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HomeMy WebLinkAboutFY24 Annual ReportANNUAL REPORT 2024 2 Table of Contents Behavioral Health Continuum ................................ Behavioral Health Key Metrics................................ Behavioral Health Administration.......................... Access and Integration............................................ Comprehensive Care for Youth and Families....... Crisis Program.......................................................... Intellectual and Developmental Disabilities......... Intensive Adult.......................................................... Outpatient Complex Care....................................... Public Health Key Metrics....................................... Public Health Administration.................................. Clinical and Family Services.................................... Communicable Diseases, STD/HIV & Immunization Program............................................ Prevention and Health Promotion......................... Environmental Health.............................................. Emergency Preparedness & COVID-19 Recovery Administrative Services............................................. Director's Office........................................................ A letter from the Director.............................................. Strategic Plan................................................................... Organizational Chart....................................................... Health Services locations............................................... Behavioral Health............................................................ Public Health................................................................... Administrative Services................................................. Personnel Highlights........................................................ Financial Highlights.......................................................... 3 4 5 6 7 8 10 11 14 17 20 23 26 29 33 3435 38 41 44 47 50 53 54 57 59 60 Brightest of all were our colleagues. What we learned together about our own resilience as we navigated a once-in-a-generation global crisis. What we developed in terms of our capacity to adapt rapidly and work across silos. The new staff and programs we brought on during a time of rapid change and enormous pressure. All are evidence of the willingness, skill and strength of our workforce. With this, we head into the coming year. Population growth as well as Public and Behavioral Health investments expanded services, placing additional pressures on space and administrative infrastructure. Already, we are looking to innovative technologies and strategic planning to address these needs. Behavioral Health access to care and achievement of certain metrics suffered during the pandemic period and workforce crisis. As we recover, we return to focused efforts to improve outcomes for those we serve, and continue to adapt services to maximize co-location with primary care and interventions for those in most acute need. We hope that investments in mobile crisis, housing and workforce, as well as legislative advocacy to reduce administrative burden and free staff to do the work that matters, will make a meaningful difference this year. Public Health, which bore much of the load of the pandemic emergency while experiencing its own workforce crisis, is coming out of the COVID-19 crisis into a landscape of Public Health emergencies related to climate, disease outbreaks, increasing requirements to address social determinants of health and the long-term community health impacts due to lack of preventative health screening and decrease in childhood vaccination coverage. A current risk is the historic phenomenon of funds for Public health evaporating as emergencies end without plans to sustain necessary ongoing preparedness and protections. Innovations such as Public Health Modernization and enhanced reimbursement for Public Health clinical services offer opportunities to address this phenomenon. And, we will need to continue to advocate for key investment in Public Health foundational programs and capacities. We see tough and rewarding challenges ahead. We feel hope as we observe the focus on the needs of those we serve as well as the welfare of our staff. And we are bolstered by what we learned in the last years and the prospect of recovery on the horizon. Letter From the Director 3 This year saw the emergence of Health Services from a global pandemic emergency into a new reality marked by challenges of recovery, growth and acuity of need as well as unique opportunities for innovation and investment. In the forefront were unprecedented workforce shortages, health inequities more fully revealed by emergencies, and growing need among our most acute service populations —individuals experiencing mental illness, addiction, chronic disease and houselessness. Bright spots were historic investments in Behavioral Health, successful efforts to recruit and retain staff, Public Health Modernization; and the profound partnerships within our Department, with other County Departments, and with community health and service providers forged in the effort to protect our community from the worst impacts of the COVID-19 pandemic. Improve Outcomes Increase Sustainability Demonstrate meaningful impact for individuals & community Enhance Public Trust and Resilience Increase access to culturally appropriate programs and services. Empower people to thrive in healthy, supportive environments. Advance health equity Ensure a culture of community & clients first Establish a culture of care, purpose & shared accountability Develop & support a diverse, excellent workforce Assure sustainable funding and efficient practices Health Services FY22 Strategic Plan Values: Mission: Vision: To promote and protect the health and safety of our community. Deschutes County Health Services provides leadership, programs, services, education, and protections to improve the health of individuals, families and communities so people enjoy longer and healthier lives. Advocacy Collaboration Equity & Inclusion Excellence Healthy Workplace Leadership Professionalism Stewardship Using public resources effectively and efficiently. Supporting individual and community health by ensuring access to health care for all. Building relationships that reflect growth, authenticity, and mutual respect. Demonstrating awareness and respect for the diversity in our workplace and community. Committing to use the best data, science, and information available to make decisions that result in high quality services. Promoting respectful interactions, healthy lifestyles, emotional and physical safety in work environments (trauma-informed practices). Advancing a shared vision with inspiration that guides our work at all levels of the organization and in the community. Conducting oneself with the highest level of personal integrity, conduct and accountability. Goals: Objectives: 4 Deschutes County Health Services Organizational Chart 5 Deschutes County Health Services Locations Main Clinic 2577 NE Courtney Drive Bend OR 97701 Wall Street Services 13400 NW Wall St. Bend OR 97703 Downtown Clinic 1128 NW Harriman St. Bend OR 97703 North County HealthServices 406 West Antler Avenue Redmond OR 97756 South County Health Services 51340 Highway 97 South La Pine OR 97739 Stabilization Center 63311 NE Jamison St. Bend OR Mike Maier Building 1130 NW Harriman St. Bend OR 97703 Williamson Building 1550 NE Williamson Blvd. Bend OR 97701 Kids Center 1375 NW Kingston Ave. Bend OR 97703 Becky Johnson Community Center 412 SW 8th St. Redmond OR 97756 7 School Based Health Centers in our Community: Bend High School, Sisters, Ensworth Elementary, Redmond High School, Lynch Elementary, La Pine and Gilchrist Coming June/July 2023 6 North County Health Services 236 NW Kingwood Redmond, OR 97756 North County Health Services 244 NW Kingwood Redmond, OR 97756 Behavioral Health Behavioral Health Administration Access and Integration Comprehensive Care for Youth and Families Crisis Intellectual and Developmental Disabilities Intensive Adult Services Outpatient Complex Care 7 8 9 Behavioral Health Key Metrics 10 Behavioral Health Administration and CCBHC Expand array of addictions and mental health services Integrate primary care screening and coordination Receive enhanced Medicaid payment rate based on costs Intended Benefits for Community Mental Health 24,591 49 % Total # of telehealth visits in 2021 This program represents the administrative and managerial functions for Behavioral Health, as well as contracts and the budgetary logistics of pass- through arrangements. Primary Contact: Holly Harris, Deputy Director for Behavioral Health Website: https://www.deschutes.org/health/page/b ehavioral-health Reduced mortality and suicide rates Reduced substance abuse Reduced hospitalization Reduced incarceration Reduced homelessness Broad Health Goals: Saving Lives Focus on reducing costly, negative health outcomes upstream Increase coordination with primary care Conduct routine BMI screenings- hypertension, diabetes, etc. Enhance systems to stabilize individuals outside of emergency department and hospital through Peers, Stabilization Services, and Psychiatry Healthcare Integration Focus 11 FY23 Highlights & Accomplishments DCHS was one of six counties to pilot a rapid engagement model to increase behavioral health access and reduce barriers for our service population. Expansion of Redmond clinic into a new location with enhanced primary care and Drop services is underway. Navigated a historic workforce crisis by creating hiring and retention bonuses with a stay agreement for 232 staff through HB4004 funding. FY24 Challenges & Opportunities Continued workforce retention and hiring challenges. Cost of living and housing challenges for new and existing employees. Rising houselessness for our service population. 12 Budget Information Project Code: HSBHGEN FY23 Funding Changes No Changes. FY24 Program Changes No Changes FTE Changes and Detail 13 Behavioral Health Access and Integration This program area, consisting of the Access Team and the Clinical Administrative Support Team, provide intake, referral, care coordination, and numerous administrative duties that support clinical work, such as CCBHC Coordination, Rapid Engagement project management, and interface with key staff training and technology support activities. Primary Contact: Amber Clegg, Program Manager Website: https://www.deschutes.org/health/page/how-access-services Access Team Main entry point for most of Deschutes County's Behavioral Health programs. This team provides screening, assessment, case management, and referrals for mental health and substance use disorder services. Clinical Administrative Support Team Provides essential role in supporting clinical work by managing and running reports, assisting with workgroups, organizing projects, overseeing fiscal processes, and tracking schedules. 14 Rapid Engagement Pilot Program FY23 Highlights & Accomplishments The Access team helped launch the pilot of the Rapid Engagement model, which strives to engage clients in a more meaningful way while reducing administrative burden for staff. The addition of a Bilingual Access team case manager has improved care coordination for individuals and families in our county, in particular to black, indigenous, and people of color (BIPOC) communities and other underserved populations. Formalizing the Clinical Administrative Support Supervisor position has improved consistency and accountability between administrative support staff and clinical teams. FY24 Challenges & Opportunities Severe staffing shortages affected the Access team's ability to meet the Access to Care timelines of 7 days consistently in 2022. Although the team is fully staffed now, there will be an ongoing focus on staff retention in FY24. Ongoing adjustments will need to be made to the Rapid Engagement process to ensure it is an effective engagement method for clients and staff. Anticipated changes to federal and state rules in 2023 related to outpatient substance use disorder services will likely change the assessment and intake process again. 15 Budget Information Project Code: HSACCESS & HSINTEGRAT FY23 Funding Changes No changes. FY24 Program Changes No changes. FTE Changes and Detail 16 Child, Family, & Young Adult Outpatient (CFYA) An outpatient treatment program that specializes in the care and treatment for children through young adults. School Based Services H ealthcare clinics that offer a range of medical and mental health services located in a school. DCHS operates seven School-Based Health Centers in partnership with La Pine Community Health, St. Charles Health System and Mosaic Medical. Early Assessment and Support Alliance (EASA) The EASA team offers support services to individuals ages 12-27, who suffer from the kind of psychosis that would lead to schizophrenia if left untreated. Wraparound (WRAP) Community-based support for children and youth whose mental health needs have not been met through usual services, and their families. Young Adults in Transition (YAT) The YAT team offers support and services for ages 14-24 who suffer from mental health and/or behavioral challenges. Transitional treatment and intervention helps young adults to graduate school, live a healthy, positive life and be a confident and beneficial member of our community. The Drop The Drop serves young adults ages 14 to 27. Offering Peer Support, guest speakers, games, discussion and socialization, and life skills introductions. Behavioral Health Comprehensive Care for Youth and Families Comprehensive Care for Youth and Families provides specialty mental health care for individuals ages 0-25 and their families through an array of integrated, intensive outpatient care teams; EASA, YAT, Wraparound, School Based Health Centers, and Child, Family & Young Adult Outpatient. Primary Contact: Shannon Brister-Raugust, Program Manager Website: https://www.deschutes.org/health/page/comprehensive-care-youth- and-families 415 51 % from 2021 Unique Client Visits at the DROP Center 17 FY23 Highlights & Accomplishments Awarded EASA Stimulus Grant, establishing shelter care contracts with local resources to safely divert hospitalization through housing stability and intensive care coordination for young people experiencing their first episode of psychosis. Established a per member per month Wraparound payment structure, that has increased family access to care, reduced administrative barriers and generated financial stability . In partnership with Central Oregon Community College, developed the first ever Peer Support Training in Central Oregon. First team within the county to have a certified Peer Support Specialist Supervisor. Formally extended Intensive Youth Services in Sisters, Redmond and LaPine by adding care coordination and case management services. FY24 Challenges & Opportunities Partnership with local shelters to continue to explore contracting for shelter care beds, through a collaborative contract that support stable housing and intensive treatment/coordination. Expansion of IYS services in Redmond by adding a Drop in Center as part of the North County Campus. Offer increased substance use outreach, engagement and treatment through the Behavioral Health Resource Network; when appropriate decriminalizing substance related offenses. 18 16 Budget Information Project Code: HSINTYOUTH FY23 Funding Changes Wraparound is now a per member per month program that is bringing in additional revenue. Revenue will be used to fund and sustain staff hired and services developed as part of the System of Care Expansion Grant once it sunsets in 2024. FY24 Program Changes In addition to an increase in FTE , the team will continue its efforts to expand children's services in Sisters, Redmond and LaPine. The first aspect of this is relocating a portion of the team to Redmond in the summer of 2023. This will involve reassigning a supervisor and two staff, permanently allowing us to fully staff a Drop in Center in Redmond and to have onsite IYS services in North County for the first time. FTE Changes and Detail 19 Behavioral Health Crisis Program This program provides 24/7 crisis services including face-to-face evaluations in the community and clinic, as well as diverts individuals with a serious and persistent mental illness (SPMI) from the hospital and criminal justice system when appropriate. Primary Contact: Adam Goggins, Interim Program Manager Website: https://www.deschutes.org/health/page/crisis-services 24-Hour Crisis Phone Line Available 24/7 to anyone who is experiencing a crisis/needs crisis support. Walk-in Crisis Services and Stabilization Services Provides immediate access to individuals experiencing a crisis. Brief stabilization open to people of all ages. 24/7 Mobile Crisis Assessment Team (MCAT) A t eam that provides crisis intervention services out in the community. Co-responder Program A c linician and officer respond together to mental health related calls. Civil Commitment Investigations A Certified Civil Commitment Investigator monitors individuals placed on a two physician involuntary hold and all civil commitments within Deschutes County. Case Management Liaises with the hospital and Brooks Respite for discharge planning to help clients with basic needs and community resources. Peer Support Peer Support Specialists are individuals with life experience of mental health and/or substance use disorders who are in recovery. They offer support and encouragement to individuals struggling with a mental health condition. Forensic Diversion Program A team of Peer Support Specialists and Case Managers dedicated to supporting individuals with a serious and persistent mental illness (SPMI) who are frequently having contact with law enforcement and the criminal justice system. 503 14 % from 2021 Number of people dropped off by Law Enforcement 453 18 % from 2021 Number of Emergency Department (ED) diversions 1901 5% from 2021 Number of people served through crisis walk-in 20 FY23 Highlights & Accomplishments Received additional funding from OHA and the City of Bend to hire several additional staff to create a non-law enforcement (LE) response component to the MCAT Team. Received additional funding as part of the Behavioral Health Resource Network (BHRN) grant and added 4 Peer Support Specialists to operations at the Deschutes County Stabilization Clinic (DCSC) to support the afterhours work of the BHRN. DCSC was re-awarded over 2 million dollars for the IMPACTS grant, which will allow DCSC to operate 24/7, 365 for another two years and secured a matching grant from COHC of $250k. FY24 Challenges & Opportunities Workforce hiring and retention continues to be a challenge. Continued search for sustainable funding for the DCSC. Lack of available placements and antiquated Civil Commitment rules continue to place high acuity individuals in the community without adequate supports, which creates challenges for the Crisis Program. 21 Budget Information Project Code: HSCRISIS FY23 Funding Changes Bureau of Justice grant will end July 2023. The grant primarily covers telepsychiatry, which will be absorbed in FY24 through Medicaid. SAMHSA Co-responder grant is slated to end September 30, 2023. The department will request a change in scope to support non-LE response as well as a no cost extension. If approved, the Qualified Mental Health Professional (QMHP) position and Peer Support position will continue past September 2023. The department requested an additional $488,974 from IMPACTS to expand crisis into Redmond by adding 2 FTE. Award of this funding is unknown at this time. FY24 Program Changes The Co-responder Program will be ending and as the team moves to enhance a non-LE response model. FTE Changes and Detail 22 Behavioral Health Intellectual & Developmental Disabilities Intake, eligibility determination, referral Case management and service coordination for adults and children Individualized planning and support Pr otective service investigations and support (for adults) Vocational services Residential services Family support Comprehensive in-home supports Foster care Employment First Inte llectual/Developmental Disability Services Available in Deschutes County: This program provides support to people with intellectual and/or developmental disabilities (I/DD), to enable them to live as independently as possible in the least restrictive environment. Services are aimed at greater access to social interaction, community engagement, and employment opportunities. Primary Contact: Paul Partridge, Program Manager Website: https://www.deschutes.org/health/page/intellectualdevelopmental- disabilities-program 100% Individual Service Plans renewed on time 23 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Completed a diversity, equity and inclusion self-assessment of the I/DD program, which is now being used to improve access to services. The Intellectual and Developmental Disabilities Advisory Committee (IDDAC) increased engagement of community partners, helping to advance project-based work related to service needs identified by members. Provided high quality services compliant with contract requirements, as exhibited by a State quality assurance audit in 2022. The audit found that over 99% of documented services met the requirements for a billable encounter, which is up from 95% during the last biennial review. Continue to refine community partnerships that will lead to improved access to mental health treatment for individuals with I/DD who experience a co-occurring mental health diagnosis. Establish or refine written workflows for programmatic tasks for which multiple team members share portions of the responsibility. This includes implementing project management software to keep sight of multiple integrated projects. Make program and budget adjustments according to a new biennial funding allocation from DHS-ODDS based on a new legislatively approved budget for I/DD. As I/DD relocates program offices, adaptation and mindfulness will be key in improving access to clients as well as maintaining a high degree of staff satisfaction. 24 Budget Information Project Code: HSIDD FY23 Funding Changes FY24 Program Changes FTE Changes and Details Entering a new biennium, DHS-ODDS will introduce a new Workload Model budget to the Legislative Finance Office for review by the Ways and Means Committee. That budget should reflect increases in I/DD enrollment across the system, as well as additions in scope of work. Increases in funding are expected during the legislative budget process, which will be announced in July. During FY24, all personnel will move to new locations in Bend and Redmond. 25 Behavioral Health Intensive Adult CSS Outpatient Treatment Team provides a blend of community and office based services, focused on intensive treatment and supports for individuals living with a SPMI. Harriman Health Care - Peer Support Specialists on the CSS team work in coordination with the co-located and integrated Mosaic Medical primary care clinic, to improve medical and behavioral health outcomes for people with SPMI. Assertive Community Treatment (ACT) ACT is a community-based program that provides intensive community based behavioral health treatment to adults with Severe and Persistent Mental Illness (SPMI). ACT’s high intensity supports serves individuals who are most at-risk for psychiatric hospitalization and for whom traditional outpatient services have not been successful. Community Outreach and Stabilization Team (COAST) COAST is a group of specialty programs that provide services to individuals with SPMI diagnosis. Community Support Services (CSS) Intensive Forensic Services This program serves individuals under the jurisdiction of the State Psychiatric Security Review Board. Individuals receive monitoring specific to the conditions of their community release as well as treatment, case management and other services as indicated. Homeless Outreach Services Team and Harm Reduction Program HOST team provides street outreach and case management support to houseless individuals with Serious Mental Illness and/or Substance Use Disorders. HRP provides syringe exchange, Narcan and other supplies and supports to people who use drugs, with the goal of reducing health and safety risks associated with substance use. This program provides outreach, engagement and community based treatment and supports to individuals with severe and persistent mental illness and substance use disorders. Primary Contact: Kara Cronin, Program Manager https://www.deschutes.org/health/page/intensive-adult-services 26 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Expansion of the homeless outreach and harm reduction programming through M110/BHRN funding, adding 6 new FTE. Aid and Assist programming continues to receive statewide recognition as a model of care for this population. Ongoing pressure and difficulty keeping up with the increasing Aid and Assist referrals. Increased client acuity due to limited placement options puts stress on community partners, teams and clinicians attempting to support gravely ill individuals in the community. Ongoing struggles with recruiting and retaining a skilled workforce. Clinic space is limited for a population growing in need that requires in-person services. 27 Budget Information Project Code: HSADLTINT FY23 Funding Changes FY24 Program Changes FTE Changes and Details Addition of new M110/BHRN funding is expected to be ongoing, which funds 6 FTE. Addition of 6 FTE to support expansion of Homeless Outreach and Harm Reduction services. 28 Adult Outpatient Integrated Care (AOPIC) Located at our Courtney Clinic in Bend, our AOPIC team provides outpatient mental health care with a focus on providing treatment in partnership with Mosaic medical to serve people who are experiencing co-occurring mental health, chronic medical, and substance use challenges. Adult Outpatient Complex Care (AOPCC) Located at our Courtney Clinic in Bend, our AOPCC team provides outpatient mental health care with a focus on providing substance use treatment for people who are experiencing challenges with substance use. We provide a wide array of options including peer support, case management, groups, psychiatric care, and individual counseling. South County Hub (SoCo) Located in La Pine, provides outpatient mental health and substance use treatment to all ages in South Deschutes County and North Klamath County. Services include counseling, psychiatric care, case management, peer support, supported employment, and care coordination. Our SoCo Hub partners with La Pine Community Health Center to support clients in meeting their health and wellness goals. North County Hub (NoCo) Located in Redmond, provides outpatient mental health and substance use treatment services to people of all ages with a focus on improving health and wellbeing. Community and office based services are offered to residents of Northern Deschutes County. A multidisciplinary team approach is utilized to support people in meeting their treatment goals. Mosaic Medical provides onsite medical care, working in partnership with our NoCo staff. Behavioral Health Outpatient Complex Care These programs provide evidence based, individual and group treatment, including counseling, case management and peer support services to adults, children and families with mental health and/or alcohol/drug concerns, with a focus on integrated care. Primary Contact: Kristin Mozzochi, Program Manager Website: https://www.deschutes.org/health/page/adult-outpatient-services 29 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Implementation of Rapid Engagement Pilot with Adult Outpatient Complex Care team. Continued integration with Mosaic Medical with our Adult Outpatient Integrated Care team, with a focus on reducing Emergency Department (ED) utilization, improving the referral process and care coordination. Utilization of a multidisciplinary team approach to address the increasing acuity of our client population, including more field based care. Increase in Certified Alcohol & Drug Counselor (CADC) certified staff, provided incentives, consults, and training to support staff in meeting credentialing requirements and further integrating Substance Use Disorder (SUD) care. Recruitment and retention of qualified supervisory and direct service staff. Access barriers due to staffing shortages, especially in South County. Increasing acuity and more complex needs of our client population, lack of access to higher levels of care both internally and externally. 30 Budget Information Project Code: HSADULT, HSNOCO, HSSOCO FY23 Funding Changes FY24 Program Changes FTE Changes and Detail Promoting Integration of Primary and Behavioral Health Care (PIPBHC) grant will be ending December 2023. No Changes. 31 32 Public Health Administration Clinical and Family Services Communicable Diseases, STD/HIV and Immunization Program Prevention and Health Promotion Environmental Health Emergency Preparedness and COVID-19 Recovery Public Health 33 Public Health Key Metrics 34 Public Health Administration This program provides leadership, management and oversight for local public health (PH) services and assures the county meets statutory, fiscal and programmatic requirements. PH Administration works to diversify, leverage and assure effective and efficient use of resources to build and support foundational programs capabilities and meet community priorities. Primary Contact: Heather Kaisner, Deputy Director for Public Health Website: https://www.deschutes.org/health/page/public-health Preventing the spread of disease; H elping new parents and babies get off to healthy starts; P roviding safety-net reproductive health services; W orking at all levels to turn the tide on chronic diseases; E nsuring drinking water is clean and restaurants are following food safety protocols, and, as we know from the last few years; P reparing for and responding to public health emergencies like communicable disease outbreaks and rolling effects of environmental hazards. Public Health Modernization - Deschutes County Public Health has received Modernization funding since FY 2018. This Public Health system transformation focuses on ensuring all communities are provided the same health protections and the public health system is able to respond to future health challenges. This includes: Epidemiology and Assessment – Epidemiologists currently study the distribution and determinants of diseases and events impacting residents’ health in Central Oregon (Crook, Deschutes, and Jefferson). This work addresses many health-related problems, including opioid and drug overdose, suicide, violence, mental health, COVID-19, influenza, and other communicable diseases, as well as program evaluation of the Healthy Schools Program, which is done in partnership with Bend-La Pine schools. National Public Health Accreditation - The goal of Public Health Accreditation is to promote a culture of continuous quality and performance improvement. Streamlining processes allow for regular assessments of strengths and opportunities within the department, which create pathways for innovation and leadership. Additionally, Accreditation promotes the use of a health equity lens to better identify community needs, while strengthening ongoing partnerships within the community. 35 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities The Public Health workforce is finally stabilized and is at pre-COVID vacancy levels. A dedicated position works on addressing Climate and Health locally. This work focuses on collecting data and creating response plans to wildfires and smoke, excessive heat, and drought. Public Health continued response efforts related to COVID-19 pandemic, including providing vaccine testing access throughout the county and responding to 179 outbreaks in high risk congregate settings. Both a challenge and opportunity, it is unknown what the level of funding for Public Health Modernization will be in the next biennium. It is anticipated funding will increase. The newly formed Emergency Preparedness and COVID-19 Recovery team will provide increased capacity to quickly and effectively prepare for and respond to public health emergencies. With staff levels increasing to meet population growth and client needs, building space for client-facing programs and clinical services continues to be a challenge. 36 Budget Information Project Code: HSPHGEN FY23 Funding Changes FY24 Program Changes FTE Changes and Detail For the FY 22-23 biennium, the Legislature allocated $33.4 million for Local Public Health Modernization funding, statewide. Additional funding is anticipated though the legislature has yet to determine the FY23-24 biennium amount. One time CDC Infrastructure funding of approximately $600k will support lease expenses for increased staffing. Public Health continues to receive COHC funding to support COVID-19 response and recovery service gaps. The Emergency Preparedness Program and Climate and Health Programs is now part of the newly formed Emergency Preparedness and COVID-19 Recovery program. This change will bring together all program staff that engage in emergency response efforts. Public Health reorganized from six sections to five, which aligns similar programs in order to maximize collaboration and effectiveness of services while ensuring appropriately-sized programs and structure. 37 Public Health Clinical and Family Services These programs are focused on providing safety-net public health services to individuals and families seeking reproductive health care, perinatal education and care coordination, nurse home visiting, nutrition education, breastfeeding support, and referrals to needed resources. Primary Contact: Anne Kilty NP, Program Manager Website: https://www.deschutes.org/health/page/clinics-and-services Clinical Services Provides free or low-cost birth control (for all ages & genders), annual exams for women and STD prevention, testing & treatment for all. Family Support Services Provides direct nursing support and referrals to pregnant and post-partum women, caregivers and their families to improve birth outcomes, increase access to health services, and improve family relationships. Women, Infants & Children (WIC) Provides nutrition education, breastfeeding support, access to healthy foods, and referrals to other needed resources for pregnant and post- partum women and their families. 38 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities 39 Clinical Services Bend and Redmond clinics saw a 5% increase in total visits and a 10% increase in new patients along with increased revenue despite a nurse practitioner vacancy January to May. Family Support Services continued to provide personal nurse home visits and perinatal care coordination throughout this year while implementing the new Family Connects Central Oregon universal in- home nurse visiting program for post-partum women. WIC continued to serve clients in the clinic and by telehealth and will implement a new electronic health record platform. A COHC grant was awarded to purchase a mobile van clinic to increase access to services to more community members throughout Deschutes County. Clinical Services continues to struggle with lack of public knowledge of available safety-net services for target populations and will renew efforts with other DCHS programs and community partners to increase awareness and access for at-risk populations. Family Support Services is implementing a universally offered post- partum nurse home visiting program, while navigating the challenges of new billing systems and engaging new partners. WIC will continue to find ways to increase its program’s reach across the community utilizing mobile services as one approach. Budget Information Project Code: HSPHDIRECT & HSCLINICAL FY23 Funding Changes FY24 Program Changes FTE Changes and Details 40 Family Support Services began implementing Family Connects – Central Oregon in November 2022, which has the potential to markedly increase program revenues due to substantial increases in reimbursement rates. COHC Perinatal Care Continuum grant ends September 2023. Expansion of the nurse home visiting and perinatal care teams may be needed as the current staffing structure will not be able to keep up with the anticipated demand of the post-partum population. Both of the reproductive health clinics will be moving to new locations during FY24; the Courtney clinic for Bend and the new Redmond campus on Kingwood. Re-locating these established clinics will require re- branding, an information campaign for current patients and the community at-large and internal DCHS changes to optimize these new spaces. Public Health Communicable Diseases, STD/HIV and Immunization Program These programs prevent and control the spread of communicable diseases and mitigate health threats through surveillance, education, investigation, outbreak control and immunizations. Moreover, we assure access to public health services and conduct community outreach providing immunizations, infection prevention consultation and communicable disease testing and treatment. Primary Contact: Rita Bacho, Program Manager Website: https://www.deschutes.org/health/page/communicable-disease- programs HIV Prevention Program Immunizations Program Sexually Transmitted Diseases (STDs) Tuberculosis Control Program Communicable diseases (CD) are those conditions that can be spread to others through air, touch, or contact with contaminated body fluids. At Deschutes County Health Services, we work to prevent the spread of these diseases in many ways. The CD team is made up of the following programs: 75 Outreach test events 744 Individuals tested for HIV, Hep. C, Syphilis and GC/CT 1,294 Flu Vaccines Provided through outreach and safety net clinics 267 Other vaccines provided through safety net clinics 41 FY23 Highlights & Accomplishments Successful Triennial Review for Communicable Disease and TB Programs. STD, HIV and Immunization Programs met all programmatic reporting requirements and were able to forego triennial reviews. Successful, timely school exclusion process throughout the year. Effective Mpox vaccine outreach to vulnerable populations, resulting in zero cases in Deschutes county. Investigated 926 reportable Communicable diseases/STIs in CY22 (311 CD cases, 615 STI/HIV cases), which included providing contact/partner follow-up and testing and treatment. Monitored ~50 Long Term Care Facilities (LTCF)/congregate settings in CY22 providing guidance, investigation, PPE and testing for 180+ outbreaks until 14 days past last positive test. Conducted 75 outreach testing events to vulnerable populations in CY22 providing rapid testing, education and referrals (236 HIV, 227 Hepatitis C and 234 Syphilis). 1,294 f lu vaccines provided to the community through outreach and safety net clinic. 73 Jynneos (mpox vaccine) provided to the most at-risk populations. 267 other vaccines provided through safety net clinic. 382 people subscribed to the flu report in 2022, compared to 305 in 2020 and 361 in 2021. Immunizations Subscriptions to Flu Report FY24 Challenges & Opportunities With involvement in COVID-19 response and understaffing during FY23, some programmatic processes and goals were not completed. We are now fully staffed and are setting new goals and metrics for our programs. Increased vaccine hesitancy leading to decreased vaccine uptake. Unable to provide infection prevention education to congregate settings due to the volume of COVID-19 case investigations and outbreaks at the facilities. An additional tri-county LTCF position through Modernization funding, gives opportunity to provide greater outreach and support for congregate settings. Opportunity to prepare for emerging communicable diseases (viruses, measles, E.coli, Ebola, tick-borne diseases, etc.) some of which may be associated with global climate change. Opportunity to provide greater outreach and support for congregate settings through an additional tri-county LTCF position through Modernization funding. Opportunity to learn from the pandemic response and strategically plan for future communicable disease public health crises. 42 Budget Information Project Code: HSCOMMDIS FY23 Funding Changes FY24 Program Changes FTE Changes and Details Ryan White Program is moving under the Advancement and Protections section. 43 End of Jefferson County funding (appx. $60K) to support individual case investigation within Jefferson County. We will continue to collaborate on projects and outreach testing as part of the Early Intervention and Outreach program. Public Health Prevention and Health Promotion Healthy Schools A local partnership between Deschutes County and Bend-La Pine Schools providing public health services directly within schools to improve adolescent health and student success. Substance Misuse and Problem Gambling Prevention Reduces and prevents problem gambling, tobacco, alcohol, marijuana, and prescription drug misuse among young people ages 10-25 years. Mental Health Promotion and Suicide Prevention Ensures proactive policies, systems, and environments are in place in order to prevent suicide attempts and deaths as well as the promotion of community resilience amongst all age groups. Youth Engagement Program Fosters youth-adult partnerships and youth-led projects to ensure student voice and leadership in mental health promotion and advocacy for School Based Health Centers. Programs in this section lead work with community partners to promote and ensure practices that improve health and well-being and prevent negative conditions that are harmful to our community both socially and financially. Primary Contact: Jessica Jacks, Program Manager Website: https://www.deschutes.org/health/page/staying-healthy-prevention 44 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Development and implementation of a data tracking system will improve the programs ability to monitor and evaluate progress. 36 suicide prevention trainings provided to 1,286 people providing lifesaving skills and knowledge across the county. Collaboration with Veterans Services to create a Veterans- focused mental health ad reaching 74,000 people. Increased FTE and sustainable resources for Problem Gambling Prevention and Outreach and Referral. Allows for service expansion to Suicide Prevention, Veterans, and Older Adults. 95% of surveyed Bend-La Pine Schools’ Health Teachers reported that the Healthy Schools partnership improved their knowledge, skills, and confidence to be able to deliver effective health education. More than $10,000 leveraged by other sources to support health education improvements at Bend-La Pine Schools through the Healthy Schools partnership. Quick pivoting by Substance Misuse Prevention staff to maximize one-time funding opportunities and develop four Public Service Announcements encouraging parents to talk with their kids about marijuana and other drugs. https://www.sharedfuturecoalition.org/start-the- conversation/ Prevention requires long-term investment to realize cost savings and improved community health (e.g. reductions in costs for healthcare, criminal justice, education, social welfare, etc.). Current funding is stratified across few stable resources and multiple short-term grants. This results in frequent staff turnover, instability of program delivery, and requires staff to spend time on resource development instead of program implementation. Oregon Suicide Postvention Legislation has significant gaps; it is an unfunded mandated, does not include Community Colleges, does not include youth who have parents who have died by suicide, nor youth who have attempted suicide. 45 FY24 Program Changes Living Well Central Oregon and Prevent Diabetes Central Oregon programming has paused due to funding uncertainties. Repurposed existing FTE to create a new supervisor for substance misuse prevention adding capacity to that area and more reasonably balances supervisor to staff ratios. Budget Information Project Code: HSPREVENT FY23 Funding Changes FTE Changes and Details Increased funding from Oregon Health Authority Health Systems Division for Problem Gambling Prevention and Outreach and Referral, from $82K to $258K annually. Increased revenue ($395,172) came through mid-year to support tobacco cessation improvements, expanded access to Nicotine Replacement Therapy and vaping cessation resources for adolescents and parents. 46 Restaurant and Health Inspections Inspections of 1,267 licensed foodservice operations in Deschutes County. Food Service Licensing & Training Food handler training and certified food manager training. Drinking Water Administration and enforcement of drinking water quality standards for the 185 Deschutes County public water systems. Tested 71 private wells in 2022. Public Pools Inspection of over 270 public pools and spas in the county with an emphasis on safety and disease prevention. Tourist Facilities Inspection of hotels, motels, resorts, Recreational Vehicle (RV) parks, and campgrounds. C hildcare Facilities Inspection of 95 Childcare facilities, including pre-school, Headstart and Pre-K. School Lunch inspections Inspection of 63 school foodservice kitchens. Public Health Environmental Health This program provides public health protections through conducting prevention education and regulatory inspections at licensed facilities. Primary Contact: Tom Kuhn, Program Manager Website: https://www.deschutes.org/health/page/environmental-health 47 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Awarded three new grants from the Food and Drug Administration (FDA) to meet Retail Food Regulatory program standards, which evaluates quality and efficacy of the food inspection regulatory program. As part of Public Health Modernization, enhanced outbreak investigation and disease prevention capacity in vulnerable populations, such as congregate settings (e.g. homeless shelters), childcares, and Adult Foster Homes. Implemented indoor air quality evaluations on HVAC and clean air conditions in vulnerable population and businesses, upon request. Implemented a safe drinking water program for private domestic well owners to evaluate presence of organic and inorganic chemicals, and identify potential hazards associated with well location. Fees and revenues not keeping pace with increased expenses; relying increasingly on Transient Room Tax and Modernization funding. 12% increase in the number of food, pool, childcares, lodging businesses and public events, post-COVID, creating increased inspections. PH Modernization funding creates opportunity to increase capacity and collaborate with Public Health teams to better serve and protect vulnerable populations. 48 Budget Information Project Code: HSENVIRON FY23 Funding Changes FY24 Program Changes FTE Changes and Details Likely increase in fees to correspond with Consumer Price Index. PH Modernization is funding one new Environmental Health position. Increase in temporary restaurants at many events. Three FDA grants totaling $44,000. Increased presence in non-regulated facilities to evaluate the health and safety of vulnerable populations, collaborating with Behavioral Health and Communicable Disease teams. Monthly quotas now put in place to ensure field inspectors are inspecting required volume of licensed facilities. 49 Public Health Emergency Preparedness and COVID-19 Recovery This program focuses on recovery efforts from the COVID-19 pandemic in our community and all hazards emergency preparedness. The team continues to provide recovery supports for COVID-19 disease mitigation including: vaccinations, testing, wraparound services for cases and infection prevention education. The team incorporates lessons learned from the Covid-19 pandemic and leverages new Covid-19 public health infrastructure into Emergency Preparedness programing. Primary Contact: Emily Horton, Program Manager Website(s): https://www.deschutes.org/health/page/emergency- preparedness https://www.deschutes.org/health/page/covid-19-novel-coronavirus Vaccine Operations Safety-net to primary care providers and the community. Offering large volume community based vaccine clinics and targeted vaccine distribution to communities and individuals at with barriers to access or increased risk of severe disease. Emergency Preparedness M onitors and strengthens the abilities of Deschutes County and our healthcare systems to protect the public’s health in disaster situations, such as disease pandemics and epidemics, chemical and radiological releases, severe weather, and natural disasters. Community Outreach Targeted education and outreach to BILIPOC, rural and houseless communities with education on Health Services programs and Covid-19 vaccine, testing and information. Wraparound Services H elps those that tested positive for COVID-19 stay home and quarantine without the worry of financial pressures, some of the services provided were food, rent and utilities. Referrals came from the CI team within 24-48 hours of tracing. Outbreak and Case Investigation Track and decrease COVID-19 cases throughout Deschutes County, provide wraparound referrals, timely data entry and education for community members who report a positive COVID-19 case.19,000 Vaccines Admini stered by the COVID Vaccine Team 161 Community clinic vaccine volunteers 4,853 Outreach contacts 50 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Provided over 19,000 Covid-19 vaccinations and distributed over 34,000 at Home Covid-19 Test kits at locations county wide. 34,094 Covid-19 cases processed with follow-up for vulnerable individuals and populations, including 179 outbreaks in high consequence settings. Provided wraparound services to support isolating 460 individuals at home and 99 individuals in temporary housing for the duration of the contagious period. Outreach to the community about Covid-19 vaccine and health services programs to 4853 individuals, prioritizing houseless and BIPOC community members. This included 164 Asians, 49 Black, 828 Latinx individuals. Hired new Climate and Health Coordinator focusing on tri-county needs, especially smoke and fire health effects through regional and Public Health Modernization funds. Reprioritizing community needs and expectations will help transition the team as it decreases to half its current size. Continue to build on lessons learned from COVID-19 response through emergency preparedness lens for community-wide communication, collaboration and coordination of health services related incidents and emerging health issues. Official creation of a Deschutes County Medical Reserve Corps in FY23 from robust Volunteer Vaccine Corps group established in 2021. Shifting utilization of this team from primarily vaccine related to supporting health services emerging health issues. 51 Budget Information Project Code: HSCOMMDIS, HSCOVID20, HSEMERPREP FY23 Funding Changes Reduction of FEMA and ARPA funding supporting operations. FY24 Program Changes This team is significantly restructuring and changing scope. The team will continue to support required COVID-19 community assurances. Some COVID-19 work for outbreak management will transition to Communicable Disease Team. We are also incorporating Emergency Preparedness team members into this program, and will shift some focus to this work as well. 52 FTE Changes and Details Administrative Services Director's Office Administrative Services 53 Administrative Services Provides operational and fiscal support, as well as oversight of assets and compliance. This includes billing, credentialing, contracting, fiscal services, health information technology, medical record services, infrastructure, workforce development, language access, safety, compliance, quality assurance, data analytics and project management. Primary Contact: Cheryl Smallman, Business Officer, Chris Weiler, Operations Officer & Jillian Weiser, Compliance and Quality Assurance Officer Business Intelligence Conducts fiscal and analytical activities, as well as initiatives and quality improvement efforts to improve the efficiency, effectiveness, and financial stability of the department. Fiscal Services Billing and Credentialing Contract Services Data and Analytics Accounting and Grant Management Operations Manages a complex and diverse set of business support services and ensures the department has the tools, equipment and facilities necessary to serve the community safely. Project Management Medical Records Health Information Technology Departmentwide Safety and Continuity of Operation Planning Behavioral Health Front Office Procurement Infrastructure Asset Management Fleet Vehicle Management 54 Compliance and Quality Assurance (CQA) Compliance and Quality Assurance: Provides auditing and oversight of department work to assure ethical conduct and compliance with local, state, federal, and professional standards and regulations; including incident reports, policies & procedures, privacy, language access, documentation training, chart audits, and department HR support. Compliance and Quality Incident Reporting Language Access Auditing Policies and Procedures HR Resource Processes DEI, TIC and Workforce Development 1,668 Opened Help Desk Tickets FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Built and launched an open source grant management software, which won a 2022 National Association of Counties Achievement Award. Consolidated and enhanced annual required trainings for +450 employees. Moved from paper to electronic submission for all purchase card receipts, mileage, personal reimbursement, and travel expenses. Aligning Administrative Services staffing ratios to correspond to growing Behavioral Health and Public Health programs, clients, and requirements. Growing need to track and report on a variety of items without an application or increased staffing to do so. Examples include HR/Payroll stipends (e.g., CADC, licensure supervision), theft-sensitive assets, and staff locations. Effectively managing remote work, including optimization of space use within current buildings to allow for hybrid work environments that promote cross-team collaboration. Difficulty in filling limited duration positions, such as DEI Strategist and Public Information Officer. The current day time Operations staffing model is a challenge to provide night-time, weekend and Holiday technical support for three daily staff shifts at a 24/7 Stabilization Center that relies on an electronic health record system to possess accurate client data to assist with client care coordination and behavioral health services. 55 Budget Information Project Code: HSADMIN FY23 Funding Changes Public Health Modernization funding decreased to Administrative Services in order to support Public Health direct service positions. FY24 Program Changes Restructured Compliance and Quality Assurance Team, reclassifying the CQA Manager to an Officer, reclassifying an analyst to senior analyst position and moving the HR Analyst and DEI Strategist under its purview. Restructured Operations, adding support for Facilities and Fleet and a Supervisor over the Health Information Technology Team. Moved all Accounting Technicians across department to Fiscal Services team. FTE Changes and Details 56 Health Services leadership implemented workforce recruitment and retention strategies, which resulted in reducing vacancies overall by 4% since January 2022. Specifically, BH and Admin decreased from 14% in January 2022 to 9% in January 2023, and PH remained at 10%. Health Services leadership directed and supported the transition from the COVID-19 emergency response to COVID-19 recovery and transition activities, including: workforce return to in-person services; step down from COVID emergency response activities and staffing to recovery activities and staffing; re-organization of Health Services leadership team; re-positioning of Public Health leadership team to prepare for recovery and PH Modernization investments. Administrative Services Director's Office This program provides agency-wide leadership and oversees programs and activities with broad public, community partner, inter-agency and cross- jurisdictional impact and involvement, including; strategic planning and communications, fiscal viability and accountability and workforce development. Primary Contact: Janice Garceau, Health Services Director 90% Of exiting Health Services employees would recommend DCHS as an employer 57 FY23 Highlights & Accomplishments FY24 Challenges & Opportunities Address continued workforce shortages in key roles such as behavioral health clinicians, nursing and psychiatry and in rural areas of the county. Maximize on Public and Behavioral Health integration by increasing collaboration and efficiencies across service areas. 58 Budget Information Project Code: HSDIRECTR FY23 Funding Changes House Bill 4004 provided one-time Behavioral Health workforce incentives. FY24 Program Changes FTE Changes and Details Restructured key positions within the Director's office. End of Public Information Officer position. Restructured Administrative Services to be led by three Officers. Health Services Personnel Highlights 59 422.80 Total FTE Director's Office 5.00 Admin Services 46.30 Behavioral Health 270.80 Public Health 100.70 +14.95 Number of new positions created in FY23 12.1% FY23 Average Vacancy Rate (through January 2023) Health Services Financial Highlights 60 Resources Requirements