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Home My WebLink About9-8-23 Audit Committee Minutes APPROVEDX For Recording Stamp Only Minutes of the Meeting of the Deschutes County Audit Committee Date: September 8, 2023 Facilitator: Elizabeth Pape, County Internal Auditor Audit Committee Public Members {6 members) Daryl Parrish, Chair Summer Sears X Joe Healy X Jodi Burch (via Zoom) Stan Turel Audit Committee County Management Members {3 members) X Patti Adair, County Commissioner X Charles Fadeley, Justice of the Peace Lee Randall, Facilities Director Others Present: X Aaron Kay, Performance Auditor Nick Lelack, County Administrator X Erik Kropp, Deputy County X Whitney Hale, Deputy County Administrator Administrator X Robert Tintle, CFO X Jana Cain, Accounting Manager/ Controller (via Zoom) X Holly Harris, Director Behavioral Health X William Kuhn, Treasurer X Angie Powers, Administrative Assistant X David Givans, Former County Internal Auditor Admin/BOCC This HYBRID meeting was held virtually via Zoom Conference Call, and in the OeArmond Room of the Deschutes Services Building. CALL TO ORDER: Vice-Chai r Joe Healy called the meeting to order at 12:03 p.m. AGENDA: 1. Introductions/ Additions to the Agenda/ Approval of Minutes for June 9, 2023 Chuck Fadeley moved approval of the minutes of the June 9, 2023 meeting. Commissioner Adair supported the motion. Votes: All YES . Motion carried. 2. Internal Audit Report: Behavioral Health Process Improvements 22/23-9 {Tentative) Aaron Kay, Performance Auditor, presented this item. David Givans' work from 2014, related to staff productivity in Behavioral Health (BH), led to this audit's objectives. Aaron thanked Holly Harris and Janice Garceau for their support throughout this audit. The goal was to look at high- AUDIT COMMITIEE MEETING September 8, 2023 Page 1 of 4 performing staff, and to determine if anything they were doing could translate to the department as a whole. This audit resulted in nine recommendations. • #1 -Current clinician productivity measures are ineffective. This tool is not working as intended, and the measure is not capturing actual work. The recommendation was to re-envision productivity for clinicians, and align clinician goals with that of the team and the department. • #2 -The service hour tool does not reflect the time clinicians spend on client care. 75% of their work consisted of client care, but the service hour tool only reflected 25% in client care . BH will review the accuracy of data contributing to clinician workload measures. Holly shared that the time study was very beneficial. • #3 -The caseload distribution system is not functioning effectively. A disparity was found amongst clinicians between the highest and lowest caseloads. Better controls are needed, to track those clients taken in to care and those exiting, with a goal to minimize staff burnout. Holly reported that FT As (First Treatment Appointments) are being examined more carefully. • #4 -Specialization limits the efficiency of the division. It limits the flexibility to make accommodations, should BH experience an influx of certain patients or staff turnover. South County highlighted this area well, due to its under-staffing. They are unique, in that they serve the entire age range of patients. Willing staff were given the opportunity to expand their skillsets. Holly reported that measures put into place to get South County better staffed have worked. • #5 -Technology can be leveraged more effectively. The EPIC system is robust and has some great features that are used by some clinicians on a limited basis. Several clinicians have "smart phrases" for use when documenting client encounters. A library of smart phrases will be made available to a wider range of sta ff, along with training and individual ized preformatted templates. o At Erik's request, Holly provided an example of smart phrases and how they are being utilized. • #6 -The on boarding procedures for new therapists could be strengthened. Reports show that EPIC training can be overwhelming. The other piece of onboarding consists of more direct supervision and job shadowing. The recommendation is to slow down the onboarding process, to let the vast amount of information soak in better. Aaron shared that employee performance evaluations are a great way to boost retention. BH prefers a two-month check-in process on new staff members' understanding of information, over a more com prehensive evaluation. Holly shared that Welcome Week is offered to new employees, and fitting in EPIC training and job shadowing is currently being re-evaluated . o Holly elaborated on how EPIC is tailored for medical health care providers and presents challenges for behavioral health clinicians. • #7 -The division's policy on supervision of interns lacks clarity. The recommendation is to clarify the policy for supervision of interns. • #8 -The ava ila bility of vehicles is an obstacle for some clinicians. There is a high utilization of vehicles at the downtown campus, yet the number of vehicles don't reflect the increase in staffing numbers. Parking shortages exist at the downtown campus, and this presents a barrier to BH teams who are based downtown. An idea is to create a downtown motor pool for use by all departments, leading to improvements in availability. Whitney shared that Facilities is currently conducting a Audit Committee Meeting September 8, 2023 Page 2 of 4 parking study and will look at the campus holistically. They will reallocate fleet, visitor and staff parking allowances. o Responding to Commissioner Adair's question about County staffing at the Veteran's Village and the Navigation Center, Holly said that there is currently one County staff member at the Navigation Center for 40 hours per week. Holly added that County staff would visit Veteran's Village if they have BH clients at that location. • #9 -Aaron shared a number of methods utilized by highly productive clinicians that could be promoted to increase productivity for all clinicians. Some examples are to schedule dedicated time for documentation and utilize smart phrases to reduce writing burden. • Responding to Commissioner Adair's question about current figures on licensure of clinicians for Substance Use and Abuse Disorder, Holly said that she will look for these figures and get back to her. • Responding to Joe, Holly reported that community mental health is a training ground for clinicians who will often go into private practice after obtaining the relevant training. This presents an ongoing challenge for BH for staff retention. Private practice is able to place limitations on caseloads, creating a disparity in caseloads amongst community behavioral health vs . private practice. • Holly said that reducing ORS administrative burden, internally, will be a primary focus of Behavioral Health in 2024. 3. Follow-Ups • Justice Court 22/23-13 Aaron said that the two recommendations are 100% completed before the follow-up date, but it was no small feat. He commended Jodi Stacy for her hard work. 4. Competence, Professional Education and Quality Assurance (GAGAS 4 and S) Aaron spoke about two chapters from the Yellow Book. o The definition of competence from Chapter 4 and Merriam-Webster were shared. A competent audit team is key, and there are key indicators for competence. Specialists can be utilized as an alternative if in-house competence isn't up to standard. o Continuing professional education is necessary to stay on top of the latest changes. Specialized knowledge is often necessary, in areas such as information technology and elections. o Internal Quality Control standards -This section of the Yellow Book is undergoing an update on systemizing. o External Quality Control -Peer review by external auditors ensures objectivity and meeting industry standards, an provides continuous feedback on process improvement. 5. Audit Committee Survey Upcoming Elizabeth Pape, County Internal Auditor, spoke about the Audit Committee Survey, which is a self-reflective survey of Audit Committee members. The survey consists of 46 questions, with ratings ranging from strongly agree to strongly disagree. The results from the most recent survey in 2020 were shared. As compared to previous surveys dating back to 2005, notable changes from 2020 were highlighted. Audit Committee Meeting September 8, 2023 Page 3 of 4 Next steps: An email survey link will be sent out mid-month. The survey deadline will be October 31. Results from the survey will be shared at the December meeting. Elizabeth will email the 2020 survey results out to the Audit Committee. 6. Update -County leadership recruitments/changes Whitney Hale, Deputy County Administrator, provided a brief update on County leadership. She welcomed Elizabeth Pape as the County Internal Auditor. Chad Centola retired, and incoming Solid Waste Director, Tim Brownell, is now working solo. Sheriff Shane Nelson announced his intent to retire January 2025, and so he will not seek re-election. If fewer than three candidates file, it will move to a November election from a May election. 7. Updates/ Other Items Elizabeth shared the continuity of operations report, which was shared at the last meeting, as an update. • Review status list (listing on agenda) • Audits and follow-ups in process: Global Follow-Up 2023, Property and Facilities Cash Handling, Follow-up Sheriff Cash Handling, DA Cash Handling, Vacation and Sick Leave Follow-Up Audit • Equity of wages and benefits and compensatory time audits are just getting started. • See Internal Audit Status Report for June 2023 through August 2023 • Ad min vs. Audit time comparison is reflected in the transition of the County Internal Auditor. • Recruitment for new committee member will take place over the next couple of months. 8. Other Business/Closing Robert Tintle shared that Moss-Adams is currently on-site for the County's external financial audit. This is the second year of the audit, and they are digging deeper. Moss-Adams' presentation will likely take place at the next Audit Committee meeting in December. Responding to Commissioner Adair, Robert provided a general timeline for an update on the Employee Health Benefits fund. Vice Chair Healy thanked everyone for their attendance and participation. The next meeting is scheduled for December 8, 2023, 12:00-3 :00 p.m. Adjournment: Being no further issues brought before the Committee, the meeting was adjourned at 1:10 p.m. Respectfully submitted, BOCC Administrative Assistant Audit Committee Meeting September 8, 2023 Page 4 of 4