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Conduct a workshop to discuss the proposed reorganization of the Health and Social Services Department
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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 that the Board of Supervisors conduct a workshop to discuss the proposed reorganization of the Health and Social Services Department.
SUMMARY:
For the past year, the Department of Health and Social Services (H&SS) has been actively working with external consultants examining state and national trends in health and human services delivery. Increasingly, counties and states have been moving toward a more integrated provision of services that are more consumer focused and lead to better outcomes. A central aspect of these trends is providing more preventive and care coordination services in the community; these are more cost effective and improve community health. The proposed reorganization will assist H&SS with delivering better integrated services to the community and result in increased effectiveness and efficiencies. This structural recommendation is based on best practices gathered from other counties with integrated services, as well as on input from staff, service recipients and community stakeholders.
FINANCIAL IMPACT:
The costs associated with preparing the agenda item are nominal and absorbed by the Department’s FY2018/19 Adopted Budget.
DISCUSSION:
On June 26, 2018, the Board received a presentation from H&SS and approved its new mission to “Promote Healthy, Safe, and Stable Lives” and its vision of “A Healthy, Safe, and Stable Community.” During the presentation, the Board encouraged H&SS to continue this work and keep the Board apprised of its efforts. H&SS identified its next steps as continuing ongoing work in culture improvement, effectiveness and efficiencies, as well as conducting an external scan and engaging with its community partners and stakeholders. H&SS partnered with two consultant organizations, Performance Works and the American Public Human Services Association (APSHA), to assist with these efforts. Additionally, H&SS has been actively involved in the Harvard Health and Human Services Summit.
Performance Works assisted with building a foundation to accelerate performance, develop leadership capacity, shape an adaptive culture and provide tools to keep employees engaged and informed. In addition, Performance Works completed an organizational assessment and provided recommendations to ensure H&SS is “future ready.” APHSA introduced the Human Services Value Curve (HSVC) which aims to drive H&SS toward an internal cultural shift and increasing collaboration with community partners to enhance practice and services within the community. The focus of the HSVC model and research is to design a system of delivery of services based on the true needs of customers, with services that are more wholistic and prevention-focused. HSVC also includes a public health approach to service delivery by working upstream with stakeholders in the community who play a part in meeting the health and human services needs of the population.
As part of H&SS’s partnership with Performance Works and APHSA, multiple surveys and listening sessions were conducted with program participants, staff and various community stakeholders. Some of the feedback received indicated that although H&SS is administratively managed as an integrated agency, much more can be done in serving and coordinating care for the whole person or whole family. Responses from program participants demonstrated that the majority would prefer a coordinated, multi-program application process with information shared between programs in order to optimize care. Meeting this preference requires better data sharing between divisions and other departments in the County, better integrated IT systems, less “siloed” funding sources, and more multi-disciplinary team involvement.
On November 6, 2018, the Board adopted a resolution as authorized by Assembly Bill (AB) 2821 and effective January 1, 2019, which allows H&SS to operate as an integrated and comprehensive County Health and Human Services agency including maintaining and evaluating an administration system that integrates and coordinates the management and support of client services and maintains a system of reporting and accountability that provides for the combined provision of services without the loss of State or Federal funds. The integration initiates the process of allowing funding to follow clients based on need.
During this workshop H&SS will present to the Board the rationale for the proposed reorganization of H&SS. In keeping with state and national trends in health and human services delivery and with emerging best practices, the objective is to create a fully integrated agency organized around the people H&SS serves and to deliver population-centric services. The workshop will include a discussion on how the landscape is changing and the current challenges. H&SS will discuss the work ahead and describe the models used by other integrated agencies to achieve a similar objective as well as the significant employee, program participant and stakeholder engagement processes that were undertaken to obtain input. Staff will also touch on key strategic priorities. In addition to describing the desired H&SS structure by 2025, the workshop will include a discussion on the current structure and its challenges and barriers, the breadth of program responsibilities in H&SS, new programs and key regulatory changes adopted since 2010, emerging issues, changes in staffing patterns and intra-departmental communications. After addressing services used by clients, workloads and caseloads in various programs, caseload trends and vacancy trends, the principle assumptions underlying the proposed reorganization and the proposed timeline for achieving the objective of integrated services focused on H&SS clients’ needs will be outlined.
ALTERNATIVES:
The Board may choose not to conduct this workshop to discuss the proposed reorganization of H&SS. This is not recommended because the workshop will provide the Board with an opportunity to better understand the Department’s rationale for the proposed reorganization and to discuss with H&SS how the proposed reorganization will achieve more efficient services delivery and better client outcomes.
OTHER AGENCY INVOLVEMENT:
In creating the recommendations and proposed organizational structure, H&SS and Performance Works worked with the County Administrator’s Office and Human Resources and solicited input from stakeholders such as local community-based organizations and customers/recipients of services.
The County Administrator’s Office has been consulted on the presentation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION