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Consider adopting a resolution amending the Position Allocation List to add 1.0 FTE Health Chief Deputy/Health Officer - TBD, add 1.0 FTE Behavioral Health Chief Deputy - TBD, add 1.0 FTE Human Services Chief Deputy - TBD, add 1.0 FTE Administration Chief Deputy - TBD, add 1.0 FTE Administrative Services Administrator - TBD, add 1.0 FTE Grant Writer - TBD, add 3.0 FTE Administrative Secretary, add 2.0 FTE Social Worker II (navigator positions), add 2.0 FTE Public Health Nurses (navigator positions), and delete 3.0 vacant FTE - TBD by July 14, 2019 to implement the proposed reorganization of the Department of Health and Social Services to support client/population-centric service delivery
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Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends the Board of Supervisors consider adopting a resolution amending the Position Allocation List to add 1.0 FTE Health Chief Deputy/Health Officer - TBD, add 1.0 FTE Behavioral Health Chief Deputy - TBD, add 1.0 FTE Human Services Chief Deputy - TBD, add 1.0 FTE Administration Chief Deputy - TBD, add 1.0 FTE Administrative Services Administrator - TBD, add 1.0 FTE Grant Writer - TBD, add 3.0 FTE Administrative Secretary, add 2.0 FTE Social Worker II (navigator positions), add 2.0 FTE Public Health Nurses (navigator positions), and delete 3.0 vacant FTE - TBD by July 14, 2019 to implement the proposed reorganization of the Department of Health and Social Services to support client/population-centric service delivery.
SUMMARY/DISCUSSION:
For the past two years H&SS has been involved in departmentwide discussions and engagement efforts and looking at operational needs in light of changing demands on its systems of services. On June 26, 2018, the Board received a presentation from H&SS and approved its new mission to “Promote Health, Safe & Stable Lives,” and its vision of “A Health, Safe & Stable Community.” At that time, H&SS identified its commitment to continue with internal culture improvement, effectiveness and efficiency improvements, and to conduct an external scan of community partners for feedback. H&SS partnered with two consultant organizations, Performance Works and the American Public Human Services Associates (APHSA) to assist with these efforts.
As part of H&SS’ work with the two consultants, multiple surveys and listening sessions were conducted with program participants, staff and various community stakeholders. Feedback indicated that H&SS could do more to serve and coordinate care for the whole person/family and program participants shared that they would prefer a coordinated, multi-program application process with information shared between programs in order optimize care. Responding to this feedback requires better data sharing between H&SS divisions and other County departments, better integrated IT systems, less “siloed” funding sources, and more multi-disciplinary teams.
On November 6, 2018 the Board adopted a resolution, authorized by Assembly Bill (AB) 1421 and effective January 1, 2019, authorizing H&SS to operate as an integrated and comprehensive County Health and Human Services agency. This integration initiates the process of addressing “siloed” funding sources by allowing funding to follow clients based on need; however, additional work is required to achieve client focused integration.
On March 12, 2019 H&SS presented the results of from the consultants’ work and the staff engagement research and proposed a reorganization of H&SS to the Board of Supervisors. At that meeting the Board requested that H&SS schedule a workshop to facilitate a more detailed discussion about the proposed plans for the redirection of services around population groups, outline the benefits to clients, and explain how its proposed reorganization will achieve the service goals.
On May 21, 2019 H&SS participated with the Board of Supervisors in a workshop (Attachment B - May 21 Presentation) that focused on three areas: (1) national and State trends and changes in health and social services delivery; (2) results of an internal assessment of strengths and vulnerabilities within H&SS; and (3) how H&SS proposes to improve health and social services delivery over the next 3-5 years. As discussed during the workshop, implementation of the proposed reorganization will create a client/population-centric focus for H&SS and integrate programs and activities to generate a more streamlined client experience. Part of the initial implementation is a pilot program of navigation teams and a navigation kiosk system to target and assist clients utilizing multiple programs.
Ongoing, comprehensive and effective navigation services will be provided so that clients can both readily identify and engage in all of the services for which they are eligible and have their services coordinated to the extent feasible. For clients seeking only one or a few H&SS services, the navigation system will assist them with rapid enrollment and management of their needs. For individuals and families eligible for multiple H&SS services, and for clients with complex needs or who are experiencing difficulties in accessing services, more intensive navigation services will be provided by teams skilled in case management. In these situations, clients will be assisted with enrollment processes, coordination of service delivery and ongoing follow-up as needed. The intent of the focused case management and navigation for higher need population of clients is to have improved and more efficient overall access to care resulting in successful outcomes, earlier intervention to address clients’ needs and prevention of the need for more intensive services.
During year one, clients currently utilizing four or more H&SS services, who typically experience a combination of complex health, behavioral health and social services issue will be assisted by the pilot navigator teams as these types of needs are best case managed by a team comprised of navigators skilled in public health nursing and social work (Attachment C). As the navigator pilot program is evaluated and refined, additional teams will be established. Also in year one, development of the navigator kiosk and call-in system will be initiated to assist clients utilizing fewer than four services and a consultant will be hired to study the consolidation of children and families’ programs to develop an optimal service delivery model.
For H&SS, program and activity integration is intended to break down the current funding and programmatic siloes and result in a more productive and efficient service delivery. Programs performing similar functions and focusing on the same populations will be able to serve their clients in a more comprehensive manner, provide more robust services and perhaps serve more clients with the same staffing levels.
The H&SS reorganization, which is expected to evolve and take up to 3-5 years to complete, is intended to create a more effective organizational structure and strengthened leadership. Employees will be more actively engaged in decision-making regarding program activities and in optimizing how their programs serve clients; they will also be able to serve their clients more knowledgably and comprehensively, and they will have more promotional opportunities. Interoperability of current IT systems will be improved, and programs will be able to braid funding from multiple sources. The H&SS reorganization is intended to enable staff and resources to will be able to focus on clients’ needs and outcomes and look further upstream, thereby intervening earlier to improve outcomes for our community. As examples, H&SS will be better positioned to prevent sudden homelessness, clients’ chronic diseases would be better managed, and clients would need to return to H&SS for services less frequently.
FINANCIAL IMPACT:
The cost associated with the requested positions is estimated at $1.65 million for the first full year and $2.01 million annually after all positions are filled. H&SS intends for some of the requested positions to be internal promotions. The Department is requesting $300,000 in FY2019/20 and ongoing in County General Fund to support one team of navigators (1 Public Health Nurse and 1 Social Worker II) and the balance will be paid with federal, State and Intergovernmental Transfer (IGT) revenue, 1991 and 2011 Realignment, and Mental Health Services Act (MHSA). As the organization evolves over the next 3-5 years, there may be opportunities for staffing changes as a result of integration efforts and increased efficiencies.
The costs associated with preparing the agenda item are nominal and absorbed by the Department’s FY2018/19 Adopted Budget.
ALTERNATIVES:
The Board could choose not to approve the proposed reorganization and association position allocation changes. This is not recommended as the current organizational structure is less likely to support client/population-centric service delivery.
OTHER AGENCY INVOLVEMENT:
H&SS worked with the County Administrator’s Office in developing the agenda item.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION