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HomeMy WebLinkAboutFY26 Annual ReportFY26ANNUALREPORT Deschutes County Health Services A letter from the Director Strategic Plan Organizational Chart Personnel Highlights Financial Highlights Director's Office Administrative Services Behavioral Health Information Behavioral Health Continuum Behavioral Health Key Statistics Behavioral Health Administration Access and Integration Comprehensive Care for Youth and Families Crisis Program Acute and Forensic Services Intellectual and Developmental Information Intellectual and Developmental Disabilities Intensive Adult Medical Team Outpatient Complex Care Public Health Information Public Health Key Metrics Public Health Administration Prevention & Health Promotion Environmental Health, Preparedness & Engagement Communicable Diseases, & Prevention Management Clinical & Family Services CONTENTS 2 Dear Health Services Staff and Community Partners, We move into 2025 with a mixture of anticipation and concern for what is ahead. For me that anticipation is rooted in my trust in the excellence of our staff. Our work together in 2024 was extensive. Our foundation of expertise, care, credibility and trust within our community is strong. We are well-positioned in Health Services to continue innovating to meet the evolving needs of our community and to weather the challenges on the horizon. This year we expanded services, formed new partnerships, and launched innovative solutions to address the most pressing needs in public and behavioral health. Below are just a few examples that reflect the hard work of staff, their resilience, and their unwavering commitment to improving the well-being of our community. Public Health Innovations Women Infants & Children celebrated 50 years of serving our community, added services in Terrebonne, and experienced a 17% increase in participation since 2023. HIV/STI Staff conducted 59 outreach testing events providing rapid testing, education and referrals, and saw declines in new syphilis cases. The team also partnered with OHA to provide local training events for health care providers to improve their knowledge, identification and treatment of STIs. Three years of Healthy Schools helped prevent 21% of the expected number of emergency departments visits related to suicide, substance use, depression, and mental health for youth ages 11-17. The ASPIRE Grant achieved by Environmental Health, facilitated equipping childcare homes with air monitors. In partnership with Bend Fire & Rescue and St. Charles, we trained Medical Reserve Corps members in “Stop the Bleed” techniques, and with Central Oregon Suicide Prevention Alliance (COSPA) DCHS launched the first Secure Firearm Storage campaign. 500 heat stress kits were distributed to 24 organizations that serve extremely vulnerable populations to prepare for extreme heat Immunization services were expanded to uninsured populations in North County. Behavioral Health Highlights DCHS completed a Request for Proposals for a 16-bed Secure Residential Treatment Facility in Redmond. The SRTF is set for completion in 2027. LETTER FROM THEDIRECTOR 3 4 Launched a scholarship program to expand the mental health workforce. Intern applications increased by 47% and retention improved by 63%. A Forensic & Acute Services Program was launched to bring together forensic and residential care teams to improve coordination for our highest risk clients. The Drop opened drop-in services to at risk youth in Redmond. Collaboration helped raise funds for a child psychiatric facility in Central Oregon. Renovations at CCYF, SOCO, WSSB, and Courtney buildings were planned to improve functionality while making use of existing properties. Additional Milestones The Stabilization Center celebrated its 4 year of saving lives, keeping officers on the street and supporting crisis work in the community. th The Health Services Director completed visits with all 46 teams to roll out key problem-solving and culture improvement projects across Health Services. As I contemplate leaving this work for retirement, I’m aware of the uncertainty of this time, of the impact change can have on the communities we serve and on those of us who serve them. I’m reminded of the wise words of others who navigated uncertainty. Dan Rather, a respected journalist who witnessed decades of events, wrote: “Two powerful words…shaped both my personal and professional life…These words, often shared by my father, have guided me through challenges and triumphs…He would often say, ‘Steady.’ ‘Courage.’ when things seemed uncertain, offering both comfort and strength.” And from Sarah-Patton Boyle, a prominent civil rights advocate in the 1950’s and 1960’s: “Service is love in action, love "made flesh"; service is the body, the incarnation of love. Love is the impetus, service the act, and creativity the result with many by-products.” These values – love, courage, steadiness, creativity – are at the core of all we accomplished together this year, the by-products of our creativity and care. They will be the bedrock of how we continue to serve with steadiness through change and uncertainty. I’m heartened by the visits I had with your teams. Your dedication, collaboration, skills, and genuine care for the people we serve shine. While the content of this report is factual and at times dry, I hope that you, our staff and community partners, can see yourselves within. It is the concrete representation of each of you and of the acts of service you engage in every day with unflagging integrity and dedication to the people and community we serve. I want to express my deep gratitude for my time with you. I’ve learned so much from your humility, courage, resilience, talent and love for our community. It’s been an honor. With sincere thanks, To Promote and Protect the Health and Safety of Our Community Health Services Director 5 ORGANIZATIONAL CHART BOARD OF COUNTY COMMISSIONERS LOCAL MENTAL HEALTH AUTHORITY, LOCAL PUBLIC HEALTH AUTHRITY County Administrator Public Health Advisory Board Behavioral Health Advisory Board Local Developmental Disabilities Planning Committee Behavioral Health Services Holly Harris, Director DCHS Compliance Officer Jillian Weiser Health Services Director Janice Garceau Administrative Services Cheryl Smallman, Business Officer Chris Weiler, Operations Officer Jillian Weiser, Compliance & Quality Assurance Officer Public Health Services Heather Kaisner, Director Emergency Preparedness & Environmental Health Prevention & Health Promotion Communicable Disease Prevention & Management Clinical & Family Services Richard Fawcett, MD. Health Officer Intensive Adult Services Comprehensive Care for Youth and Families Access and Integration Intellectual/ Developmental Disabilities Sam Murray, MD. Medical Director Outpatient Complex Care Services Crisis Services Business Intelligence Operations Compliance and Quality Assurance 6 Behavioral Health Med Team Forensic and Acute Services 7 PERSONNEL HIGHLIGHTS 423 Total FTEDirector's Office 2.00Admin Services 53.50Behavioral Health 291.82Public Health 99.93 12 Number of positions reallocatedin FY25 38 Number of new positionscreated in FY24 8 FINANCIAL HIGHLIGHTS FY25-26 Resources FY25-26 Requirements 9 DIRECTOR’S OFFICE [HSDIRECTR] 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 communication, fiscal viability and accountability and workforce development. Primary Contact: Janice Garceau, Director of Health Services website: https://www.deschutes.org/health/page/behavioral-health FY 25 Highlights and Accomplishments Launched a comprehensive orientation program covering Health Services’ Purpose, Mission, Vision, Values, and Culture for new hires. Formalized Chartered Workgroups to drive meaningful support and measurable outcomes. Implemented a Culture Framework across the department based on staff survey feedback. Directed fiscal and talent resources toward impactful improvement projects. Supported streamlining of Behavioral Health and Public Health for cost savings and better performance. Partnered on key community initiatives like the Regional Health Improvement Assessment, Juniper Ridge Safe Stay Area, and legislative efforts to reduce administrative burdens. FY 26 Challenges and Opportunities Addressing the imbalance in Public Health and Behavioral Health funding, revenue streams, size, and expenditures. Ongoing strain on services due to housing needs, climate-related emergencies, and increasing acuity among those served. FTE Changes and Detail ADMIN SERVICES [HSADMIN] These programs provide operational and fiscal support, as well as oversight of assets and quality. Primary Contact: Cheryl Smallman, Business Officer, Chris Weiler, Operations Officer & Jillian Weiser, Compliance and Quality Assurance Officer 10 Business Intelligence Conducts fiscal and analytical activities, as well as strategic initiatives to improve the efficiency, effectiveness, and financial stability of the department. Fiscal Services Contract Services Data and Analytics Accounting and Grant Management Project Management Operations Manages a complex and diverse set of business support services to ensure the department has the tools, equipment and facilities necessary to serve the community safely. Medical Records Health Information Technology Departmentwide Safety and Continuity of Operation Planning Billing and Credentialing Front Office Procurement Infrastructure Asset Management Fleet Vehicle Management Vital Records Compliance and Quality Assurance (CQA) Provides auditing and oversight of department work to assure ethical conduct and compliance with local, state, federal, and professional standards and regulations. Compliance and Quality Incident Reporting Language Access Auditing Protective Services Policies and Procedures HR Support Diversity Equity & Inclusion Workforce Development Privacy ADMIN SERVICES FY 25 Highlights and Accomplishments 11 Established the Project Management Office (PMO): The team already created dashboards and tools, worked with leadership to update the organization’s Mission, Vision, Values, established strategic priorities, and launched an annual space planning process. Developed the Community Impact Report for Behavioral Health Crisis Program. This comprehensive report enhances the department’s ability to communicate the scope and impact of Crisis services to community partners and potential funders. Launched Vital Records online death certificate platform. Implemented my EOP, a mobile application that staff are able to access emergency preparedness plans. DCHS became an “Outreach and Engagement” provider for health-related social needs. This includes broadly screening for social determinants of health and providing resources to reduce barriers by connecting Oregon Health Plan members with resources. FY 26 Challenges and Opportunities Staffing across all areas of Administrative Services has not kept pace with other service areas, resulting in absorption of workload without additional bandwidth. Understaffing and turnover at both Public Health and Behavioral Health front desks makes public facing coverage across eight buildings in three cities a challenge. Language access needs (interpreting/translation) have continued to grow, with challenges in building capacity both internally and externally. A new opportunity through Oregon Health Plan that connects community members with supports around social determinants of health challenges is proving challenging to bill and recoup revenue related to it. Develop a service vision and long-term office space plan for downtown Bend though Health Services participation in the County’s space planning committee. FY 25 Funding Changes FY 26 Program Changes Awarded an 18-month Community Capacity Building grant through PacificSource to stand up social determinant of health technology supports. Bringing in additional resource, and developing clarity and consistency in policy, for bilingual staffing and language access services. Move 1.0 FTE Supervisor from Crisis Program to Admin Services Combining Public Health Front Office, Women, Infant, and Child (WIC) Front Office, and Vital Records into one team, overseen by Admin Services. 12 ADMIN SERVICES FTE Changes and Detail 13 Local Mental Health Authority (LMHA) Governance The LMHA appoints a Mental Health Director and designates the Community Mental Health Program County Commissioners and Judges are the Local Mental Health Authority (LMHA) for the CMHPs and Community Developmental Disabilities Program's (CDDPs) in their counties $63.2M Behavioral Health operational Budget 281.45FTE Behavioral Health To Promote and Protect the Health and Safety of Our Community Janice Garceau 3% Budget supportedby General Funds The Community Mental Health Programs (CMHP) is designated by the Local Mental Health Authority (LMHA) to provide services mandated by ORS 430.610. Behavioral Health Director Health Services Director Local Mental Health Authority: County Commissioners - BoCC Local Mental Health Agency (LMHA): Deschutes County Behavioral Health Division is authorized by the BoCC to perform Public Health LMHA requirements and responsibilities on behalf of the county (Behavioral Health is a division of Health Services) Local Mental Health Administrator: DCHS Behavioral Health Director, authorized by the BoCC to oversee the Local Mental Health Agency Local Mental Health Delegations of Authority Community-based Services not Provided Elsewhere such as School Based HealthCenters or Co-occurring Outpatient Mental Health and Substance Use DisorderTreatment, Supported Housing & Employment, Rental Assistance, IntegratedBehavioral & Primary Care, etc. Justice System Related Services and services that impact rights, such as Aid &Assist or Civil Commitment and Psychiatric Security Review Board Monitoring. Mandated Services Core Services Safety Net Services Services Required by Rule/Contract such as Jail Diversion or Housing Supports,Older Adult, and Intensive Services provide by programs like AssertiveCommunity Treatment (ACT), First Episode Psychosis (EASA), Stabilization Center,Wraparound services to children, Crisis Services such as 24/7 Mobile Crisis Teamsetc. What We Do As the designated CMHP, Deschutes County Behavioral Health ensures a system of comprehensive, coordinated, services to meet the mental health needs of the community. We provide accessible, timely, community-based behavioral health services to Deschutes County residents regardless of ability to pay. Holly Harris Behavioral Health Programs How the System is Funded: community based intensive treatment supports to adults with an SPMI diagnoses. Aid and Assist Rental Assistance Supported Employment Coordination of Residential Spectrum Two Housing Property Support Outpatient SPMI BH Older Adult BH Care Integrated Care with Mosaic Medical ACT Homeless Outreach Services & Harm Reduction Individual and group treatment services to adults, children, and families with mental health and or alcohol and drug concerns. Referral Services for continued care Individual, Family and Group Counseling Integrated Care with Mosaic Medical Co-Occurring Substance Use Treatment Psychiatric Care and medication management Veterans Services Parent Child Interaction Therapy (PCIT) Care Coordination and Skills Training Intensive Adult Services 58.1 FTE Outpatient Complex Care 40.5 FTE Comprehensive Care for Youth & Families 47.5 FTE Provides specialty mental healthcare for individuals ages 0-25 and their families through an array of integrated, intensive outpatient care teams. Generation Parent Management Training Oregon (GEN-PMTO) Parent Child Interaction Therapy (PCIT) Young Adults in Transition The Drop Behavioral Health Resource Network Affirming Care (True Colors) School Based Health Centers System of Care Early assessment and support alliance Wraparound CCO Coordinated Care Organizations are the Managed Care Entities (MCEs) tasked with managing Medicaid dollars to ensure the provision of required healthcare services to OHP members in their region. CCOs contract with CMHPs for behavioral health services to their members. CCO contracts are negotiated annually, Deschutes County includes Fee for Service Revenue, Capitation and Program Allocation lines of reimbursement. OHA The Oregon Health Authority provides Medicaid and State General Fund dollars to CMHPs through County Financial Assistance Award (CFAA) contracts for services to indigent uninsured and key strategic investments such as block grants or pilot projects. Grants Deschutes County receives local, state and federal grant funds. Most grants are time limited and cover distinct costs. Some grants, such as CCBHC and federal CAHOOTS funding provide enhanced Medicaid payments intended to expand services. A 24-hour program that responds by phone or face-to- face. Services may include assessment, intervention planning, information and referral services. In addition, we provide brief crisis stabilization through individual or group treatment. Intervention Planning referral Services 24/7 Crisis Coverage 24/7 Mobile Crisis Services Stabilization Co Responders Provides intake, referrals, and care coordination for individuals of all ages, in addition, provides training and technology support to clinical staff. Screenings/ Assessments Referrals Treatment Recommendations Case Management Brief Therapy CCBHC Coordination Rapid Engagement CANS Assessments for DHS Administrative Support for Behavioral Health Teams BH Medical Team Crisis & Stabilization 43.70 FTE Access & Integration 33.3 FTE Intellectual/Developmental Disability Services 48.85 FTE Supports people with intellectual and/or developmental disabilities (I/DD). Services are aimed at greater access to social interaction, community engagement, and employment opportunities. Screening and investigating allegations of abuse for adults with I/DD coordinating protective services to avoid occurrences of abuse Applications and eligibility for services Case Management services- assessment, service plans, authorizing/referring to chosen services and support Monitoring authorized services Statutorily or contract required services, grant funded and fidelity programs. Forensic & Acute Services 0.0 FTE Care coordination, referrals, treatment and supports for individuals who are forensically involved or in acute care / residential settings. Exceptional Needs Care Coordination (ENCC) Aid and Assist Psychiatric Security Review Board CHOICE MODEL Civil Commitment investigation and monitoring Forensic Diversion 15 ServiceTypes CommonProblemsAddressedCOMMUNITY BEHAVIORAL HEALTH SERVICE CONTINUUMHigh Risk High Need High Complexity Oregon State Hospital St Charles Sageview and/or EmergencyPsychiatric Services (PES) BedsSagebrush Academy Day Treatment Deschutes Recovery Center (DRC) Moderate Risk High Need High Complexity Deschutes County Health Services (DCHS) Behavioral Health24/7 Mobile Crisis Response & Stabilization CenterYouth Villages, Intercept & Intensive In Home Behavioral HealthTreatment (IIBHT) DCHS Specialty Intensive Community-Based Services DCHS Complex Outpatient Care Intellectual/Developmental Disability ServicesPrivate/Non-Profit agency and/or private practice providersLow Risk Moderate NeedModerate ComplexityPrivate/Non-Profit agency and/or private practice providersPrimary Care BH ConsultantsLow Risk Low Need Low Complexity Persons immediate danger due to acutepsychiatric symptoms and risk of harm to self orothers: persons in need of residential care dueto severe mental illness impacting ability to livesafely without supports in community Persons with severe and debilitating mentalhealth conditions often accompanied bypsychosis or co-occurring medical diagnosis orsubstance use disorders; often experiencehomelessness; may have frequent involvementwith law enforcement due to poorly managedacute symptoms. Children with serious emotional disturbance ormental illness and multi-system involvement(foster care, Juvenile Justice); often at risk forloss of home or school placement.Persons with serious mental illness without psychosissuch as Complex PTSD or major depression; history ofpsychiatric hospitalizations, frequent ER visits, co-occurring physical/substance us conditions; may be atrisk of losing housing, employment, or independence. Person with Post Traumatic Stress Disorder, eatingdisorder, moderate depression or anxiety, some familysupport; struggles to maintain high level of daily functioningand compliance with treatment and medications. Self-referred after loss or life circumstance, has familyconnection, sense of purpose in life, history of stability,current functioning decline (job instability due to symptoms,other destructive behavior, poor insight).Life change resulting in trouble sleeping, self-doubt, mild mood changes; no thoughts ofsuicide or self-harm; trouble managing healthdue to stress; takes medications asprescribed.Overall good life satisfaction, goodrelationships, productive and connected toothers; experiencing minor anxiety; talkingwith others helps.Provider Types HospitalsDetoxResidential Community MentalHealth Safety Net ProgramsCommunity Mental Health Safety Net ProgramsNon-Profit Outpatient Specialty CareNon-Profit Outpatient Specialty CareCommunity Outpatient ProvidersCommunity Outpatient ProvidersCommunity Based SupportEntitiesPrivate/Non-Profit agency and/or privatepractice providers Family, Friends, Religious Organizations,Support Groups, etc.BH CONTINUUM 16 BEHAVIORAL HEALTH KEY STATISTICS BEHAVIORAL HEALTH ADMINISTRATION AND CCBHC[HSBHGEN] This program represents the administrative and managerial functions for the Behavioral Health Division, as well contracts and the budgetary logistics of pass-thru arrangements, and Behavioral Health Front Office. Primary Contact: Holly Harris, Behavioral Health Deputy Director https://www.deschutes.org/health/page/behavioral-health 17 Broad Health Goals: Saving LivesReduced mortality and suicide rates. Reduced substance abuse. Reduced hospitalization. Reduced incarceration. Reduced homelessness. Intended Benefits for Community Mental HealthExpand array of addictions and mental health services. Integrate primary care screening and coordination. Receive enhanced Medicaid payment rate based on costs. Healthcare Integration Focus 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. 18 BEHAVIORAL HEALTH ADMINISTRATION AND CCBHC FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Obtained funding and completed RFP to develop a new SRTF in Redmond. Implemented three workgroups focused on improving access to care, reducing administrative burden and improving clinical outcomes. Created the new Forensic and Acute Services Program, which will help align all forensically involved teams under one manager, creating efficiencies and added capacity for other parts of the department. Continued QMHP workforce retention and hiring challenges. Cost of living and housing challenges for new and existing employees. Rising houselessness for our service population. FY 25 Funding Changes FY 26 Program Changes None None FTE Changes and Detail 19 BEHAVIORAL HEALTH ACCESS [HSACCESS, HSINTEGRAT] Primary Contact: Amber Clegg, Program Manager 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 screenings, assessments, placement recommendations, care coordination, case management, and referrals for mental health and substance use disorder services. Clinical Administrative Support Team (CAST) Provides critical administrative and logistical support for day-to-day operations and projects, which reduces administrative burden for clinical staff. This Team helps manage and run reports, assists with workgroups and meetings, organizes projects, oversees fiscal processes, and tracks schedules. 20 FY 25 Funding Changes FY 26 Program Changes None. None. FTE Changes and Detail BEHAVIORAL HEALTH ACCESS FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Despite several significant staffing changes and vacancies, the Access team maintained an overall rate of access to care (routine and urgent) of 89%, including an outstanding 100% of urgent appointments. Due to grant dollars and the shifting of an admin position to the new Forensic and Acute Services Team, the CAST team was able to hire a permanent FTE that supports the COAST/HOST teams. The Access team continues to experience severe staffing shortages despite active and varied recruiting efforts. Although there was some reduction in admin burden for the Access team, the implementation of newly required American Society of Addition Medicine and Social Determinants of Health processes added more work to clinical and documentation workflows. Work space can be a challenge in some locations, impacting some of the CAST team. Pending plans for expanding space will likely alleviate this. BEHAVIORAL HEALTH COMPREHENSIVE CARE FOR YOUTH,FAMILIES & YOUNG ADULTS [HSINTYOUTH] Comprehensive Care for Youth, Families & Young Adults provides specialty mental health care and substance abuse treatment for individual’s ages 0-27 and their families through an array of integrated, intensive outpatient care teams: EASA, YAT, Wraparound, 2 Young Adult Drop-in Centers, 7 School Based Health Centers, and Child, Family & Young Adult Outpatient. Primary Contact: Shannon Brister-Raugust, Program Manager https://www.deschutes.org/health/page/comprehensive-care-youth- families-young-adults 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 Healthcare 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 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 Offered in Bend and Redmond, The Drop serves young adults ages 14 to 27. Offering Peer Support, guest speakers, games, discussion and socialization, and life skills introductions. The Behavioral Health Resources Network (BHRN) Team Provides substance use disorder treatment, peer support, harm reduction and recover services to Youth and Young adults. 21 We continue to experience a shortage of Comprehensive Care for Youth, Families and Young Adults positions and providers in South County. Particularly, the need for additional therapy and case management staff in the LaPine School Based Health Center. Currently this site is staffed at a .75 QMHP, which is insufficient in supporting the volume of students and referrals. Ongoing work at the OHA level continues, to bring Psychiatric Residential Care to Central Oregon. The Central Oregon System of Care, and Acute Care Council, in partnership with St. Charles, Pacific Source, Deschutes/Crook/Jefferson Counties, and local schools are all supportive of these actions, but need OHA funding and support. A vendor and land have been identified, if funding is available. In addition to Psychiatric Residential Care, we are working with local elected officials and community partners to decrease the gap in care for youth who enter the hospital in need of acute care services. The data highlights significant system gaps, which lead to inadequate support to our young people. 2026 presents some unique opportunities to close this gap, through legislation and partnership by increasing residential, crisis and acute care services. Comprehensive Care for Youth, Families and Young Adults has significant space challenges in Bend. There are opportunities that would combine all youth, family and young adult services into one centralized location. We experienced a 45% increase in The Drop attendance and have heard from our community an increased need for Drop-In hours. The Drop is currently staffed by Peers and Case Managers, who have full time caseloads and duties outlined by OAR’s in addition to The Drop. Additionally, The Drop is shared space with the Behavioral Health waiting room in Bend, and unstaffed during non-Drop hours in Redmond, limiting expansion. To expand The Drop hours, additional staffing and space are required. BEHAVIORAL HEALTH COMPREHENSIVE CARE FOR YOUTH, FAMILIES & YOUNG ADULTS [HSINTYOUTH] FY 25 Highlights and Accomplishments 22 FY 26 Challenges and Opportunities Two contracted shelter beds available to youth and young adults experiencing houselessness, who are at risk of hospitalization or incarceration. Three contracted shelter beds available to young adults experiencing psychosis, with an integrated memorandum of understanding between local agencies to coordinate care. Met with State Representatives, Bend Mayor, County Commissioner, families and key stake holders regarding barrier of children’s residential care; resulted in a formal Request for Information to the Oregon Health Authority. Expansion of services in Redmond, Oregon. We obtained a portion of our North County Campus (IYS NOCO), renovating facilities to support a second IYS campus. Expanded Fee for Service billing to all Wraparound Medicaid enrollees. Successfully completed 4 Year, 4 million-dollar Substance Abuse and Mental Health Services Grant. 1308 CLIENT VISITS AT THE DROP CENTER 45% FROM CY2023 23 BEHAVIORAL HEALTH COMPREHENSIVE CARE FOR YOUTH, FAMILIES & YOUNG ADULTS [HSINTYOUTH] FY 25 Funding Changes FY 26 Program Changes End of a 4-year, $4 million Substance Abuse and Mental Health Administration System of Care grant and local match requirements. None FTE Changes and Detail 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 Community Crisis Assessment Team (CCRT) A team that provides crisis intervention services out in the community. Co-responder Program A clinician and officer respond together to mental health related calls. 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. 24 174 NUMBER OF PEOPLE DROPPED OFF BY LAW ENFORCEMENT 48% FROM CY2023 646 PEOPLE SERVED THROUGH FACE TO FACES ON CCRT 36% FROM CY2023 3356 PEOPLE SERVED THROUGH PHONE BASED SUPPORT FOR CCRT 148% FROM CY2023 BEHAVIORAL HEALTH CRISIS [HSCRISIS] This program provides 24/7 crisis response including face-to-face and over the phone evaluations in the community and at the Deschutes County Stabilization Center (DCSC). Program goals include providing 24/7 access to crisis care. This program works to divert individuals with a serious and persistent mental illness (SPMI) from the criminal justice system when appropriate. Primary Contact: Nicole Von Laven, Program Manager https://www.deschutes.org/health/page/crisis-services 25 BEHAVIORAL HEALTH CRISIS FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Deschutes County Stabilization Center (DCSC) served 2289 individuals in 2024 and has served 11,118 total since opening. 159 of those individuals state they would have ended their life and 2927 say they do not know what they would have done if they had not accessed DCSC. Community based crisis team (CCRT) has served 3356 people through phone-based support. Staffing a 24/7 facility and community-based team continues to be a challenge within the behavioral health field, however we have been able to remain operational 24/7 for both programs. There continues to be a need for increased beds across various levels of care in the state of Oregon for all ages, but in particular youth in crisis. Deschutes County, in collaboration with community partners are working to increase level of care options in our community for all ages and needs. FY 25 Funding Changes FY 26 Program Changes A couple one-time grants are ending, including House Bill 5202 for 1.5 million. The crisis program continues to look for opportunities to receive consistent, ongoing funding in order for programs to remain operational 24/7. If any current grants we receive were to end, this would also impact operations, however that is not currently anticipated. None FTE Changes and Detail BEHAVIORAL HEALTH FORENSIC AND ACUTE SERVICES[HSFORENSIC] This program provides care coordination, referrals, treatment and supports for individuals who are forensically involved or in acute care / residential settings. Primary Contact: Evan Namkung, Program Manager https://www.deschutes.org/health/page/forensic-and-acute-services Exceptional Needs Care Coordination (ENCC) ENCC’s support members who are older or have disabilities, multiple chronic conditions, high health care needs, or special health care needs. They support these individuals in referrals to residential placement services, coordination of care between providers, and ongoing case management with community residential facilities and licensed care systems. Aid and Assist This program serves individuals who have been found unable to aid and assist in their own defense against criminal charges as a result of their mental illness. Individuals receive treatment, skills training, case management and resource coordination, and monitoring in order to restore their ability to participate in the legal process. Psychiatric Security Review Board This program serves individuals under the jurisdiction of the State PSRB. Individuals receive monitoring specific to the conditions of their community release as well as treatment, case management and other services as indicated. Civil Commitment The civil commitment team serves individuals who have been ordered to treatment by a court as a result of their mental illness. Individuals receive assessment and monitoring throughout the process, and the team coordinates with the courts, local hospitals, attorneys and other entities involved in the process. Forensic Diversion The Forensic Diversion team works with individuals who have current or previous involvement in the criminal justice system and who struggle with mental health issues. The team’s goal is to prevent recidivism and provide supports to help individuals remain in the community successfully. Mental Health Court Mental Health Court is a program where individuals agree to participate in mental health treatment and other requirements for a period of 12-18 months. If the program is completed successfully, charges can be reduced or dropped entirely. Typical participation requirements include taking medications, going to therapeutic appointments, attending substance treatment if appropriate, regular drug testing, and frequent case management appointments. 26 27 BEHAVIORAL HEALTH FORENSIC AND ACUTE SERVICES FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Deschutes County was one of six counties selected to pilot an Aid and Assist Community Navigator grant program, funding support for increased engagement with clients in this process. The new Forensic and Acute Services Program was created to better serve and collaborate around clients involved in the systems. The Forensic Diversion team added a new case manager position, which is embedded with the Parole and Probation (P&P) Department, to improve access to behavioral health services for those individuals under P&P. Community programs in the forensic realm continue to be underfunded, while caseloads increase and responsibility is funneled to counties to provide solutions for these populations. There is a severe shortage in community resources needed for these populations, specifically residential treatment services. FY 25 Funding Changes FY 26 Program Changes None None FTE Changes and Detail DHS The Department of Human Services – Office of Developmental Disability Services provides Medicaid and State General Fund dollars to CDDPs (Community Developmental Disability Programs) to provide eligibility determination, case management, abuse investigations, licensing and certification for foster homes for persons with IDD within the community. Case Management: Case management services are provided to all eligible kids and adults. Adult Abuse Investigation: Investigative authority for I/DD Adults in Deschutes, Crook and Jefferson Counties. Foster Home Licensing : Adult and child foster licensing, certification, renewal and monitoring. Case Management When Case Management is fully funded: Rapid Response to changing needs or crisis situations. Services are coordinated with community partners. Assurance that individual needs and goals are being met. Long term relationship with their Service Coordinators. Prevention and protection from abuse and neglect. Timely access to medical supports, employment, and housing. In order to participate in the match program the following must be met: Actual expenses are more than State base rate (FY26 expenses must be >$6.1 million). Reach service goals (# of encounters): 11k encounters per year. Have enough CGF (approximately 41% of Actual expense). Have enough CGF for uncovered indirect costs. Match Program $9.1M I/DD OperationalBudget 49.85FTE Intellectual and Developmental Disability Services (I/DD) To Promote and Protect the Health and Safety of Our Community Janice Garceau Holly Harris 15% Budget supportedby General Funds Community Based Care Behavioral Health Director Health Services Director People with intellectual and developmental disabilities (I/DD) often need community- based long term supports and services to support their needs and to live as independently as possible. This includes person centered case management, voluntary choice of services, services that span lifetime, and assistance for clients to access all services they are interested in. How the System is Funded: Core Services IDD Funding Model DHS conducts a “workload model” study each biennium. Study measures the scope, frequency and duration of all tasks performed by (CDDPs) using caseload data paired with forecasting of population growth to determine funding needed. 28 29 INTELLECTUAL & DEVELOPMENTAL DISABILITIES [HSIDD] 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/intensive-adult-services Int ellectual/Developmental Disability Services Available in Deschutes County: Intake, eligibility determination, referral Case management and service coordinat ion for adults and children Individualized planning and support Protect ive service investigations and support (for adults) Vocatio nal services Residential services Family support Comprehensive in-home supports Foster care Employment First 100% Individual Service Plans Renewed on Time The I/DD program is partnering with Behavioral Health in the development of a new residential licensed home to serve adults with I/DD who have co-occurring mental health conditions. This project will help serve these specific needs locally rather than relying upon seeking these types of services outside Deschutes County. Program is faced with transitioning this next budget year to a new electronic record system the State (DHS-ODDS) is developing and rolling out state-wide. This will be a significant change for our personnel to navigate while maintaining the high level of service quality our community relies upon us for. Sustainability: Funding projections from our contractor are uncertain and operating costs continue to increase, so our program will be actively exploring efficiencies that will allow us to continue at current service and quality levels while our enrollment numbers continue to climb. BEHAVIORAL HEALTH I/DD FY 25 Highlights and Accomplishments 30 FY 26 Challenges and Opportunities Moved the I/DD Program to two new office locations: one at W. Antler in Redmond and one at Wyatt Court in NE Bend. Operational adjustments were made in order to provide better public access to the geographic regions we serve. Completed a program audit by the State Quality Assurance team with a high degree of compliance consistent with prior program reviews. Administered a grant project utilizing over $100,000 in ARPA funding to provide disaster readiness supplies and equipment for individuals with I/DD, increasing their readiness and decreasing their reliance upon first responders during emergencies. 31 BEHAVIORAL HEALTH I/DD FY 25 Funding Changes FY 26 Program Changes We are moving into a new biennial funding allocation in July 2025. This is always a time of uncertainty until we are able to become aware of the “Workload Model” proposed by DHS- ODDS and submitted to the Legislative Finance Office and then what the Ways and Means committee advances as the Legislatively Approved Budget for our Community Developmental Disabilities Programs (CDDPs). During this year’s County Budget process, we have attempted to forecast revenue based on patterns of past fiscal awards and may be faced with making additional adjustments upon receiving the final budget allocation from DHS. None beyond staying apace of ever-growing client enrollment numbers. We’ve just hit 1000 clients enrolled which is a milestone that represents our outreach efforts across all corners of the community, celebrating its diversity, and expanding access to our services. FTE Changes and Detail 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) 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. Homeless Outreach Services Team (HOST) HOST team provides street outreach and case management support to houseless individuals with Serious Mental Illness and/or Substance Use Disorders. 32 BEHAVIORAL HEALTH INTENSIVE ADULT SERVICES[HSADLTINT] This program provides intensive 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 Website: https://www.deschutes.org/health/page/intensive-adult-services 33 BEHAVIORAL HEALTH INTENSIVE ADULT SERVICES FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Added on-site dental options for our clientele which complements our on-site primary care, pharmacy and Behavioral health care for serious and persistent mental illness (SPMI) clients. We restructured our housing project, Horizon House, to prioritize SPMI houseless clients, and increased on-site treatment support delivered by our Homeless Outreach Services Team. Our Homeless Outreach Services team provided 875 visits to 225 clients 2024. There are some community housing programs coming online that are likely going to support our clientele. FY 25 Funding Changes We are exploring potential certification for Environmental Council of the States (ECOS) that may expand revenue for our Older Adult and Homeless Outreach Services teams. Older Adult Behavioral Health Initiative (OABHI) is funding an additional position for our Older Adult team. FY 26 Program Changes The department underwent some restructuring, creating a Forensic and Acute Care Services program. Residential, Aid and Assist, PSRB, and Mental Health Court are now a part of this new program and are no longer a part of Intensive Adult Services. FTE Changes and Detail 34 BEHAVIORAL HEALTH MEDICAL TEAM [HSMEDICAL] This program integrates psychiatry into all clinical services. Collaborates with primary care to provide integrated, holistic care. Supports health promotion, health literacy, and health maintenance through a harm reduction lens. Primary Contact: Chandra Mola, Program Manager Website: https://www.deschutes.org/health/page/behavioral-health Street Psychiatry Outreach Providers rotate one time a month for half a day partnering with the homeless outreach team to bring psychiatric services directly to China Hat. Much of the work is building rapport and working to identify people suffering from severe mental illness an assessment, medication if indicated, and connection to services. Addiction Medicine Programming Use knowledge and expertise of our staff to enhance our SUD Services agency wide. Harm Reduction (HRP) 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. 35 BEHAVIORAL HEALTH MEDICAL TEAM FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Successfully transitioned from 4 telehealth providers to 2 telehealth providers and added 2 in person providers. Added an in person Licensed Mental Health Professional (LMHP) support to South and North County. Added a supervisor to support a growing team and services. Expanded Street Psychiatry Outreach services to China Hat and Juniper Ridge. Added urgent care, drop-in crisis psychiatric services to the Stabilization Center. Expanded Harm Reduction Services to Sisters. Hosted 5 Psychiatric Mental Health Nurse Practitioner (PMHNP) students. Continue to expand crisis psychiatric services at Deschutes County Stabilization Center (DCSC). Continue to expand and restructure street psychiatry to meet the need of our unhoused population. Continue our efforts to eliminate all telehealth contracts and transition to all in person LMHP’s. Add a clozapine clinic to support independence and stability for clients ready to transition to maintenance model. FY 25 Funding Changes FY 26 Program Changes None. The Harm Reduction team was moved under the medical team umbrella. The team added a supervisor to support the team growth. FTE Changes and Detail 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 treatment with a focus on providing co-occurring substance use and mental health treatment. 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 [HSADULT,HSNOCO, HSSOCO] 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 36 37 FY 26 Challenges and Opportunities The Complex Care Team was awarded the Veteran Behavioral Health Peer Support Specialist Grant. Staffing on all four of the teams (AOP and the Hubs) has been stable, all teams are fully staffed with minimal turnover this past year. All teams report a significant improvement in the reduction of administrative burden with the changes made to our documentation requirements. This has improved morale and work satisfaction. Engaged in a continuous improvement process to identify gaps and improve our processes to better serve our clients. BEHAVIORAL HEALTH OUTPATENT COMPLEX CARE FY 25 Highlights and Accomplishments Space continues to be a challenge in our South County Clinic. We do not have enough space to accommodate all the staff that we have and the services that we provide. Our North County and AOP teams are in need of additional funding to support a more robust case management and peer support team. High level of acuity and complex needs of the population we serve coupled with a lack of access to needed resources that support recovery. FY 25 Funding Changes None. 38 BEHAVIORAL HEALTH OUTPATENT COMPLEX CARE FY 26 Program Changes The Complex Care Team will be implementing a new co-occurring mental health and substance use disorder treatment pilot. The pilot will serve individuals who are needing more intensive treatment to support their recovery. Our goal is to expand this pilot to all four teams as well as other DCBH teams by the end of this year. FTE Changes and Detail 39 PUBLIC HEALTH KEY STATS Public Health To Promote and Protect the Health and Safety of Our Community$20.8M Public Health Operating Budget Budget Janice Garceau Heather Kaisner Prevent, investigate and protect people from communicable diseases. Ensure safe food and water. Promote health and prevent chronic disease and injury. Prepare for and respond to natural or human caused emergencies and emerging health threats. Ensure equitable access to preventive health services. Create and ensure conditions that equitably improve health and well- being for all. Foster policy, systems and environmental change to prevent and reduce unhealthy behaviors and reduce healthcare costs. Convene community engagement to sustainably prioritize change across multiple sectors and systems of care. Local Public Health Authority: County Commissioners - BoCC. Local Public Health Agency (LPHA): 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 PH Director, authorized by the BoCC to oversee the Local Public Health Agency. 23% Budget supported by General Funds What We Do Local Public Health Delegations of Authority Public Health Director Health Services Director 90.95FTE Public Health promotes and protects the health of everyone who lives, works, and plays in Deschutes County: 40 Public Health Sections Statutorily or contract required services and grant funded programs How the System is Funded: The Environmental Health, Preparedness, and Engagement team is committed to protecting public health by ensuring the safety of resources while also strengthening community resilience and engagement through emergency preparedness, epidemiology, community partnership development, and communication initiatives. Food Service, Pool & Tourist Facility Licensing & Inspections, School Lunch Inspections, Food Handler & Manager Training Drinking Water Education & Regulatory Management Childcare Facility Inspections & Education Environmental Hazard Response including lead and animal bites Indoor Air Quality Program Climate & Health Initiatives including smoke response Public Health Emergency Preparedness Community Partnership Development & Communications Assessment & Epidemiology Health Risk & Crisis Communications Ensures and promotes practices to improve health and well-being and prevent negative conditions that are harmful to our community both socially and financially Suicide prevention and postvention Central Oregon Suicide Prevention Alliance (COSPA) Mental Health Promotion My Future My Choice program (6th grade) Healthy Schools, Sources of Strength, UpShift, School Based Health Centers Alcohol, tobacco, and other drug prevention Substance overdose prevention & response Problem gambling prevention, outreach and referral Shared Future Coalition Teen Community Health Advocates Youth Engagement School Based Health Centers Family-focused services including family-child home visiting nurses, perinatal care coordination and Women, Infants and Children (WIC). Comprehensive maternal and infant/child assessments including developmental screenings Breastfeeding support Case management and resource navigation Parent health education and family coaching Nutrition education and counseling Birth and death certificates Prevention & Health Promotion FTE 17.60 Clinical & Family Services FTE 32.4 Preparedness Engagement & Environmental Health 18.1 Communicable Disease Prevention & Management FTE 13.4 PH Administration FTE 9.45 Overall leadership and oversight of local public health staff, programs, and services. Assures statutory, fiscal, and programmatic requirements are met. Works to diversify and prioritize resources to meet changing community health needs and emerging public health threats. Also responsible for coordination of: Public Health Advisory Board Ambulance Service Area Administrative and Legislative Advocacy Prevent and control the spread of communicable diseases (CDs) and mitigate health threats through surveillance, education, investigation, outbreak control and immunizations. Communicable Disease & Outbreak Investigation Infection Prevention in Congregate Settings Tuberculosis Program Immunization Program, including School Law Regional CD/STI/HIV Epidemiology HIV and Sexually Transmitted Disease Programs Access to Preventive Clinical Services HIV Ryan White Case Management OHA The Oregon Health Authority provides Federal Grant and State General Fund dollars to local public health authorities through the Intergovernmental Agreement (IGA) for the Financing of Public Health Services. The IGA sets forth the duties, functions and responsibilities of the local public health authority. Grants Deschutes County Public Health receives local, state, and federal grant funds. Most grants are time limited and cover distinct costs and programs. A limited number of Public Health services collect fees through licensing, birth and death certificates, and insurance billing for clinical preventative services. Fee for Service CGF Local resources applied to help cover costs of mandated or other county service priorities not covered by other revenue sources. PUBLIC HEALTH ADMINISTRATION [HSPHGEN] This program provides leadership, management and oversight for local public health (PH) services and assures that the county meets statutory, fiscal and programmatic requirements. PH Administration works to diversify, leverage and assure effective and efficient use of resources to build foundational programs and capabilities as well as meet community priorities and respond to emerging public health issues. Primary Contact: Heather Kaisner, Public Health Deputy Director Website: https://www.deschutes.org/health/page/public-health Broad Public Health Goal: Promote and protect the health of people in Deschutes County through: Preventing the spread of communicable diseases and outbreaks Food and consumer safety Clean and safe drinking water Ensuring access to essential preventative health services Helping new parents and babies get off to a healthy start Education about healthy lifestyles Reducing and preventing high-risk behaviors among youth Responding to pandemics, climate impacts, and other emerging health Public Health Modernization A set of foundational capabilities and programs to ensure a core set of public health services is available in every county in Oregon. Deschutes County Public Health continues to move toward full implementation of Public Health Modernization and received increased State funding in the FY 24-25 Biennium. This public health transformation focuses on ensuring all communities have the same health protections through a sustainable public health system ready to respond to current and future public health challenges. 42 43 PUBLIC HEALTH ADMINISTRATION FY 25 Highlights and Accomplishments FY 26 Challenges and Opportunities Increased collaboration, communication, and active surveillance to respond to drug overdose fatalities and non-fatalities. Including: hiring a dedicated overdose prevention coordinator, internal cross-collaboration with Harm Reduction, Epidemiology, and Prevention, active monitoring and implementation of a spike response and communication plan, real time data collaboration with the County Medical Examiner, providing monthly situational awareness to community partners, development of public education campaigns, implementation of a county-wide needs assessment, and feasibility assessment of community Naloxone distribution containers. Preliminary data is showing Deschutes County rate of overdose deaths is substantially lower than the State rate. Continued to assess programs and services to ensure ongoing sustainability and changing community needs. This resulted in moving HIV case management services to a local community-based organization and pivoting away from providing direct reproductive health services to ensuring quality access and providing technical and subject matter expertise to all clinics in the community. Stable funding for core Public Health services to prevent and respond to emerging issues and threats continues to be a challenge. Continued challenges in recruiting and retaining clinical Registered Nurse (RN) positions. Growing threat of communicable diseases such as syphilis, pertussis, and measles. Opportunity to advocate for more primary prevention and public health modernization funding at the State level. 44 PUBLIC HEALTH ADMINISTRATION FY 25 Funding Changes Uncertainty about public health modernization funding in the next biennium. Uncertainty about public health programs and services that rely heavily on federal funding. FY 26 Program Changes None. FTE Changes and Detail Adolescent Health Provides information, training, and materials to assure comprehensive sexuality education is accessible to all adolescents. Coordinates the My Future-My Choice (MFMC) program for Deschutes County. MFMC is a sexuality education curriculum that meets 6th grade requirements set by the Oregon Department of Education. Healthy Schools Local partnership between Deschutes County and Bend-La Pine Schools embedding public health services directly within schools to assure students, families, and school staff have access to high quality prevention and health promotion programs and services through their K-12 school. Mental Health Promotion and Suicide Prevention Public Health expertise to ensure proactive policies, systems, and environments are in place in order to prevent suicide death and attempts and to promote community resilience among all age groups. Substance Misuse and Problem Gambling Prevention Public Health expertise to ensure policies, systems, and environments align to prevent and reduce problem gambling, misuse of tobacco, alcohol, cannabis, and prescription drug or illicit drug use among 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. PUBLIC HEALTH PREVENTION AND HEALTH PROMOTION[HSPREVENT] Programs in this section work together to lead work with partners that promote and ensure practices to 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 45 2022 Deschutes 11th Grade, 30-Day Use of Substances 2022 Oregon Student Health Survey OPHAT, CDC Wonder * data for 2023—2024 is preliminary and subject to change PUBLIC HEALTH PREVENTION AND HEALTH PROMOTION FY 25 Highlights and Accomplishments 46 FY 26 Challenges and Opportunities Three years of Healthy Schools has prevented 21% (84 of 408) of the expected number of emergency departments visits for ages 11-17 related to suicide, substance use, depression, and mental health. 100% of middle and high school Health teachers in Bend-La Pine Schools are using at least 2 effective skills-based prevention education programs, and 100% are covering important prevention topics, including suicide and child sexual abuse prevention. Creation and implementation of the Overdose Surveillance and Response Plan, which outlines how Deschutes County mobilizes and responds to increases in substance-related harms, especially fatalities. Collaborative development of a Central Oregon Secure Firearm Storage program, including a marketing campaign, community awareness, and distribution of firearm locks and safes for suicide prevention. In partnership with Spanish-speaking community partners, ensure all Prevention and Health Promotion resources, educational materials, campaigns, and outreach events are translated and culturally relevant. Prevention requires long-term investment to result in cost savings and improved community health (e.g. reductions in costs for healthcare, criminal justice, education, social welfare, etc.). Funding has historically been 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 legislation has significant gaps; all suicide postvention legislation are unfunded. In addition, legislation does not include Community Colleges, does not include youth who have parents who have died by suicide, nor youth who have attempted suicide. Overdose postvention legislation has been based on suicide postvention legislation, which has not been evaluated for effectiveness and is also an unfunded mandate. Changes in some OHA program requirements are allowing for integration of service areas across Prevention where prior requirements were very siloing. An example is fiscal support from Tobacco Prevention for Healthy Schools programming. Healthy Schools Family Night 47 FTE Changes and Detail PUBLIC HEALTH PREVENTION AND HEALTH PROMOTION FY 25 Funding Changes The Garrett Lee Smith Grant was awarded to Deschutes County for two more years through September 2026 to support youth suicide prevention. The Strategic Prevention Framework-Partnerships for Success grant was awarded to Deschutes County for four years through September 2028 to support substance misuse prevention community collaboration. The Behavioral Health 2023 Shared Savings Investment funds were awarded to Deschutes County for Calendar year 2026 to support Healthy Schools. The Opioid Settlement Board through OHA has awarded counties one-time funds to support primary drug prevention strategies and workforce support The CDC Drug Free Communities grant sunsets in September 2025. The OHA anticipates a 20% reduction in biennial allocations for Tobacco Prevention. FY 26 Program Changes Loss of the 1.0 FTE Public Health Educator II in Adolescent Health. This work prevents or delays initiation of adolescent sex, prevents sexually transmitted infections and teen pregnancies, and builds youth’s skills to make informed choices about relationships and their health. Emergency Preparedness and Response Monitors 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. Assessment and Epidemiology Assessing the effectiveness of public health programs and their outcomes, as well as continuously analyzing health risks within our community. Community Partnership Development and Communications Outreach and engagement efforts targeting all communities and demographic groups, with a specific focus on tailored outreach for those experiencing health inequities. Fostering collaborative relationships across different sectors of the community and engaging in strategic planning with community-based organizations and partners to achieve public health objectives. Health Risk and Crisis Communications Disseminating information regarding local public health risks and advising individuals on steps to safeguard themselves, their families and the community. ENVIRONMENTAL HEALTH, PREPAREDNESS AND ENGAGEMENT[HSENVIRON] [EMERPREP] This public health section embodies a comprehensive approach to modernizing public health, incorporating foundational capabilities such as emergency preparedness, epidemiology, health equity promotion, community partnership development, and communication. These efforts continue to be integrated across all public health program areas. The Environmental Public Health Program stands out for its dedication to community protection, ensuring the safety of vital resources like food, air, and water. Through a combination of prevention education initiatives and regulatory inspections, the program actively safeguards public health, reflecting a commitment to proactive health promotion and disease prevention. Primary Contact: Emily Horton, Program Manager Website: https://www.deschutes.org/health/page/environmental-health https://www.deschutes.org/health/page/emergency-preparedness 48 Food Service, Pool and Tourist Facility Licensing and Regulatory Inspections Regulatory oversight encompasses 1,156 food service facilities, 149 lodging establishments (including motels, hotels, resorts, RV parks, and campgrounds), 349 temporary restauraunts and 301 public pools and spas. Inspections emphasize education and disease prevention to ensure safety standards are met. 200 Complaint Responses/year. Implemented a quality improvement program through the Voluntary Retail Program Standards (FDA Program). PUBLIC HEALTH EMERGENCY PREPAREDNESS & ENVIRONMENTAL HEALTH 49 Childcare Facilities Inspection and educational outreach of 165 Childcare facilities, including pre-school, Headstart and Pre-K. Environmental Hazard Response Response to detected elevated blood lead level cases including education, investigation and environmental assessment. Respond to 300-400 animal bites/year. Provide consultation on rabies risk, quarantine and testing options to individuals, families, veterinarians and community organizations. Respond to community questions and concerns for environmental health hazards such as blue green algae, air quality and mold. Indoor Air Quality Program Direct outreach and education to schools and childcares including providing air quality monitors and follow up related to poor air quality. Climate and Health Community education, communications and coordination for climate and health issues including wildfire smoke, extreme heat, drought, vector borne disease, and wildfires. School Lunch Inspections Inspection of 63 local area school lunch programs serving students of Deschutes County. Food Handler and Manager Training Food handler training and certified food manager training offered to local business owners and their staff. Drinking Water Education and Regulatory Management Administration and enforcement of drinking water quality standards for the 185 Deschutes County public water systems. Educational outreach and technical support for private well owners throughout the county. Eric Mone presenting results of inspectional data at the Food Safety and Sustainability Summit at COCC, Fall 2024 PUBLIC HEALTH EMERGENCY PREPAREDNESS & ENVIRONMENTAL HEALTH FY 25 Highlights and Accomplishments 50 FY 26 Challenges and Opportunities Environmental Health Restructure Continuity planning and cross training in drinking water program, pool and spa inspections. Improved Environmental Health’s food safety inspection program by establishing standardization exercises and consistent training, and field reviews (regular assessment). Using the Voluntary Retail Program Standards as a model, met and audited 3 standards (standards 3, 7 and 9). Award winning Public Health Emergency Preparedness Program- Expanded exercises and Medical Reserve Corps development through mission sets and training. Continuing reliance on fees for Environmental Health (EH) services. Economic challenges for licensed Mobile Food Units (MFU), Oregon State Fire Marshal now requiring installation of a Type 1 grease hood. Requirement went into effect Jan. 1, 2025. Average cost of hood is $3k-6k. Anticipated decrease in number of MFU operating. Upcoming retirements of staff with decades of experience, program expertise and institutional knowledge. Leveraging built relationships with community partners and better capitalization on Oregon Health Authority Community Based Organization funding work to align programmatic goals and objectives with community organizations. FY 25 Funding Changes NEHA-FDA Grants: Year 1 (April 1, 2025-March 31, 2026) $21,500 Year 2 (April 1, 2026 – March 31, 2027) $15,000 Year 3 (April 1, 2027 – March 31, 2028) $15,000 increased county investment in EH including Video Lottery Funds, Transient Room Tax, and County General Funds. MRC STRONG Grant ending FY 26 Program Changes EHS-Net Grant: Anticipated. $200,000 for budget period beginning Sept. 30, 2025. Expected Award Announcement Date: August 29, 2025 PUBLIC HEALTH EMERGENCY PREPAREDNESS & ENVIRONMENTAL HEALTH FTE Changes and Detail 51 Communicable Disease & Outbreak Investigation Work to Reduce the risk of spread of CD by tracking infectious diseases to their source and notifying people who have been exposed. Infection Prevention in Congregate Settings Works with congregate care facilities such as long-term care facilities and shelters to mitigate the spread of infectious diseases through education and technical assistance. Regional CD/STI/HIV Epidemiology Evaluates health risks and general CD trends within our community through surveillance, data analysis, and timely community messaging. HIV and Sexually Transmitted Disease Programs This Program section has a duty to identify and investigate HIV and STIs to minimize complications and prevent spread. This is achieved through educational services, community outreach, prevention counseling, testing, and assuring treatment for case and their partners. Immunization Program, including School Law Assesses county immunization rates and barriers to vaccine access and strategies with providers to remove barriers to increase vaccine access and improve immunization rates with the goal of decreasing rates of vaccine-preventable disease, disability, and death. Strategies include vaccine provision, clinic logistics as well as provider and public education. HIV Ryan White Case Management Empowers people living with HIV/AIDS to effectively manage their HIV and improve their overall health and quality of life. Local case managers have a thorough understanding of the services and programs available to help clients manage challenges and crises related to health, housing, treatment, coverage for health care, and referrals for needed services. Tuberculosis (TB) Program Oversees, manages, and facilitates activities and interventions needed to identify and properly treat all individuals with TB to stop its spread to others. COMMUNICABLE DISEASE, PREVENTION AND MANAGEMENT(CD P&M) [HSCOMMDIS] Prevent and control the spread of communicable diseases (CDs) and mitigate health threats through surveillance, education, investigation, outbreak control and immunizations. Primary Contact: Rita Bacho, Program Manager Website: https://www.deschutes.org/health/page/communicable-disease- programs 52 1,009 total non-COVID communicable disease cases (538 STI/HIV; 471 CD (non-STI/HIV)) reported to Public Health in 2024, 67 total outbreaks managed (38 COVID; 29 non-COVID). Managed one active tuberculosis case, delivering daily directly observed therapy (DOT), conducting home visits, and coordinating care with healthcare providers, totaling 170 staff hours. 63 flu vaccines provided to the community through outreach and safety net clinics. 479 other vaccines provided through safety net clinic. 418 people subscribed to the flu report in 2024, compared to 472 in 2023 and 382 in 2022 Successful, timely school exclusion process during school year 2023/2024. Strengthened Local Public Health Authority (LPHA) partnership with congregate settings. Created and updated Standard Operating Procedures (SOPs) for immunization programs. 98% of syphilis cases were interviewed and received appropriate treatment: 74% of these cases received treatment from the STI/HIV nurses. The STI/HIV Team conducted 59 outreach testing events in CY24 providing rapid testing, education and referrals (401 HIV, 372 Hep C, and 391 syphilis). Initiated framework for conducting a community assessment of reproductive health access and barriers. PUBLIC HEALTH COMMUNICABLE DISEASE, STD/HIV, EPIDEMIOLOGY AND IMMUNIZATION PROGRAMS FY 25 Highlights and Accomplishments 53 FY 26 Challenges and Opportunities Vaccine hesitancy. Staffing changes causing increased workloads. Syphilis is a complicated disease STI nurses spent over 180 hours in CY24 following up on syphilis labs that did not result in a case. Increased opportunities to collaborate with providers and the community through the ‘Access to Preventive Clinical Services’ program element. 54 PUBLIC HEALTH COMMUNICABLE DISEASE, STD/HIV, EPIDEMIOLOGY AND IMMUNIZATION PROGRAMS FY 25 Funding Changes New HIV/STI Statewide Services (HSSS) Program Element was created to combine PE07, PE10 and PE73 to provide HIV/STI funding to all counties in Oregon. The new Program Element will begin FY26 with no funding changes for Deschutes County until FY28. PE 46 Access to Preventative Clinical Services was moved to the STI/HIV Team within CD Prevention and Management. The STI/HIV Team took on providing safety net clinic services for STI/HIV screening visits. FY 26 Program Changes The Ryan White Case Management Program will be transitioned to Eastern Oregon Council on Independent Living (EOCIL) starting FY26. EOCIL has provided Ryan White services since 2003 and currently serves 14 other Eastern Oregon Counties. FTE Changes and Detail Nurse Family Supp ort Services (NFSS) Provides direct nursing support to pregnant and post-partum women, new parents and families to improve birth, postpartum, infant and child health outcomes, and enhance family relationships. Perinatal Care Coordination (PCC) Provides pregnant and postpartum individuals access to and enrollment in prenatal care, medical insurance application assistance, nutrition resources, primary care, behavioral health and dental care coordination, medical transportation, and many other services. 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 infants and children. 55 CLINICAL AND FAMILY SERVICES [HSPHDIRECT &HSCLINICAL] These programs are focused on providing safety-net public health services to individuals and families seeking perinatal education and care coordination, nurse home visiting, nutrition education, breastfeeding support, and referrals to needed resources. Primary Contact: Anne Kilty, Program Manager Website: https://www.deschutes.org/health/page/clinics-and-services PUBLIC HEALTH CLINICAL AND FAMILY SERVICES FY 25 Highlights and Accomplishments 56 FY 26 Challenges and Opportunities In July 2024, Public Health’s NFSS team applied for and was granted the Family Connects Community Lead role, providing greater flexibility and control over the Family Connects program in Deschutes County. In November 2024, the Family Connects team was fully staffed and working with prenatal and pediatric partners to increase promotion of and participation in Family Connects visits. Over the past 2 years WIC has increased participation by 17% after nearly 2 decades of declining caseloads. At the OHA biennial review in May 2024, WIC was recognized for consistently serving above their assigned caseload. Deschutes County WIC accounts for 4% of the state’s caseload, yet it accounts for 10% of the state’s increased participation. PCC celebrated its 9th anniversary in October 2024. With the expansion and growth of the program, the team has been able to cast a wider net in the community providing more support to pregnant and postpartum people. Since the PCC program was launched, they have served over 8,000 pregnant and postpartum individuals in the community! The Clinical & Family Services leadership team with the support of Health Services’ Business Intelligence team are developing a data-driven strategic plan that will optimize the NFSS and PCC team structures to balance workloads, provide redundancy for TML/Vacancies, decrease burnout, enhance longevity, and increase revenue thereby ensuring sustainability. Family Connects Oregon continues to evolve at the state and local levels, challenged by underutilization. The latter half of FY25 and FY26 will be focused on assessment and optimization of the Family Connects program including community demand, staffing support, and fiscal stewardship. WIC’s great success at reaching and serving more families in Deschutes County has resulted in increased staff workload and coverage pressures. The challenge will be to meet this demand and prepare for continued increase in participants while maintaining awareness of fiscal constraints. PUBLIC HEALTH CLINICAL AND FAMILY SERVICES 57 FY 25 Funding Changes There is a proposal in the FY26 state budget that, if passed, will eliminate the 40% LPHA match for Babies First! and CaCoon visit revenue. Based on FY24 visits, this would have resulted in an additional $240,000 for those programs. FY 26 Program Changes During FY25, the decision was made to close the reproductive health clinics and move from providing direct reproductive health services to assuring robust access to these services in our community, through community partners. Midway through FY25, the WIC and Public Health front desk teams were combined into a single Public Health Front Desk team. This will address changing workloads with the closing of the clinics, increased caseloads in WIC, and balancing of workloads. This combining of teams allows for cross-training, increased administrative support to staff, sustainability, and will improve the experience of clients and the public. FTE Changes and Detail