WRIGHT COUNTY HUMAN SERVICES AGENCY MINUTES January 28, 2013

Transcription

1 1:30 P.M. PLEDGE OF ALLEGIANCE. WRIGHT COUNTY HUMAN SERVICES AGENCY MINUTES The regular meeting of the Wright County Human Services Board was called to order at 1:30 P.M., Monday,, by Chairperson Husom. The agenda was moved for approval by Daleiden, seconded by Sawatzke and carried. Chairperson Husom adjourned the meeting at 3:22 P.M. The next regular meeting will be held at 1:30 P.M., Monday, February 11, 2013, in the Commissioners Room, at the Wright County Government Center. ROLL CALL: Members Present: Christine Husom - District 1 Michael Potter District 4 Pat Sawatzke District 2 Charlie Borrell District 5 Mark Daleiden District 3 Staff Present: Jay Kieft, Director Jami Schwartz, Financial Services Manager Linda Antl, Financial Services Supervisor Carol Schefers, Public Health Nurse Director Christine Austin-Roehler, Health Promotion Coordinator Michelle Miller, Social Services Manager Diane Erkens, Social Services Supervisor Michele Raymond, Collections Officer Aggie Gunnerson, Secretary New Staff: Katie Brown, Social Worker, Family Assessment Unit, 12/19/12 date of hire Jill DeMars, Social Worker in Family Assessment Unit, 1/22/13 date of hire MINUTES: Approval of Minutes of January 14, Action: Motion by Sawatzke, seconded by Daleiden, to approve the Minutes as presented. Motion carries 5-0. CONSENT AGENDA 1. Social Services Payments Abstract $311, Personnel: a. Anniversary Evaluations Laurie Perkins, Tammy Peterson, LeeAnn Thimell, Janice Vanderlinde b. Probationary Evaluation Jena Cox 3. Contracts: a) Patricia M. Hilker - Home & Community-Based Services Adult Foster Care, Respite Care; for period of 1/28/2013-1/31/2014; no maximum amount in contract. New Contract Action: Motion by Potter, seconded by Borrell, to approve the Consent Agenda. Motion carries 5-0. REGULAR AGENDA ADMINISTRATIVE PAYMENTS: Daleiden asked for an acronym list. Kieft said he will provide a list of accounts. Action: Motion by Daleiden, seconded by Borrell, to approve payments for a total of $27, ; 51 vendors, and 125 transactions, subject to audit. Motion carries 5-0.

2 H.S. Board Agenda Page 2 PERSONNEL: 1. Personnel Leave request Shannon Nelson, Financial Worker in the Family Financial Services Unit; beginning approximately February 4, 2013, for duration undetermined. Jami Schwartz said request is for a personal leave by a Financial Worker; she has consulted with Human Resources, they received documentation that request is based on; we agree to recommend the personal leave with the contingency that doctor s statements are forthcoming monthly or upon request from the Personnel Department. Action: Motion by Daleiden, seconded by Sawatzke, to approve personal leave request for Shannon Nelson beginning approximately February 4, 2013, for duration undetermined.. Motion open for discussion. Schwartz said she spoke with Human Resources, the nature of the Financial Worker job is such that it is difficult to have somebody come back sporadically or intermittently, to fill in as a case manager in a large caseload. The Personnel Office will work with her if there is a basis for her to come back while on this personal leave on a parttime or non-sporadic basis, they may work towards that with her. Situations have come up more frequently than she (Schwartz) would like. The Agency does not have a backfill for position at this time. Husom asked about undetermined duration. Schwartz said if we get documentation that she is able to return to work, then potentially it would be shorter than the six months that the policy allows for. Potter questioned length of leave. Schwartz said leave is for six months. Potter said how does this fit into employment law? Schwartz said our personal leave policy is broad, and cannot speak to the underlining law. Potter said if it is arbitrary, somewhere down the road we end up with a problem; is there is there a law that says we can t/can do things. Schwartz said Wright County has a generous leave, FMLA requirements, but because of ADA we cannot make too many discretionary changes. Kieft said we are allowing what the law requires, we are within the law and try to be consistent, and the Human Resource Department guides and consults with us. The thing that is good about this request is as we need it or on a monthly basis ongoing medical updates. Schwartz said we have been successful in the past to bring in a retired worker. Right now, we don t have anybody in mine. Daleiden gave an example of people on the bench in an electrical/plumbing union get called in, do we have this. Kieft said no. Borrell asked if a supervisor could sit in. Schwartz said their workload is such that they can t step in and work a regular caseload. Borrell said when this person is gone what happens to her clientele. Linda Antl said cases have already been distributed among other workers when she went out on FMLA. Borrell said you have a team concept, and the work is not getting dropped. Daleiden said your may see overtime. Antl said there is no overtime. Sawatzke said in an organization this large, there is always somebody taking personal leave of absence and different things going on, it is rare for us to replace them with some temporary people, but have allowed that from time-totime, to refill it is the exception rather than the norm. Sawatzke said we would backfill if more than one person is out, then there is an extra effort to find someone. Kieft said the reality of things is timeframes are impacted; customer service is impacted, there might be longer delays, a missed item on an application. In our organization, like Commissioner Sawatzke said, there is not a day when everybody is here, there are sick people, these extended leaves does have an impact, we spread work out and do the best we can, but it does have an impact. Antl said she does not pick up a caseload, but does support and help as much as she can for her workers in things they cannot get done, such as picking up phone calls. Schwartz said it s constant as Jay said, and has been a reality for awhile. Sawatzke said the important thing is we need to keep on top of things so if worker isn t going to make it back in some point of time, that we cut ties. Motion carries 5-0. SOCIAL SERVICES/PUBLIC HEALTH/FINANCIAL SERVICES: 1. Family Planning Update and Grant recommendation. Kieft said Carol Schefers and Christine Austin-Roehler are here to share program summary and a recommendation. Schefers said there are times she will come to the Board and ask the Board to put on their Community Health Board hats. The Board assumes role of the Community Health Board, there are

3 H.S. Board Agenda Page 3 certain roles you play, there are certain things you must do, and they are usually done through Schefers or Public Health staff. We will talk next week about this in your orientation. The Community Health Board is responsible to do a Community Health Assessment. This is done every five years. The Agency is almost done with the assessment; it will be presented to the Public Health Task Force, and then the Board. One area we looked at closely is the Family Planning area. We looked at the population served, the needs of the community, how community is being served, and what partners are doing the service. We have had grant for over 20 years, and will be asking for permission to apply for grant independently. Christine Austin-Roehler is our expert in Family Planning. Christine originally was our sexuality consultant, and the schools use her services, has won an award for work on teen family planning. Christine will speak on the Family Planning Grant, our program, and then the proposal for the next grant cycle. Roehler reviewed a PowerPoint presentation on Family Planning. The State Department of Health has a grant program called Family Planning Special Projects Grant. Money is set aside for under-insured couples to provide them with family planning services when because of income and health insurance they are not able to access services. We have had grant since 1986, when there was an epidemic of teenage pregnancies in the County. We have made a lot of progress over time; want to continue program and way it is done in Wright County. Family Planning means couples are able to plan when they have children, so those families have better outcomes for their children. Public Health Nurses work with young moms so they get prenatal care and have the outcomes. Nationwide half of pregnancies are unintended. The CDC decided what are the greatest accomplishments among those are immunization and how to prevent disease, and part of that top ten group is that we now have the means that people can plan their families. Unintended pregnancy can lead to poor pregnancy outcomes, delayed pre-natal care, exposure to alcohol/tobacco/drugs, mental health issues, and/or abortions. Family Planning dollars save dollars in the long run it is estimated that for every dollar spend, $4 is saved. Financial Services and Social Services work with clients who end up on Medicaid programs. At the State level, the grant program was implemented in 1979, is governed by MN Statute/Rule, and provides funds for individuals at risk of unintended pregnancies. Funds are distributed throughout the State. We are in 14-county region. There are 8 regions in the State. The State pot of money is divided by regions, and we compete for funds with others in the region. We write a grant proposal and almost always have been on the top of group. In Wright County (9 th largest county in the State), we have people who are very poor, without insurance, no clinics in every town in the County, or transportation. There are barriers we feel we can improve. Money can be used for public information, outreach. Since 1994, we had this grant jointly with Wright County Community Action (WCCA). We have worked collaborative to provide counseling, working with medical clinics in the County, referral and follow-up. In Minnesota, its estimated 200,000 women need this service. 22% of younger population don t have insurance and at child bearing years (in Wright County, it is 41% or 25,000). 12% live in poverty (2900 in Wright County); 20-34% in Minnesota don t have insurance. There is a sister program available in the State called MN Family Planning Program; began in 2006; for Medicaid Waiver eligible people. These two programs work hand-in-hand. We act as a safety net for vulnerable people. Currently, we received a $75,000 grant for 2 years. Grant pays for 25% of Christine s time/salary, plus part of a contracted worker. FPSP funding covers: Public Information - Who Ya Gonna Call cards (contains resource information); and Outreach (Education & Consultation). Graphs were reviewed regarding: Statistics on Teen Birth Rates for ages years for years ; Reduction in Teen Sexual Activity; and Additional Prevention Work and Partnerships to Reduce STI Rates. Christine said our Agency would like to independently apply for grant, no longer collaborate with Wright County Community Action, and provide all services. Agency has concerns about the medical part of program not operating as high as it should be; the medical side of program needs to be run more efficiently and not duplicate services. Wright County is the 9 th largest county in the State. The Agency can take on this service with the staff we have right now. Right now with current programs, all clients have to travel to access service some clients see our nurses right now. We would take a step out of the process by having to work with another agency. With our WOW van we would be able to provide the counseling services. One deficit that is ongoing is the more effective, long-acting methods of birth control are not being offered. The State may make that a requirement this year in the proposal. We have a strong partnership with the clinics. There is a deficit in medical clients receiving birth control methods

4 H.S. Board Agenda Page 4 since in 1998 (they saw 374 clients); the County has grown 67%, and currently WCCA s numbers are lower than in We project they should be serving 600 clients. Jay and Carol have had conversation with the WCCA Executive Director already. WCCA has had high staff turnover. Christine has worked with 11 different nurses since There is one person in the job, and have reduced services. Grant proposal is due March 31, The grant starts in July and runs for two years. If we apply independently, this would mean an estimated $300,000 for us, and would pay for some of the services we doing now and are not paid. 53% would be fore Christine s time, nursing time, coordinating the grant; 25% clinic services; 16% underwrite the cost of medical methods/supplies; 6% space/telephone, etc. Board approval to go ahead with this competitive grant is needed. We are confident we will have a successful proposal. Husom said this is two separate issues not sharing services with WCCA. Christine said they are fiscal agent and they not willing for us to do this. Schefers said we are very good partners with WCCA, that she and Kieft met with Mark Sexton on this. Family Planning is an area that we ve always done a lot of work with; one of our roles is to reduce barriers for the citizens of the County. If clients are referred to them; there is paperwork to complete (this is a barrier); our nurses are not able to call clinics to get appointments for clients but need to go through WCCA. She felt Public Health could do a better job with this. WCCA has one nurse and doesn t have a nurse to backup. We have excellent relations with the clinics, we do majority of Outreach; we are hearing about barriers from the schools; we can do a better job for our citizens. Daleiden said request is $300,000 for two years, can you ask for more, will they reduce that amount if they feel it is not necessary. Schefers said that depends on the number of proposals; amount depends on who the State decides to fund. Christine said people with highest scores get their money, and then they go down the line. WCCA may apply independently. Schefers said this is not our only funding source we have funding through the MCH Grant, and funding with home visits, we have other resources that blend with this. Daleiden said what did the region receive two years ago. Christine said there is $10,000,000 at the State level for two years. Making the process for community residents more efficient, making it more efficient within our Agency. One-third of teenagers have mental health diagnosis, and we have mental health and chemical dependency services in our Agency. We want approval to more forward to apply and apply to the State. Borrell said how come there is no one from WCCA here today, and wanted to hear both sides. Daleiden said they are meeting next Tuesday evening. Sawatzke asked when is proposal due. Christine said proposal is due March 31, and the RFP comes out next week. Borrell said you knew you were doing this last week; someone could have planted seed out there and would not vote for it today. He needs to hear both sides, and wants both in the same room to have dialogue. It would have been a good thing if they came today if they would have known. Daleiden said they are not cooperating in some ways. Kieft said this is about improvement, doing program better; the program is not reaching capacity. We met with Sexton and told him we were going to apply, that there are gaps. Sexton said they would probably compete too because it is part of their mission - on poverty. We did not come up with a solution. We have the most immediate and broadest access to this population, have the best established relations with the clinics, and have a system of backup with some of these services in the Agency. We are a County Department, it would not be appropriate for him to come and have discussion here. We are here to make recommendation of better services to constituents. Borrell said you know thing, we don t and only know one side one thing you mentioned is dual paperwork. Have you sat down and said is there a way you can accept the paperwork we do. Daleiden said one concern is 374 medical clients, and 2011 have less people taken care of that is a concern. Christine said they do have more clients without non-medical methods (pills, shots, etc.) vs. using condoms alone. Our County population has grown. Borrell said they might be reaching people using a different form of contraception, because the results look good before, this is a more expensive procedure. Sawatzke said are seeing less people, but overall the County unwanted pregnancies are going down; ultimately that is the goal. He agreed with Borrell, sometimes things on the surface looks good, it is not unreasonable for and Daleiden and Borrell to hear WCCA s side of the story. If there is such a short timetable here that two weeks will destroy this whole thing, then we should wait and do it a year, or two years from now. Schefers said we don t have that choice. Christine said we will start preparing grant in the meantime because it will take a long time. Sawatzke said it is no unreasonable for the Board of Directors of that Agency to ask for two weeks to be able to go over there and hear their side of the story. Christine said she will not disagree, and it is also possible that you (Board) could give approval for both agencies to apply

5 H.S. Board Agenda Page 5 because it is a competitive process. Borrell said by voting for this, that is what we would be doing and said Don t go there. Christine said that she was presenting this as something to consider. Borrell said he would not as a Commissioner, would not vote given this information, there was noting else on the agenda other than this, and it was pretty hard to make out what you just presented to us on what we would be voting on. Don t ever come to me as the Human Services Department expect me to make a last minute vote, unless it is an emergency. Daleiden said when you do have something like this, to provide us some information, it is easier to follow along, and it sent ahead of time state that it will be gone over at the meeting and we could review ahead of time, it is an overview. Husom said the deadline for grant is March 21 st, and asked how long will it take to write it? Christine said a good 40+ hours. Sawatzke said to place item on the February 11 th Board agenda. Action: Motion by Daleiden, seconded by Sawatzke, to postpone action until February 11 th meeting to make a decision. Borrell said this is a public meeting, if WCCA wanted to come here and make a presentation or answer some concerns, they could. Sawatzke said it is a public meeting, ultimately we will make that decision, and sometimes there is some conflict. Husom said she does not see this as a conflict for both entities to apply for this grant. It s not competition necessarily, but who is best suited for these dollars and that is what would be determined by both parties applying. Motion carries Community Support Program (CSP) Update and partnership recommendation. Michelle Miller gave an overview of CSP program and requested recommendation. This program serves adults who have mental illness living in the community. Wright County has provided program for a number of years under Adult Mental Health grant. Grant is made of two component - a group component and AILS (Assistance in Independent Living Skills). It is a one-on-one service provided to adults to focus on their needs to live in the community. Previously, this service was being provided by CMMHC (Central Minnesota Mental Health Center). Services were not going as well as we were hoping. There was ongoing discussion as far as billing, we received grant from the State and then paying CMMHC - what are you using the funds for, documentation on client visits, not good communication between CMMHC and us. We came to Board and asked to pilot program for one year, in-house at Wright County. It would be done by a half-time case aide in Social Services and a half-time case aide in Public Health. We took this on as a one year pilot to see if we could improve this program. We developed expectations for program after running program for one year. We found we had staff, internally, not trained as a mental health practitioners but provided those level of services with some support, and that we need our staff to be doing the mandated services that we have in-house. The Social Services case aide, half of her time is dedicated to CSP; the other half is CD (Chemical Dependency), those numbers continue to rise, and her job is to support the CD Assessor in getting the Rule 24 and 25 assessments so money piece and actual assessments completed. Internal staff need to do mandated services. Miller has had conversations with Lori Schmidt (CMMHC) to provide service again. We made a list of expectations of things we need to see - monthly documentation, quarterly meetings with provider on budget, and have the billings that come in be itemized and what is actually be billed and spent. We asked CMMHC for a Letter of Intent on providing the services, and received letter last Tuesday. Sawatzke said he received an on this issue a week ago, and was surprised Lori was expressing a Letter of Intent based on her own position when the Board hasn t been apprised of this, that we were going to talk about it this evening, and no decision has been made. They haven t met yet, Lori has a fixed budget for 2013, and doesn t have the authority to add new staff, people or do things outside of the Board. They (Board) haven t met yet, and this will be discussed tonight. Borrell said this sounds more like a mutual thing. Sawatzke asked for the Minutes of when the Human Services Board talked about this, a year and half ago, prior to the meeting tonight. He asked for 2013 the budgetary impact, you are not talking about laying off staff - how much are we going to pay the Mental Health? Miller said $82,000 was paid previously. She received a Letter of Intent - they would provide the same services for same dollar amount. For a year and a quarter, we have been paying our own staff out of that grant. In addition to needing more work out of our internal staff, she asked the Fiscal Manager what is the reimbursement for case aide position doing CD service? Essentially, it is 20% of her time under Title XX, and the half time case aide in Public Health. Sawatzke asked if we added personnel. Miller said no. Kieft said that is part in relationship to the quality of service we are concerned

6 H.S. Board Agenda Page 6 about, our capacity to deliver it without adding staff, we have suffered from this. There was also dissatisfaction a year and a quarter ago. We are at a point of having a better relationship with the Mental Health Center (MHC), a clearer understanding on coordinating this program together. It s about improvement, how it will work better, and try to put a proposal together the Board will understand. He apologized if it feels like we are pushing through things, that there isn t enough information. We need you to be fully informed and allies in this work we are doing.. We do need to change, there are areas and services we provide, where as a management team, we need to be aware of and ready to change for improvement. Sawatzke said this one was a little sketchy on supporting documentation, too; because until mentioned he had not idea that you were talking about this issue, and thought the first time he was going talk about it was this evening. Kieft no action is needed. Husom said $82,000 grant is it for one year. Miller said it is an ongoing grant. Miller said it is not just CSP; there are other services under the umbrella. The whole grant amount is about $189,000 to pay ourselves to provide other mental health services. There is excitement on both parts not only could this program be improved beyond what has been done, but we have learned so much in taking in-house on what is required to do service. Miller met with Bill Tregaskis he had some ideas about developing and advisory board, to meet quarterly. Exciting ideas came out of it to make it better than before. Sawatzke said some of us feel there has been too much excitement up there (MHC) lately. He asked for an of date when this was talked about before at Board, and send to everybody. Daleiden said to commend yourselves you were willing to try something different and learned we can t do it, giving it a shot if it didn t work, it didn t work. Miller said if the CMMHC Board approves it we will go forward and draft a contract on this. Sawatzke said we will see how discussion goes on this, and wants to see how this went a year and half ago. Miller said two parttime people were laid off (at MHC) at the Buffalo office. This is same folks, but grant funded, use ARMHS (Adult Rehabilitative Mental Health Services) Coordinator and grant person will go under that person. Sawatzke said Lori was driving force it would work so well here, now wants it at MHC. Sawatzke said he wants to refresh memory before a decision is made, it is not critical we do it now or in two weeks. ADMINISTRATION 1. Write-Off Report. (attachment) Kieft said attachment describes criteria for each of write-offs being proposed today. Michele Raymond said our write-off is $47, for January-December Half of write-offs are beyond our control deceased or bankruptcy court. Sawatzke said there are thirty (30) names how many folks owe us money? Raymond said she can t answer that probably between 3,000-5,000. Today s list is Social Services only, does not include Income Maintenance, and is for programs we are allowed to collect through MN Statutes or County Plan for Social Service program. Borrell said with one child custody study, how did that person end up owing us money? Raymond said custody studies are court ordered. Raymond said one of the parties did not cooperate with us. With the MA case, we make claim against the estate, and MA gets paid back. We make claim on estate for money owed to the State and County; we lost only part and the rest goes to the State. Borrell asked about custody study. Raymond said we lost total amount. Raymond said the Board approved criteria. Borrell referred to custody study, and said why let the bill go after three years? Look at changing rule, redo policy. Raymond said we can only obtain judgment if six years or younger, the likelihood of collecting is slim. Daleiden said they didn t pay us in 1998 for custody study. Raymond said the judge court ordered. Raymond said this is not a big amount. Kieft said amount of collections, we can figure it out and give that to you. Sawatzke said at one time you collected for the Courts. Raymond said we no longer do that. When asked who does custody studies, Miller said they are done by a private agency. Sawatzke said we first used Catholic Charities; we ve changed how we ve done this 3-4 time since Action: Motion by Daleiden, seconded by Borrell to accept list of write-off report for January- December Motion carries Director s Comments none given.