they don't always know the client mix, so this is the best guess based on past experience. They try to use others' funds first. What is ahead for Health is not totally known. They are clarifying roles, and learning in this new healthcare world who is to do what. Mr. Maier said that he is glad they are not asking for more general fund. He appreciated the budget as presented since it is easier to understand. Commissioner Unger added that he approves of them staying the course and using a longer view. Commissioner DeBone referred to the foundational capabilities, and where policy decisions come in. Health can advise on what to invest in and the best science to meet the needs of constituents. This was a very important conversation to walk them through. Ms. Smiles stated they have the resources to analyze most of the data, articulate the needs, and then figure out where it goes from there. Being no further discussion, the session ended at 5:15 p.m. Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 8 of 9 DATED this Day of `/ 2015 for the Deschutes County Board of Commissioners. a3464126----- Anthony DeBone, Chair Caert„.„_, Alan Unger, Vice Chair ATTEST: ' Tammy Baney, Corn�''ssioner Recording Secretary Minutes of Budget Meeting—Health Services Monday, May 26, 2015 Page 9 of 9 • Deschutes County Health Services Use of County General Funds DCHS provides a variety of services directly to individuals, such as WIC, behavioral health treatment and services for persons with intellectual and development disabilities. In addition to these direct services, DCHS provides health programs, protections and services that benefit residents county-wide. Disease monitoring, prevention and control, food and consumer safety, assuring clean indoor air and safe drinking water, providing education about healthy lifestyles and health risks, and responding rapidly to emerging threats and events are health services functions that touch the lives of each and every Deschutes County citizen. While the list of health services contributions to the health of the community is lengthy, when prevention efforts are successful, problems often do not arise; therefore, many citizens may not recognize the impact of these services. DCHS receives funding from a variety of state, federal, and grant sources. These resources combine to fund 89%of the total DCHS budget. While the diversity of funding allows DCHS to provide a wide array of programs, protections and services, many funding sources have restrictions regarding populations served, services provided, allowable program activities and some are just not sufficient to ensure programs reach citizens county-wide. County general funds allow DCHS to more comprehensively carry out the mission and values that are at the core of the Deschutes County commitment to residents. Communicable Disease Communicable disease prevention and control efforts promptly identify, investigate, prevent, and control communicable diseases and outbreaks that pose a threat to the health of the public. DCHS receives reports and works with providers to ensure proper follow-up and contact investigation necessary to prevent additional illnesses. DCHS communicable disease prevention and control activities include: disease tracking, epidemiological investigation, and control; HIV and Hepatitis C prevention; case management services for persons with HIV infection; immunizations and public health emergency preparedness. County general funds account for 38%of the communicable disease prevention and control budget. The role of county general funds in supporting communicable disease prevention and control includes: • Protecting the community and meeting standards: Without county general funds, DCHS would not have adequate staffing to respond to reportable diseases that are required by statute to be investigated within 24 hours or one working day of a report. Disease outbreaks require a significant amount of resource to ensure thorough investigations and effective interventions are applied quickly. Maintaining this capacity is essential to the health of the community. • Assuring capability to respond to emergencies: DCHS works in concert with community partners to respond to all types of hazards including large scale disease outbreaks, human caused emergencies, as well as natural disasters. County general fund support 1 ensures that a minimum level of emergency preparedness and response is available to lessen the health impacts of emergencies. Environmental Health • Environmental health services protect the public from illness and death caused by exposure to biological, chemical, and physical factors in the environment. DCHS environmental health activities include plan reviews, consultations, and inspections of regulated public facilities including restaurants, pools, water systems, temporary food services, child care centers, and tourist facilities. In addition,the environmental health staff assists with outbreak investigations and provides consultation to citizens on a variety of environmental health issues. County general funds account for 17%of the environmental health budget. The role of county general funds in supporting environmental health services includes: • Protecting the community and meeting standards: Environmental health staff conducted over 2,700 licensed facility inspections in 2014. Without county general funds, it is estimated that 400 fewer inspections could be conducted in a year, diminishing the ability to reach state inspection rate standards. Such a gap in service would put the community at greater risk of food and waterborne illness. Further,there would be less support to the community in the form of consultation and education, as well as outbreak investigation. Prevention and Health Promotion Many of the leading causes of disease, death, disability, and health care expenditures can be prevented or better managed. DCHS has a number of programs that prevent and/or manage chronic disease, promote healthy behaviors and create healthier community environments including the Living Well with Chronic Disease Self-Management Program,tobacco, substance abuse, dating violence, suicide prevention, reproductive health education and nurse home visiting. WIC is a nutrition education program that promotes optimal health for pregnant, breastfeeding and postpartum women, infants and children. County general funds account for 35% of the prevention and health promotion budget The role of county general funds in supporting prevention and health promotion includes: • Improving the reach of these efforts: The "reach" of DCHS prevention and health promotion programs would be substantially diminished without the support of county general funds. Since DCHS funding is primarily used for staffing,fewer individuals, schools, businesses, providers and other community-based organizations could be involved with prevent i on and h ea lth promotion efforts. Su pp ort for community-based coalitions and student groups would be lessened. The disease burden and costs for healthcare in Deschutes County could potentially grow over time without adequate prevention and health promotion programming. See two examples of economic and health impacts below. 2 0 • Impacting health and healthcare costs: o The WIC program has documented positive impacts on the health of women, infants and children over the course of several decades. The United States Department of Agriculture estimates that for every dollar spent on a pregnant woman in WIC, up to $3.13 is saved to Medicaid,just in the first 60 days after birth. This is due to documented reductions in preterm birth and low birth- weight among WIC participants. In addition,the program brings over$2.4M to Deschutes County in federal dollars spent at local grocery stores. A reduction in county general fund support would reduce services, as well as dollars spent in the county. o Without county general fund, the Living Well with Chronic Disease Program could not be delivered. This would result in fewer persons with chronic disease able to learn to manage their costly conditions. According to the American Diabetes Association, people with diagnosed diabetes incur average medical expenditures of about$13,700 per year, of which about $7,900 is attributed to diabetes. • Gaining federal match dollars: Maternal child health home visiting programs require local county general fund support to match a substantial amount of federal Medicaid dollars. Typically the match rate is 35/65, so for every county general fund dollar spent, the program receives $3. These funds allow the county to continue providing prenatal and postnatal prevention and health promotion services, as well as care coordination to • a high-risk population. Access to Clinical Preventive Services Access to clinical preventive services, such as immunizations, prenatal care and screening for preventable cancers is important in reducing preventable deaths and disability and for improving the health of the population. These services are aimed at preventing illness and/or detecting illness in early more treatable stages. A key role for the public health system is to ensure residents receive recommended cost-effective clinical preventive services. County general funds account for 30%of the budget for access to clinical preventive services. The role of county general funds in supporting access to clinical preventive services includes: • Leveraging funds and community collaborations for clinical preventive services: The role of public health in access to clinical preventive services is often to assure these services are provided, rather than providing them directly as a public health agency. County general funds support DCHS' ability to apply for and receive grants that advance this goal, such as the School Based Health Center and Sustainable Relationships grants. That funding supports partnerships with medical sponsors, school districts and the coordinated care organization that ensure access to clinical preventive services. • Increasing services delivered and organizations reached: DCHS funding is primarily used for staffing and supplies related to assuring clinical preventive services. Again, with reduced capacity, fewer individuals, daycares, schools and providers would be impacted and involved in these programs and services. The disease burden and costs for 3 healthcare in Deschutes County could potentially grow over time without adequate attention to clinical preventive services. Two examples are provided below. • Impacting health and healthcare costs: o Without county general fund support,there would be a diminished role in ensuring that children and adults receive recommended immunizations, putting the population at greater risk for vaccine preventable disease and death. The CDC estimates that in the U.S., vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years. o Clinical reproductive health services provide critically important services vital to the overall health of an individual. These include screening and early detection of a variety of diseases, including infectious diseases and cancers, as well as promoting planned, healthy pregnancies. Nationally, six in 10 women who receive publicly-funded reproductive health services, report this as their primary means of accessing the healthcare system, according to the Guttmacher Institute. The Institute also estimates that for every$1 invested in these services, taxpayers save more than $5. Healthcare Reform and Access to Behavioral Health Services As of January 2015, 95%of Oregon residents are reported to have healthcare coverage. However, for individuals who are not covered by the Oregon Health Plan (OHP)the ability to access comprehensive behavioral health treatment is limited. The 76% of Deschutes County residents who do not have OHP coverage can be faced with a restricted amount of covered 411) behavioral health services and no way to pay for the services they need. State general fund dollars provides some support for these services, but are insufficient to cover the level of need within the county. Intensive Behavioral Health Services for Adults, Children, and Families Intensive Community Services teams provide supports to the individual, families, and community partners in order to maintain individuals with their families and/or within their community. Individuals receiving these services are struggling with serious mental illness and complex clinical circumstances. Treatment requires a significant level of community-based services and coordination activities. County general funds account for 8%of the budget for Intensive Behavioral Health Services. • Outpatient Behavioral Health and Addiction Services for Adults, Children, and Families Outpatient Service teams provide services to individuals and families struggling with mental health and addiction challenges in a variety of settings including office, home, schools, and the community. Individuals receiving these services are often struggling with major depression, anxiety, significant trauma histories, and/or addiction. Children may be at risk for out-of-home placement or already be in a foster home setting. County general funds account for 4%of the budget for outpatient behavioral health and addiction services. The role of County general funds in supporting these individuals includes: 111 4 0 • Augmenting where Medicare and commercial insurance fall short: For example Medicare will cover traditional "talk therapy" but does not cover important services that maintain individuals within their community such as case management, consultation to community partners, skills training, and peer support services.This is significant considering that 44%of current seriously and persistently mentally ill clients have Medicare as their primary insurance. This percent increases to 68%for the senior population. For adults receiving addiction focused services, 21%have non-OHP coverage. • Providing support and technical assistance to families and community partners: The need for support for families and community partners is not limited to situations that involve current clients of DCHS. For example, a primary function of the seniors team is to provide information regarding aging and community resources to families, as well as consultation to community partners who are struggling to meet the needs of older adults. • Assuring access to services: In 2014,the DCHS Access Team provided 2,346 behavioral health assessments and 810 screenings. Of these 3,156, services 21%were delivered to individual with non-OHP coverage. In addition to assessments/screenings, the Access Team provides referrals to and education regarding community resources to individuals and community partners. Services for Persons with Intellectual and Developmental Disabilities(I/DD)and their Families The I/DD Team provides services to individuals and families struggling with intellectual and developmental disabilities. Services and supports focus on maximizing an individual's ability to • live as independently as possible within their community. Services promote health, safety, and quality of life. In addition to direct services,the I/DD Team is responsible for significant oversight of foster care services including recruiting, training, licensing, and monitoring of providers. The I/DD Team also manages a sub-contracted system of residential,transportation, and vocational/employment services. County general funds account for 13%of the budget for Intellectual and Developmental Disabilities Services. The role of county general funds in supporting I/DD individuals and systems includes: • Gaining federal match dollars: County general funds are used by the I/DD program primarily as matching funds in order to gain federal matching dollars for the program and services. o Program administration:for every$1 dollar of county general funds we gain $2 dollars in federal funds. o Client services: match rates vary between 35/65 and 30/70 which means for every$1 dollar of county general funds we gain about $3 dollars in federal funds. • Meeting increasing system and capacity demands: The State of Oregon is currently making changes to the state "K Plan" which impact workloads and system complexity. County general funds also allow DCHS to address service costs that are not fully funded by state dollars with the increasing client base and system demands. Early Learning Hub of Central Oregon The purpose of the Early Learning Hub (EL Hub) is to create an efficient and effective early learning system to ensure all children, prenatal through eight, receive the opportunities and 5 supports they need to be healthy and successful in school. From needs assessments, program evaluation and resource procurement through professional development and referrals, the EL Hub brings partners together to improve the lives of children using evidence-based and best practice programs. Thirteen programs are funded, supported and monitored for outcomes under the EL Hub. These include programs to improve: 1) early literacy; 2)the quality of child care available through professional development and implementation of higher standards; and 3) access to needed services. Certified in October 2014, the EL Hub has been successful in helping the community receive grants valued at$699,301 in the first year. Early Learning Division The Early Learning Division (EL Division) is part of Deschutes County Health Services. The staff for this division represents the interests of Deschutes County in the region's EL Hub and ensures resources are allocated in a manner that assures the needs of Deschutes County are met. The EL Division staff(2.0 FTE) provide leadership and backbone support for the EL Hub in partnership with Crook and Jefferson County staff liaisons. The EL Division staff also provides grant management for 28 performance-based contracted projects valued at over$1.1 million and work to leverage, secure and increase resources to address needs specific to Deschutes County. County general funds account for 34%of the Early Learning Division budget. The role of County general funds in supporting the early learning work includes: • Leveraging funds and community collaboration for early learning services: One of the roles of the Early Learning Division is to improve access and to assure needed services are provided. County general funds support the EL Division's ability to apply for and receive grants to address identified needs and disparities. While not the sole provider, the county funding supports the staffing capacity needed not only for resource development, but facilitation of partnerships to better leverage existing resources to meet shared needs among providers. • Resource allocation and capacity building to impact health and healthcare costs: The research is clear, investments in early childhood not only lead to improved performance in school, but to better health and a more prosperous and sustainable society. 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E § � 2 � �E o U 1 1 F I ( / § 0) ) \ ) \ ) a0L0. ■ Q Ta C.", 0 / ® ® . . 5 , , �co E Iiii !\ ' 2 ; 2. } }ƒ \ / \}k 3 ) w y , &mom a-' f' 2 `\mg N} �, = 0. ®7 f ®` r ) w , � El 2\\� [ \\ 7/ \ w223 al ai) , 22 «� ,— .— an 200@020 + 3 �} / / } }\ „ — o �/m / ` al nf \ \/ K ( £ £ £ K, / a. § 7 - ' '' ' co a g \ §) � » uf U- CO CC ts- In wi /} { \ g ii, AI- \ /f ) (To Wa ® — = § k \ I 00 .di } { $ { _ U, & ] ° ~ § - < =. 0 a ! a ■ ! .2• / e \ /\ CL / \j ) . ƒ 2E . 7 } } / § \\ ) \ ) k /- \ } / ƒ \ Early Learning Hub of Central Oregon (REV.11/14/14) ACRONYMS AND DEFINITIONS 40:40:20 Long range goal of the Governor and legislation is that by the year 2025: • 40% of OR population will have a Bachelors degree or higher • 40% will have a two year degree, and the remaining • 20%will posses their high school diploma or GED AAP American Academy of Pediatrics ABHA Accountable Behavioral Health Alliance (Now PacificSource in our region) ACES Adverse Childhood Experiences Study(impact of maltreatment on health, illness&death) AEPS Assessment, Evaluation, Programming System (for Infants and Children) AEYC Association for the Education of Young Children A&D/ATOD Alcohol and Drugs/Alcohol Tobacco and Other Drugs ALERT IIS Statewide Immunization Information System (OR Registry&Tracking System) AMH State of Oregon-DHS Addictions and Mental Health Division AOC Association of Oregon Counties ASQ-3 Ages and Stages Questionnaire -Version 3("General Screen")(PMD may use PEDS) ASQ-SE Ages and Stages Questionnaire - Social Emotional ("Specific Screen") BF Babies First or Breast Feeding • BH Behavioral Health BHAB Behavioral Health Advisory Board BHIP Behavioral Health Improvement Plan BHO Behavioral Health Organization BMI Body Mass Index (#calculated from person's wt. and ht.) BoC/BoCC Board of Commissioners/ Board of County Commissioners BT Better Together(Central Oregon's P-20 Regional Achievement Collaborative) C2C Cradle to Career (Better Together using Strive education improvement model) CACOON CAre COOrdinatioN (for children with complex health conditions) CBRS Child Behavior Rating Scale CC/ Crook. Co. Crook County or Child Care (depending on context) CCHD/ CCHS Crook County Health Department/ Health Services CCO Coordinated Care Organization (PacificSource in C.O.) managing Medicaid/OHP CCITSN Carolina Curriculum for Infants &Toddlers with Special Needs, 3rd Ed (B-36 mo.) CCPH Crook County Public Health CCPSN Carolina Curriculum for Preschoolers with Special Needs, 2nd Edition (24-60 mo.) CCR/ CCR&R Child Care Resources/ Child Care Resource and Referral (Neighborlmpact) CHW Community Health Worker (also called FRM, BHO, PWS, PSS) Acronyms&Definitions REV 11.14-14 Page 1 of 7 Early Learning Hub of Central Oregon (REV. 11/14/14) ACRONYMS AND DEFINITIONS CI Collective Impact and/or Continuous Improvement CLHO Coalition of Local Health Officials (Coalition of Oregon Counties Public Health) 411) C. 0./CO Central Oregon COCC Central Oregon Community College COECC Central Oregon Early Childhood Collaborative (Crook, Deschutes,Jefferson) COHB Central Oregon Health Board (now COHC Central Oregon Health Council COHIP Central Oregon Health Improvement Plan (also called RHIP) CSBS Communication and Symbolic Behavior Scales DC/ Des. Co. Deschutes County DCBH Deschutes County Behavioral Health (now called Deschutes Co. Health Services) DCHD/ DCHS Deschutes County Health Department/ Health Services (Public&Behavioral Health) DCPH Deschutes County Public Health DD Developmental Disabilities DHS Department of Human Services DIAL Developmental Indicators for the Assessment of Learning DIBELS Dynamic Indicators of Basic Early Literacy Skills DOC Declaration of Commitment EasyCBM K-8 Assessment System (reading and math) EB/ EBP Evidence Based/ Evidence Based Practices EC Early Childhood ECE Early Care and Education Providers ECERS Early Childhood Environment Rating Scale ECSE Early Childhood Special Education EHR Electronic Health Record (Health, Behavioral Health, Medical Care) EHS Early Head Start El - ECSE Early Intervention - Early Childhood Special Education EL Early Learning ELC Early Learning Council (appointed by Governor) ELCCO Education Leadership Council of Central Oregon (region's K-12 and ESD Superintendents,COCC and OSU-Cascades Presidents) ELD Early Learning Division (State Early Learning office/staff) ELDT Early Learning Development Team ELH/EL Hub Early Learning Hub Acronyms&Definitions REV 11-1414 Page 2 of 7 Early Learning Hub of Central Oregon (REV.11/14/14) ACRONYMS AND DEFINITIONS ELLC Early Learning Leadership Council (cross-sector governance for C 0's ELH) EPDS Edinburgh Postnatal Depression Scale ERDC Employment Related Day Care (program) ESD Education Services District FAN Family Access Network FERPA Family Educational Rights and Privacy Act FPL Federal Poverty Level FPSI Family Preservation and Support Initiative FRC Family Resource Center FRM Family Resource Manager(aka:CHW, BHO, PWS, PSS, FAN Advocate - serve diff. pop.) FSG Foundation Strategy Group (Collective Impact resource) FSM/ FSW Family Support Manager/ Family Support Worker HDESD High Desert Education Service District HB Healthy Beginnings (1.2 pt. screenings, adjunct to PCP health care) HECC Oregon's Higher Education Coordinating Commission HETF Health Equity Task Force 0 HF Healthy Families (Crook and Jefferson) HFHD Healthy Families of the High Desert(Deschutes Co. Healthy Families) HHS Health and Human Services HIPPA Health Insurance Portability and Accountability Act HS Head Start HS/ HF Healthy Start/ now called Healthy Families (Crook, Des.,Jeff.Co.,state) HT/ Ht. Height HV Home Visiting Hx History IEP Individual Education Plan IGA Inter-Governmental Agreement ITFI Infant-Toddler and Family Instrument JC/Jeff. Co. Jefferson County JCHD/JCHS Jefferson County Health Department/ Health Services JCPH Jefferson County Public Health KA Kindergarten Assessment KR Kindergarten Readiness or Kindergarten Ready Acronyms&Definitions REV 11-14-14 Page 3 of 7 Early Learning Hub of Central Oregon (REV. 11/14/14) ACRONYMS AND DEFINITIONS • KRA Kindergarten Readiness Assessment LAUNCH Linking Actions for Unmet Needs in Children's Health • MCH Maternal Child Health M-Chat Modified Checklist for Autism in Toddlers MCM Maternity Case Management MIECHV Maternal Infant Early Childhood Home Visiting NBQ New Baby Questionnaire (Eligibility screening tool used by Healthy Families program) NCCP National Center for Children in Poverty NI Neighborlmpact(Community Action Agency,Social services non-profit) NFP Nurse Family Partnership OCHIN Oregon Community Health Information Network (EHR for PH, BH, &Mosaic Med.) ODE Oregon Department of Education' OEIB Oregon Education Investment Board (0-20 years) OHA Oregon Health Authority OHPB Oregon Health Policy Board OPEC- HUB Oregon Parenting Education Collaborative (Central Oregon Parenting Ed. Hub) ORCHIDS Oregon Community Health Integrated Data System (HV Data System) OSU-Cascades Oregon State University - Cascades Branch P-3 Prenatal through 3rd Grade (OHA and OCF) or PK through 3 years (ODE) P-20 Prenatal through 20 years (OHA) or PK through 20 years(ODE) PAT Parents As Teachers PBIS Positive Behavior Intervention and Supports PCIT Parent Child Interactive Therapy PCP/ PCH Primary Care Provider/ Primary Care Home PCPCH Patient Centered Primary Care Home PEDS Parents Evaluation of Developmental Status (AAP "General Screen" used by drs ) PH Public Health PHAB Public Health Advisory Board PHS Physical Health Screening(Vision, weight/BMI, oral health, otoacoustic emissions) PHQ 2&9 Patient Health Questionnaire PiP Partners In Practice Grant (Professional Dev.for ECE Providers) PK/Pre-K Pre-Kindergarten • PK-3 Pre-Kindergarten through 3rd Grade Acronyms&Definitions REV 11-14-14 Page 4 of 7 _ _ Early Learning Hub of Central Oregon (REV.11/14/14) ACRONYMS AND DEFINITIONS PLC Professional Learning Community PRAMS Pregnancy Risk Assessment Monitoring System (data collection system on maternal attitudes and experiences prior,during&immediately after pregnancy -sample of OR women) PSI-SF Parenting Stress Inventory(Short Form) PSS Peer Support Specialist PWS Peer Wellness Specialist PYC Partnerships for Young Children QIM Quality Incentive Metric(Health Care Measure for CCO) QRIS Quality Rating Improvement System (for child care) RAC Regional Achievement Compact(metrics) &/or Collaborative (CO: Better Together) RFK Ready for Kindergarten RHIP Regional Health Improvement Plan (also called COHIP) R&R Roles & Responsibilities RTI Response To Intervention (K-12 social emotional, behavioral intervention) SA/S&A Screening and Assessment SBHC School Based Health Center • SBIRT Screening, Brief Intervention & Referral to Treatment (not valid for prenatal) SCERTS Social Communication, Emotional Regulation and Transactional Support SCHS Saint Charles Health Services SDQ Strengths and Difficulty Questionnaire SE/SEL Social Emotional Learning SLP Speech Language Pathologist SSID Secure Student ID(unique Identifier assigned to every OR public school student) STEP Systematic Training for Effective Parenting STRAP Strategic Plan STRIVE Collective Impact Framework/ Resource (Cradle to Career) TABS Temperament and Atypical Behavior Scale TANF Temporary Assistance to Needy Families TFC Together for Children TOC Theory of Change TPBA Trans-disciplinary Play-Based Assessment • TSG Teaching Strategies GOLD WEBCO Wellness & Education Board of Central Oregon WIC Women, Infants and Children (federal nutrition program) Acronyms&Definitions RCN 11-14-14 Page 5 of 7 Early Learning Hub of Central Oregon (REV. 11114/14) ACRONYMS AND DEFINITIONS WT/Wt. Weight YDC Youth Development Council (State Governance Structure for Early Learning) YDD Youth Development Division (State Early Learning staff) • I Acronyms&Definitions REV 11-14-14 Page 6 of 7 BUDGET COMMITTEE AGENDA Tuesday, May 26th, 2015 Program • Budget Tab/Page Black Butte Ranch • Motion to be seconded Svc District(Cont'd) • Budget Committee votes • Close budget meeting jaL�;J:��'1,,,.1 e.�rx:':. ,.�.,'; .'. „vr sce;:,F�„Mlsrdai"r war`.r4:i,,.e.:i ar s.i,:.r^"'„ i,4 �'&rw.f�ll�k$!,a"f•a+,;�.:.`, .:..Si""SF+;�1 kr�4L°z�usr.:�A.:Ru,ri�,�ta�"u';„^�tti?ru,$� uRiMY.�p¢�k, ;,y`Y}�!ht"Mrht{.},;�4;+ ',4Di P'(�Nk .t. 9:35 - 9:50 AM Deschutes County Extension and 4-H Service 7 / 260 District (Funds 720 & 721) (Budget Committee-Commissioners, Joe Cross, Gayle Hoagland & Katrina Van Dis) • Open public meeting and introductions • Budget discussion • Public comment • Motions to: 1) Approve Deschutes County Extension & 4-H Service District operating budget of$683,883 and set tax rate at $.0224 per $1,000 of assessed valuation (Fund 720) 2) Approve Deschutes County Extension & 4- H Service District Reserve budget of$460,500 (Fund 721) • Motions to be seconded • Budget Committee votes • Close budget meeting ��, " �it,uR.,�, 'rl8 ?; 4„ • � ,;% ,a� !.w n.,.u:s,l^r,, rICS!:;+.�x �;fr49§ul$I.d,�"t ,>„ 9:50 - 10:00 AM Break 10:00 AM - Noon Deschutes County • Open public meeting • Deschutes County Budget Proposal Noon - 1:00 PM Capital Improvement Program (Lunch Discussion) 8 / 275 1:00 - 1:30 PM Economic Development of Central Oregon (EDCO) 1:30 - 2:30 PM Other Funds Health Benefits Trust (Fund 675) 6 / 224 PERS Reserve (Fund 135) 6 / 229 Economic Development Fund (Fund 105) 6 / 218 Video Lottery (Fund 165) 6 / 214 General Fund (Fund 001-00 and 001-45); Special Request 14/414 6 / 206 2:30 - 2:45 PM Break 2:45 - 4:45 PM Health Services 5 / 182 • Introductions • Budget discussion; Special Requests 14/418 • Continue the Deschutes County budget meeting to Wednesday, May 27th , at 9:00 AM Page 2