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2020-186-Minutes for Meeting April 16,2020 Recorded 6/8/2020• '' D OF COMMISSIONERS 1300 NW Wall Street, Bend, Oregon (541) 388-6570 Recorded in Deschutes County GJ2020-186 Nancy Blankenship, County Clerk Commissioners' Journal 06/08/2020 1:58:59 PM �C\'J Fs C�</L� II' I I II I �I'II II I I I�I I I II I II I'I� ,,w 2020-186 FOR RECORDING STAMP ONLY k 1:30 PM THURSDAY,<_ $: BARNESA • ROOMS Present were Budget Committee Members Bill Anderson. Mike Maier (present via conference call). Bruce Barrett was absent/excused. Commissioners Phil Henderson, Patti Adair, and Anthony DeBone (present via conference call). Also present were Tom Anderson, County Administrator; Greg Munn, Chief Financial Officer; Andrea Perkins, Budget Analyst (present via conference call); and Sharon Keith, Board Executive Assistant. This meeting was audio and video recorded and con be accessed on the Public Meeting Portal of www.deschutes.org. CALL TO ORDER: Chair Patti Adair called the meeting to order at 1:32 p.m. This meeting is a preparation for this year's budget hearing. DISTRICT ATTORNEY OFFICE District Attorney John Hummel reported on the process on the search for a staffing consultant to review the department's staffing levels. The plan is to form a committee to interview the applicants. HR Director Kathleen Hinman was present via conference call and reviewed the process for the selection committee. Mr. Hummel stated he is not requesting any additional FTE in his initial proposed BOCC BUDGET MEETING APRIL 16, 2020 PAGE 1 OF 3 budget. The staffing study is expected to span over three months and any staffing recommendations would be presented this Fall, 2020. Mr. Hummel recommended a special budget meeting at that time to review the staffing level report. Commissioner DeBone and Mike Maier offered to participate on the selection committee. Mr. Hummel stated in the next budget cycle, the department is requesting an increase in the general fund for the Victims Advocate Program. It was determined that the Victim's Advocates grant does not cover the full cost of positions funded by the grant, and he is requesting that the General Fund make up the difference. HEALTH SERVICES DEPARTMENT: Health Services Business Officer Cheryl Smallman presented the department's budget committee briefing. Presentation is attached to the record. Deputy Director Janice Garceau presented information on the Community Mental Health Program and Behavioral Health Services. Ms. Smallman reviewed the requested allocations from the general fund for fiscal year 21. An increase in general fund is also requested for critical programs. A transfer of funds was also requested from OHP Mental Health reserves. The opioid response peer support specialist funding ends this year and the department requests the position be transferred from a limited duration to a permanent position. The department also requests an increase in Aid and Assist Services. Deputy Director Hillary Saraceno presented the services provided by Public Health. The ask in fiscal year 21 for general funds includes covering funding for a 3-month gap for drug free communites grant, continuation of substance abuse specialist, prevention and student success partnership, and environmental health fee increases. Ms. Smallman noted a request from the department is for a 1.0 FTE Administative Assistant. Ms. Smallman reviewed the department's COVID-19 financial impacts. A tentative date of April 30 was scheduled for another presentation by Health Services. The Committee feels the information was covered and there is no need for the second meeting. The budget hearing is scheduled for the last week of May. BOCC BUDGET MEETING APRIL 16, 2020 PAGE 2 OF 3 COVID19 Update: A brief discussion was going to be held regarding budget impacts of the Deschutes County departments but will be postponed for another meeting. Being no further items to come before the Budget Committee, the meeting was adjourned at 4:42 p.m. DATED this Day of� Commissioners F 2020 for the Deschutes County Board of i&r� -- 1"A( ATTI ADAIR, CHAIR ANTHONY DEBONE, VICE CHAIR 'b�3a BOCC BUDGET MEETING APRIL 16, 2020 PAGE 3 OF 3 Deschutes County Board of Commissioners 1300 NW Wall St, Bend, OR 97703 (541) 388-6570 - www.deschutes.orZ BUDGET COMMITTEE AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS 1:00 PM, THURSDAY, APRIL 16, 2020 Barnes Sawyer Rooms - Deschutes Services Center - 1300 NW Wall Street - Bend I. Budget Committee 1. District Attorney Staffing Analysis Update & Victims Assistance Update 2. Health Services FY21 Budget Preview 3. Next Meeting, Wrap Up, and Other Topics To watch this meeting on line, go to: www.deschutes.org/meetings Please note that the video will not show up until recording begins. You can also view past meetings on video by selecting the date shown on the website calendar. Deschutes County encourages persons with disabilities to participate in all programs and activities. This event/location is accessible to people with disabilities. If you need accommodations to make participation possible, please call (541) 617-4747. FUTURE MEETINGS: Additional meeting dates available at www.deschutes.org/meetingcalendar (Please note: Meeting dates and times are subject to change. All meetings take place in the Board of Commissioners' meeting rooms at 1300 NW Wall St., Bend, unless otherwise indicated. If you have questions regarding a meeting, please call 388-6S72.) Board of Commissioners Budget Committee Agenda Thursday, April 16, 2020 Page 1 of 1 4/15/2020 4/15/2020 DCHS I Behavioral Health Services Promoting and protecting the health and safety of our community How is County General Fund Applied? 3 4/15/2020 FY 20 Requested PROGRAM AREA Adopted CGF Changes to FY 21 CGF Access Services $ 111,113 $ - Comprehensive Care for Youth & Families 203,563 + 319,319 Crisis Services 547,117 - Outpatient Complex Care 124,407 - Intensive Adult Services 329,593 + 319,319 Intellectual & Developmental Disabilities (I/DD) 418,314 - 418,314 Behavioral Health Admin - - TOTAL $ 1,734,107 + $ 220,324 .� I/DD state funding increased every biennium. Local Match participation option, calculated after June 301h annually. I/DD does not require additional CGF in FY21 to participate in Local Match. Expend > #� ofKj[lxpend State Base Excessvious Rate ($) Encountersar's ch ($) 5 4/15/2020 • 13 year -old: referred to IYS after being hospitalized for a suicide attempt • Needs: multifaceted intellectual/developmental, physical, mental health and substance abuse needs; family extremely limited financially, including lack of transportation; mother has a chronic disease; youth not able to attend school because of aggression; limited placement options �r • Services: Fidelity Wraparound; coordination with over 9 team members; intensive home based therapy services • Uncovered Costs: employment, travel and parent supports " not covered • Outcome: returned to school in supportive placement; parents learned techniques for safety at home and school, 01, family referred to assistance with stable employment; t additional support for mother's health condition Ending Working Capital: All EH Funds 18 ($millions) 16 14 12 10 8 6 4 2 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 r, Behavioral Health Acute Services Reserve ■ Behavioral Health OI-IP Reserve ib Behavioral Health Operations M 7 4/15/2020 mmr#��� gIIg�rffvmvmq -M Public Health is primarily focused on the population, NOT the individual eX� b• 115 4/15/2020 DCHS I Public Health Services Promoting and protecting the health and safety of our community PH 101: FY20 Snapshot of PH $1 1 .9M Putillt eelth F\'19 Budget 33% 9f. of budget supported by General Funtls 65 ETE Fulfilled by 75 Public Health employees "Neafrn.o+e Is "t.1 ra n!F of - u:67Ic h—srh is vitcW rc> c11 of afJ JU�e re,z;r C. E•:er etc Ko,?p, F.,.'er lJS Sur geo" General `� To Promote and Ptotecithe Heea/th an Safety of Our Community `vvflat. We fro P,,t,1 c health prom"t's, a«d protects the h.,a th of eve,yo,ie who lives - ar visits Deschutes County by: P revent:r`g. i, v stegatmliK all, p,-orect'n�9 people fron- d:seasas to .", sure our food -,,,d -at., 's e safe p,-omoting health and counterll:g the harnirul ti,l3 ct of chro+llc disease anlj init: r-ies Pre; arng for and responding co natural as Itt;man -a- _ed en-�ergen Cies and emerging haaltn threats El1ssl+- g acre - to t r; \i ntive I 'Ith -:.e rvice Local FUblic €- lrh DEAegatiotls of Authority ity - LPHf::� (OAK 335-67.7 -OS30) Laccrl Pub#.:- H—fth Authority: Coalllty - BOCC • LocW Pubfic f-r'C'C.khy Aglfl,Cy: Desc>.iuteS COUIlt'y P,,bllC H+ GICI'i DiVis-on 1s authorized by the BaCC to Cerfon» PLILIic Health and :-expo n s±bilitses an hehatf of the --ty (Puh91c HcalV", is a envision o€ Healeh Sere rCes) =oeert Public i-,'eat th Administratorr DC: H5 Director, authorized by the B—CC to ,sV r �= the =_oral Plshlic Heaizh Agency Re spolisihil my ofthe Local Pr..lblic Health Authoa ivy (BOCC) . Receive and robes gate arl =eschutea {_aunty re;s—ts c.f co+,r 1-riu nicable 11 4/15/2020 ®Who: Underserved, vulnerable senior citizens • Need: —70% of outbreaks occurring in Long Term Care Facilities (LTCF) • Services: 3 Years implementing infection control measures & training • COVID-19: In addition to daily updates, ensuring all LTCF facilities: • receive and follow all OHA COVID-19 restrictions & use Toolkit • PH nurse doing regular phone & site consults • advocating & providing PPE as able Oregon"s Investment in Public Health $86.20 per capita $39.99 $27.02 per capita per capita � ❑ i Oregon Washington Idaho Trust JorAmerica's Health 13 4/15/2020 FY21 Cost Savings - $148,000 (reduction of 1.1 FTE non -limited duration) 111111 : :�p �1��r it 9 f R � W b,•,i�i 11 1 ZRA =0 11111111111111 q111111111111 Vaping Usage in Deschutes County III` Graders 2016 M 2018 State 29.4 2 0.8 19.2 SEEN 9.4 7.3 %w m 5 8 g S..,­ 2018 Oregon 51.&nt Wd—, Surrey UK, PH PD #1 Funding to cover 3-Month Gap NEED: Grant funding ends Sept 2020 and restarts Jan. 2021 IMPACT: Layoff -rehire -retrain, no school start OUTCOME: To reduce substance use amongst youth in Bend area. AMOUNT: $31,141 FUNDING SOURCE: County General Fund k, IF 15 4/15/2020 PH .D Prevention & Youth Health Partnership What is the data telling us? 1 in 3 (8th & 11Th graders) feel sad or hopeless One of highest rates of youth suicides in OR Spike in use of e-cigarettes, vape pens Increased use of social media leading to higher psychological distress, depression , etc. High alcohol use - still #1 Bullying continues to be issue We believe we can do better - 2 Year Conversation - School administrators, counselors, teachers - More recently: La Pine youth & parents Approve 3-year Pilot Funding NEED: Long-term gap in prevention & El services for youth "in -the -middle" IMPACT: Reach more youth with best practices & strategies = better results OUTCOME: Helping youth to find success and to become healthy adults AMOUNT MULTI -YEAR REQUEST: Year 1: $170,624 (start up) Net: 3.4 FTE Year 2: +$88K Year 3: +$12K FUNDING SOURCE: County General Fund cc, PH PD #4 Environmental Health Servicess FA0LIflES iNSPECTE BY YEAR" & FTE Approve Fee Increase 2000 1,946 20 NEED: To maintain current service levels 1950 18 1900 1,852 16 IMPACT: Facility to FTE ratio already too high 1850 1,777 14 1800 1,733 OUTCOME: To keep food and water safe 1,739 12 1750 1,687 10 AMOUNT: 3% +variable targeted increase 1700 1,632 8 1650 6 6 5 5 5 5 5.5 5.5 6 6 FUNDING SOURCE: Fee -for -Service 1600 1550 4 1500 2 1450 0 2013 2014 2015 2016 2017 2018 2019 17 4/15/2020 Support Behavioral and Public Health to provide the highest quality of service to the Deschutes County community. I L S 11 1 1 lip I Promoting and protecting the health and safety of our community 19 4/15/2020 Service Area Title FTE Total Cost [GF Requested BHPO#2 Increase [6FtnBehavioral Health 0.0 $220'324 $ 220,324 BHPD#3 Approve OHPMental Health Reserve 0.0 $2,379,865 $ ' TraDsfer 8H PID #4 Continue 1.0 FTE Op|oid Peer 1.0 $ 57,945 $ ' Support Specialist* BH PD #5 Increase 0.1 FTE for Aid &Assist 0.1 $8.245 $ - TOTAL 1'1 $3'094'693 $220'324 `n 21 4/15/2020 23 SafeProtect the community through planning, preparedness, and delivery of coordinated services. Healthy People: Enhance and protect the health and well-being of communities and their residents. Economic ic Vitality: Promote policies and actions that sustain and stimulate economic vitality. e} Service Delivery: Provide solution -oriented service that is cost-effective and efficient. PERFORMANCE OVERTIME... Safe Co mm ufir. (:. i ` zfffs Objective., Reduce crit'noe and reddivism through preven'don, inten,,iention, supervision and f;;' N1 f o rc e m t,,' t. Ensure that 20% of individuals served by the Forensic Diversion Program will experience a reduction in recidivism. Healthy People Objective: Promote ell -being through behavioral health and community support See Behavioral Health Oregon Health Plan clients within state timelines as specified in the following categories: Emergent/Urgent within 24-48 hours; Routine within 2 weeks. => Offer a behavioral health appointment that falls within the seven (7) day period post -discharge to g4% 95% 93% 73% 92% 82.7% of individuals discharged from a hospital. _ _.__ —_ Public Health FY19 Budget of budget supported by General Funds Fulfilled by 75 Public Health employees "Healthcare is vital to all of us some of the time, but public health is vital to all of us all of the time." -C. Everett KOOp, Former US Surgeon General George Conway, MD, MPH Deputy Public Health Hillary Saraceno, MS To Promote and Protect the Health and Safety of Our Community Public health promotes and protects the health of everyone who lives in or visits Deschutes County by: • Preventing, investigating and protecting people from diseases • Making sure our food and water are safe • Promoting health and countering the harmful impact of chronic disease and injuries ® Preparing for and responding to natural or human caused emergencies and emerging health threats • Ensuring equitable access to preventive health services • Local Public Health Authority: County Commissioners - BoCC • Local Public Healthy Agency: Deschutes County Public Health Division is authorized by the BoCC to perform Public Health requirements and responsibilities on behalf of the county (Public Health is a division of Health Services) • Local Public Health Administrator: DCHS Director, authorized by the BoCC to oversee the Local Public Health Agency • Receive and investigate all Deschutes County reports of communicable diseases, outbreaks or epidemics • Issue or petition for isolation and quarantine orders • Review immunization records and issue school exclusion orders • Assure access to family planning, birth control services, and immunizations • Perform duties and activities related to enforcing the Indoor Clean Air Act • Licensure and inspections of tourist accommodations, pools and spas, restaurants, mobile food units, and some public water systems • Enforcement of public health laws under ORS 431.150 • Assure meeting of PH service requirements in ORS 431.413 (PH Modernization minimum required programs and capabilities) Opioid Peer Provides: • Support to Syringe Exchange Program (2x/wk) outreach and engagement with non -client, IV/ Opioid drug users to connect to treatment • Narcan administration training and distribution to internal teams • Peer support services for DCBH clients identified with SLID issues o Accompanying DCBH clients to 12-Step meetings as away to connect them to community supports o Phone outreach to DCBH clients who have fallen off radar to try and reengage them in support services • David has worked with 45 open DCBH clients for a total of 320 visits Since hire date in September 2019, Opioid Peer has: • Provided 80 Narcan administration trainings, among various community programs/agencies, to a total of 894 participants, including: o Mosaic Medical o DC Syringe Exchange Program o Prevention Services (Sisters/La Pine) o All local homeless shelters, Family Kitchen for homeless, Local Emergency Respite/Shelters o Central Oregon Community College o Sisters Pharmacy @ Rays Market o Recovery Housing/Sober Living (Bend, Redmond, Prineville) o Local high school and elementary school staff o Local community security company o Central Oregon Intergovernmental Council (Tri County) o All local AOD Treatment programs (Bend, Redmond, Prineville) • David has distributed 840 boxes (1680 doses) of Narcan to programs and individuals 25 Syringe Exchange Program (SEP)recipients have reported recovering from an overdose using Narcan distributed by the Peer Last month one young male, who was present at Syringe Exchange Program, experienced overdose event when the Peer was present. Individual was unresponsive. The Peer and our SEP Coordinator administered 3 doses of Narcan and individual's life was saved (taken to hospital by EMT's). Email from Tom McCutcheon, Compass Security and Investigation: "Hello David_I just wanted to reach out and exchange information. I also wanted to thank you for helping Compass become the first Security Company in Central Oregon to carry Narcan. I will reach out to you in the next couple of months and try to schedule a training for the rest of our staff. " Year 1: Substance Abuse Prevention Specialist The following are some of the successes from this past year that will be continued and built up on in FY 2021: La Pine: • Developed a La Pine prevention work group made up of 10 stakeholders (La Pine Parks and Recreation District, Sheriff's Office -School Resource Officer (SRO), La Pine Community Health Center, Deschutes Co. Behavioral Health, La Pine Elementary, Middle and High Schools, Faith Community Member, La Pine High School Student, and Deschutes Co Juvenile Community Justice) who convened on five separate occasions to design a youth marijuana use assessment and began data collection with three community volunteers assisting in qualitative data collection (focus groups and community stakeholder interviews). • Began analyzing quantitative data from the Oregon Student Wellness Survey, law enforcement, healthcare, and substance abuse treatment to create a priority action list to prevent and reduce La Pine youth marijuana use. • Conducted two focus groups (11 people total), one with parents and one with "concerned citizens", as well as four stakeholder interviews, as part of the underage marijuana use assessment. • Coordinated the alternative to out -of -school suspension pilot project and provided technical assistance to school staff. Pilot results will be available fall 2020 and used to improve project implementation and outcomes. Sisters: • Developed a Sisters prevention work group made up of 8 stakeholders (Age Friendly Sisters Country, Deschutes Co Juvenile Community Justice, Sheriffs Office -SRO, Sisters Park and Recreation District, Sisters School District (SSD), Sisters High School Student, and multiple Parents) who convened on two separate occasions to design a youth marijuana use assessment and began data collection with three community volunteers assisting in qualitative data collection (community stakeholder interviews). • Recruited a high school student as an intern to help with youth focus groups and engaging youth. • Advocated for participation in the Oregon Student Health Survey to SSD's superintendent. Received confirmation of SSD participation in the fall 2020 survey. Sisters has not participated in the state survey since 2012. Data is critical for establishing trends and prioritizing community needs. • Began analyzing quantitative data from law enforcement, healthcare, and substance abuse treatment to create a priority action list to prevent and reduce Sisters youth marijuana use. • Worked with Sisters Middle and High School's staff (principals and counselors) to explore an alternative to out of school suspension model. Will be presenting a formal proposal in April. This will include facilitating a discussion to identify a model that is feasible, sustainable, and meets the needs of the school community. Year 2• Request to continue for the second year to do the following The 1.0 FTE Community Health Prevention Specialist would allow the Prevention team to continue to support substance abuse prevention efforts and coordination in the communities of La Pine and Sisters, with emphasis on preventing and reducing youth use of marijuana, reaching an estimated 1,600 youth aged 10 to 20 years. Work to be prioritized in FY21 includes: Identify vaping prevention and education strategies in each community, specifically for parents. Provide technical assistance to schools to support alternatives to out of school suspension for alcohol, tobacco, and drug policy violations. Use the results of the underage marijuana assessment to create a youth -centered substance abuse prevention action plan to implement with each community. Funding Source: In FY 2020, the Deschutes County Budget Committee approved appropriation of $115,000 from marijuana tax revenue to support this work. As these funds may no longer be available, it is being requested to continue funding it with County General Funds in the amount of $121,085 in FY 2021 to begin developing and implementing prevention strategies based on the first assessment findings and community priorities. 01E5 G Certified Community Behavioral Health Clinic PY G Demonstration Project CLIENT VISITS EUVETERANS SERVED._ C ' D • _e INCREASE INCREASE MEDIANINCREASE .:.. f ,TE . ITTOBACCOSCREENING 1� NEW CLIENTS.��� SAVINGS (9 COUNSELING & MEDICATION r 8 $1*07 ,• :.. it 3704 PER MONTH INCREASE MILLION REFERRALS SCREENING TYPES 'DEPRESSION :SUICIDE RISK BMI SCREEN ALCOHOL &TOBACCO 62%CHILDREN BRIDGESPHQ-9 DEPRESSION SCORING 31% PROGRAM POINT • SHAPED POPULATION OF URGENT ~ + HIGH PISK CLIENTS S Mel, ommam 3 . 1 4 * AMERICAN MEDICAL ASSOCIATION ** STATE OF OBESITY STUDY Lj tA 0 0 (uVo 'tj K ce- 4j 4j Y 4J C 4 > m u C_ . 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