PROPOSED FY 2019 BUDGET HIGHLIGHTS County Board Work Session February 28, 2018
: Vision, Mission & Ideal Culture Vision A community of healthy, safe and economically secure children, adults and families Mission Strengthen, protect and empower those in need Ideal Culture Customers are our highest priority, receiving quality, integrated services Employees are engaged and committed to continuous improvement Our organization is built on mutual trust and shared responsibility
Clients Department Served by Initiatives Program Aging & Disability Behavioral Health Child & Family 747 - Nursing Case Management 552 - Independent Living Services 502 - Case Management 308 - Adult Protective Services 272 - Senior Adult Mental Health 1,942 Psychiatric Services 1,604 Emergency Services 1,389 Outpatient Mental Health 988 Jail Mental Health 272 Substance Abuse 415 Child Protective Services 279 Youth Mental Health 273 Child Advocacy Center 228 Child Care Licensing 104 Foster Care 2
Clients Department Served by Initiatives Program Economic Independence Public Health 17,407 Medicaid, SNAP, TANF 1,585 Energy Assistance 1,516 Housing Choice Voucher 1,229 - Housing Grants 251 Permanent Supportive Housing 20,167 School Health 4,088 Immunization Clinic 3,556 Laboratory Services 2,658 Family Planning 809 - Dental Clinic 3
Department Initiatives Child Care Initiative Promotes an inclusive, integrated child care system serving all Arlington families, especially vulnerable populations Increased availability, accessibility, affordability, and improved quality of child care programs 30 organizations, including providers, parents, non-profits, schools and government involved in leadership and working groups Draft Action Plan under review by community approximately 500 comments received; County Board to receive final draft in Spring Opioid Response Over 20 entities, representing law enforcement, courts, schools, providers, hospitals and local government addressing the opioid crisis Priorities are increased awareness, community education, expanded treatment access, naloxone dissemination and safe prescribing, enforcement, and reduced supply Actions underway: 24/7 drug take back at 2 fire stations, April 2018 Town Hall meeting, 24/7 hotline through PRS (Crisis Link), community naloxone training Destination 2027 Public Health initiative and campaign to achieve health equity through system changes by 2027 Uses community feedback, health data, and national standards to identify how DHS can empower Arlingtonians and community organizations to improve public health 35 entities representing health care providers, non-profits, schools, universities, foundations, law enforcement and local government will analyze data and develop goals and strategies for addressing them through system changes 2,540 people responded to the community health survey - access to affordable housing, health care, and meeting basic needs are areas for improvement 4
Department Initiatives Bridges Out of Poverty 23 non-profits, DHS, schools, and the Arlington Community Foundation making improvements to the service delivery system for shared clients and strengthening client voice Developing new tools to share information on programs and clients across agencies Addressing social determinants of health in Arlington census tracts with worst health outcomes AC Works Inventory County-supported employment and workforce development activities and programs across all departments to identify redundant services Propose strategies to eliminate redundancies, create efficiencies and increase effectiveness in meeting desired workforce outcomes Improve collaboration, integration and performance between the public and private sectors Same Day Access (SDA) Mandated best practice that allows clients to walk in for mental health intakes with no scheduled appointment Increases client engagement, reduces wait time for first appointment, reduces paperwork and improves collaboration with partners Since initiating in December 2017, have doubled number of mental health intakes and eliminated all wait lists for initial appointments 5
Proposed Budget Changes for FY 2019 FY 2018 Adopted FY 2019 Proposed Net Change % Change Expenses $137,101,996 $138,794,705 $1,692,709 1.2% Revenue $39,610,153 $41,144,648 $1,534,495 3.9% Net Tax Support $97,491,843 (71%) $97,650,057 (70%) $158,214 0.2% Permanent Staff 705.52 FTEs 691.82 FTEs -13.7 FTEs -1.9% FY 2019 proposed revenue budget includes a $12,000 increase for new state-mandated client fees regarding testing for sexually transmitted infections. 6
Proposed Reductions DHS FY 2019 REDUCTION SUMMARY Personnel Non-Personnel Total Reduction FTE OPTIONAL: An image or graphic can be used to help show, explain or quantify a 16.0 FY 2019 Reduction $1,650,035 $557,101 $2,207,136 proposed reduction. (11 filled; 5 vacant) 7
Proposed Reductions Administrative Support Staff Service Impacts Public Health Division Office Supervisor ($95,603) Transfer supervision of seven staff to the administrative officer, increasing direct reports from three to ten. Redistribute vital records requests & reporting, front desk support, as well as purchasing & payables tasks to other administrative staff under the direction of the administrative officer. Director s Office Administrative Technician ($81,017) Reduce capacity for records tracking, delivering & retrieving. Require program staff to track & monitor records independently. Enlist contractor to deliver & retrieve records as needed ($12,000 cost included in FY 2019 impact). Budget Impact FY 2019 Change: -$164,620 Staff Impact -1.0 Office Supervisor (filled) -1.0 Administrative Technician (filled) 8
Proposed Reductions Eliminate Non-Essential Contingency Funding for Behavioral Healthcare Division Contracts Service Impacts Eliminate non-essential contingency funding for Community Residences Group Homes, Crisis Stabilization, Intensive Support and Living Services Contracts. Budget Impact FY 2019 Change: -$80,000 There is no impact on clients or service delivery as vendors historically did not utilize contingency funding in order to meet contract goals and outcomes. If contractual needs change in future years, funding levels may be revised. 9
Proposed Reductions Pharmacy Services Service Impacts By contracting pharmacy services, DHS will provide more efficient pharmacy operations at a lower cost. The pharmacy contract will include dispensing, pharmacist consultation and medication subsidy assistance for an estimated $134,040 per year (based on market research). Expenses will be covered by reallocating existing, on-going grant funds. Budget Impact FY 2019 Change: -$176,353 Staff Impact -2.0 Administrative Technicians (vacant) Client outcomes will improve by co-locating pharmacy services with mental health and primary care providers through easier access to medications. Clinical staff will no longer conduct medication management in order to focus on other direct client services. Proposal includes the elimination of two administrative technicians ($159,153) and a reduction in pharmacy contract funding ($17,200). 10
Proposed Reductions Employment Services and REEP Contract Funding Service Impacts Administrative, education and training duties of the management specialist and program manager would be absorbed by the director and remaining employment supervisor. Case management and employment coaching duties of the three eliminated employment specialists will be redistributed to the remaining 13 specialists resulting in higher caseloads. If caseloads rise, clients will have to wait longer for appointments and receive less coaching. Management duties for 13 employment and administrative staff provided by the eliminated employment supervisor will be transferred to the remaining supervisor. REEP grant reduction reduces administrative support and increases revenue by implementing a revenue generating TOEFL class ($171,901). Reduction does not impact ESL slots or the tuition amount. Budget Impact FY 2018: $4,650,774 FY 2019: $3,825,190 Change: -$825,584 Staff Impact - 1.0 DHS Program Manager (filled) - 1.0 Management Specialist (filled) - 1.0 Employment Services Supervisor (filled) - 3.0 Employment Services Specialist (2 filled; 1 vacant) 11
Proposed Reductions Public Assistance Service Impacts Reducing one of 13 eligibility workers would not significantly impact the program due to decreasing public assistance caseloads. The caseload of 700 assigned to this position will be redistributed to the remaining 12 eligibility workers. Due to the implementation of a more streamlined application process, workers will be able to absorb the additional cases with minimal impact. Budget Impact FY 2019 Change: -$105,493 Staff Impact -1.0 Eligibility Worker (vacant) 12
Proposed Reductions Developmental Disability Residential Services (DDS) Service Impacts In FY 2016 and FY 2017, Virginia allocated additional Medicaid waivers to Arlington, reducing the need for local funding for the program. Prior to FY 2016, Medicaid waiver funding was only available to support individuals living in residential institutions. Budget Impact FY 2019 Change: -$300,000 The program provides safe, assisted living options to persons with developmental disabilities so they can live in the community rather than institutions. The additional Medicaid waivers provided by the state will allow the county to meet demand with less local tax support. In FY 2019, we project the addition of nine students into DDS programs. There will be no impact on transportation or staff ability to absorb case management duties. 13
Proposed Reductions Public Health Division s Community Health Program Service Impacts The management specialist s clinic scheduling and health record quality assurance duties would be transferred to existing nurses and nursing supervisors. The transfer of duties to nursing staff would increase the likelihood of scheduling errors, reduce health record data quality and eliminate practice management process and procedure reviews to increase efficiencies. Budget Impact FY 2019 Change: -$105,727 Staff Impact -1.0 Management Specialist (vacant) 14
Proposed Reductions Laboratory Services Service Impacts Closure of the laboratory includes eliminating four of six support staff and requires one of five tests to be sent to a contracted laboratory for testing. The existing laboratory is one of only two operated locally in Virginia. Other jurisdictions rely on private sector contracts for testing services. Urinalysis, pregnancy, HIV and diabetes testing will be provided in-house by the remaining two lab technologists. The wet prep test to diagnose gynecological conditions will be sent to a contracted laboratory. In the absence of lab staff, nurses and clinic aides will have to be retrained on specimen packaging, storing and shipping protocols. Staff will also have to be educated on the protocols for preparing medical waste for transportation and disposal. Existing clinical staff will be required to perform phlebotomy duties in a back-up capacity during times of high volume; this will reduce their time providing direct clinical, disease surveillance and investigative services. Budget Impact FY 2018: $643,648 FY 2019: $194,289 Change: -$449,359 Staff Impact -1.0 Laboratory Section Supervisor (filled) -3.0 Laboratory Technologists (filled) 15
Non-Profit Proposed Requests Reductions Arlington Street People s Assistance Network (ASPAN) ASPAN operates the year-round Homeless Services Center (HSC) through a county contract. HSC and RPC services will be out for competitive RFP in FY 2019. The FY 2018 contract is $1.4 million. FY 2019 request is $117,426 includes $18,000 cleaning, $46,926 staff fringe benefits and $52,500 administrative fee increase 6% to 10%. Arlington Food Assistance Center (AFAC) AFAC provides emergency food assistance to clients referred from DHS. Contract funds are used for the purchase of food only. FY 2018 funding is $527,925 ($477,925 on-going; $50,000 one-time). FY 2019 Request: a) Restore $50,000 in FY 2018 one-time funds on an on-going basis and b) Contribute $150,000 - $250,000 towards building renovations. Arlington Neighborhood Village (ANV) ANV provides support to Arlington s 55+ population to assist them in aging in their homes and living active, connected lives. ANV received $30,000 in one-time funds in FY 2015 and FY 2017. Arlington provided no funding in FY 2018. FY 2019 request is to restore $30,000 in FY 2017 funding on an on-going basis. 16
Non-Profit Proposed Requests Reductions Arlington Thrive Thrive is a provider of same-day emergency financial assistance in Arlington County for people who need help paying rent, utilities, medical bills, prescriptions, or transportation to work or medical appointments FY 2018 funding is $464,630 FY 2019 Request is $50,000 to increase emergency financial assistance to in-need County residents. If approved, new contract amount would be $514,630 Non-Profit Resource Center - Arlington Community Foundation NRC convenes 23+ safety net non-profits for the Bridges Out of Poverty initiative After receiving one-time funding of $25,000 in FY 2016, NRC raised $140,000 in the past two years FY 2019 Request is $25,000 to support non-profits to implement human services initiatives 17
Community Proposed Services Reductions Board Requests The CSB identified emerging needs for individuals needing mental health, substance abuse and developmental disability services. DHS is reallocating 3.0 existing FTEs and utilizing state grant funding for an additional 2.0 positions to meet these needs. Despite substantial DHS effort, a significant need for staffing and programmatic support remains. The unfunded FY 2019 CSB request is $296,598; 2.0 FTEs. Young Adult Mental Health Therapist Position would provide therapy and case management to adults aged 18 to 24 Current average case load is 36; benchmark for this population is 20-25. Estimated cost of 1.0 Mental Health Therapist is $91,463 Peer Specialist Position conducts opioid outreach, connects unengaged clients and supports community reintegration to recently incarcerated and hospitalized individuals Estimated cost of 1.0 Peer Specialist is $85,135 Customized Employment Pilot Capacity of 4 persons with developmental disabilities to find and maintain employment Program meets new federal requirements for competitive, integrated employment Employment integrating the disabled and non-disabled populations has better outcomes than sheltered programs Estimated cost is $120,000 18
DHS Housing Programs
Households Housing Grants 1,350 Housing Grants: Number of Households in Program 1,300 1,302 1,299 1,250 1,200 1,219 1,229 1,214 1,198 1,150 1,100 FY14 (Actuals: $8.3M) FY15 (Actuals: $9.1M) FY16 (Actuals: $9.0M) FY17 (Actuals: $8.7M) FY18 (proj) (Actuals: $8.7M) FY19 (proj) (Actuals: $8.7M) FY 2019 projected average cost per household is $605; total projected expenditures are $8.7M 20
Permanent Supportive Housing Housing Grants FY 2016 FY 2017 FY 2018 (Projected) FY 2019 (Projected) Available Units (as of 6/30) 217 236 246 256 Occupied Units - (as of 6/30) 178 190 200 210 New Units Serrano 8 Spectrum 4 Total: 12 Pierce Queen 8 The Springs 11 Total: 19 Clarendon Court 10 Total: 10 Columbia Hills - 10 Total: 10 Average Monthly Grant $877 $887 $900 $910 Adopted Budget $2,064,870 $2,064,870 $2,064,870 $2,064,870 Expenditures $1,931,993 $2,031,812 $2,093,400 $2,211,932 (Over)/Under Budget $132,877 $33,058 ($28,530) ($147,062) The permanent supportive housing waitlist has approximately 35-40 clients who wait an average of 4-6 months before they can secure housing. Deficits in FY 2018 and FY 2019 will be absorbed by the DHS base budget. 21