 Welcome to Sheboygan County government working for you my name is Adam Payne County administrator and co-host of this program with chairman Roger Distruty and today we're pleased to have not one but two guests with us from one of our very very important programs one of our very important departments the Health and Human Services Department and within that department a number of very important programs one being public health so with us today is Tom Eggebrecht our Health and Human Services Director and Dale Hippenstiel our Public Health Manager welcome gentlemen thanks Adam thanks now we're gonna have to tag team this a little bit between the two of them and Tom's been here for three years and Dale for 12 so Dale's got the tenure but Tom's the boss so I think we'll try to balance this out pretty well and it's been a very good team in fact we have an excellent team at the Health and Human Services Department a lot going on a lot of programs and services and Tom if you could start by just giving our viewers a little flavor for the roles and responsibilities of your department sure nice to be here first of all thank you Adam yeah our department I think most people know provides a wide variety of services we've got 180 employees and we operate out of three different work locations starting with our job center which is on Wilgus Road a little bit west of Taylor Drive and there our staff provide eligibility determination for Medicaid and food share assistance and we provide employment and training programs go a little bit west of that to Sheboygan Falls and on the north side of town we operate an aging and disability resource center so staff there provide information and assistance for individuals and families that are inquiring about long-term care we offer our senior meal program and coordinate volunteer driver assistance through the ADRC we also provide adult protective services and benefits counseling for folks who are struggling with social security information things of that nature our main building is located downtown across from Fountain Park and there we offer behavioral health outpatient services as well as case management child protective services juvenile justice and as you mentioned public health and glad to have my partner Dale with me today and for those watching this program and coming and going in the city of Sheboygan some might get the appearance that new additions going on at your facility well what's happening yeah someone asked me recently if our department was being torn down and I said no it's just getting a facelift so we've actually had a stucco facing on the east side of the building that has deteriorated over the years so it's kind of acting as a sponge at this point so that's all being resurfaced and we'll have a kind of upgraded appearance to the building when it's all done yeah we need to take care of our infrastructure too so about 180 employees 30 31 million dollar budget it's our largest department budget critically important programs and services for the neediest of the needy and as you said one of the areas very important public health and Dale you've been our public health manager for a number of years now I'm sure people are familiar seeing your name from time to time in the newspaper and please tell us a little bit about your area and the core services provided sure I could spend a whole program on public health so I'll try to keep this what belongs in this day and age we've seen a change in the public health services that are delivered throughout the state in the country there was a time where you'd come to public health and all you would think about are immunizations you come in and get your chickenpox shots and you come in and get your your polio cubes from the old days those those kinds of things we still do a lot of those kinds of direct service activities we do a great deal of communicable disease investigation people would be quite surprised to see our list of diseases that are reported to us by the laboratories and the hospitals and clinicians doctor's offices in Sheboyin County that that we have to follow up on presently we're in a the state has a very large number of pertussis cases which is whooping cough and we've experienced that here we've experienced that in the schools these are real life kinds of things that our people are involved in we also do our women's infants and children program and maternal child health childhood lead poisoning programs at an abatement identification and so forth one of the one of the more interesting programs that we do is the environmental health component and that is the inspections and review and consultation of the restaurants the swimming pools the spas the hotels the campgrounds the summer camps public water supplies around the country kind of a little known program our restaurant owners generally are very supportive of that and our staff does a great job in helping those folks and we're we take the educational mode in that area the other large component that we've really seen a change is we are into collaboration we we finally learned in public health that we need partners and we'll talk a little more later about some of the partners in the community health center so you know again I could go on about programs and public health and I love it great great staff and I and I have to say that this county has been very supportive I look at my friends and the eastern side of the the state and and people are just struggling to keep services together because of cuts and budget cuts so it's it's really appreciated here well what Roger and I appreciate is the excellent leadership that the two of you provide in the team you have in place so we have so many hard-working caring dedicated people in public health and throughout the health and human services department and for those of us from time to time who you know get into some of the detail and the critically important work that's done it can be heart wrenching gut-wrenching work very very important and what I've particularly been pleased with with public health Dale and your role in leadership there is the collaboration with the schools and everyone else with emergency response planning if there is a disaster I know you've been active in that area and then as we're going to talk about in a few moments the Lakeshore clinic so we'll get back to you in a second Tom we've been feeling the pinch from the state for years counties local units of government across the state everybody's being asked to do more with less I don't think there's a department in the county that hasn't streamlined to reduce their staffing or done what they could to be part of the solution what's happened in health and human services over the years because you and I both know we have a smaller department today than we did a few years ago absolutely Adam and I think it starts with one of the key things that Dale commented on collaboration so as we look down the road and we understand that we're not going to have the same resources in the future that we might have today it's pretty critical for us I think to try to integrate care what I mean by that is in the past we may have been able to have three or four different individuals work with a family the more we can prep and support an individual staff member to provide assistance at least on a baseline level we're going to be a little bit better off so Dale and his staff have been great partners in terms of integrating care within the department we've got a public health nurse that's now assigned on a part-time basis to the ADRC we have another public health nurse that recently this year moved from public health responsibilities into behavioral health responsibilities so as a byproduct of that we're able to reduce some expense we're able to capture some new revenues we're able to cross trained staff and they can kind of learn from each other and at the end of the day I think we provide better service obviously health related knowledge is a key ingredient in terms of aging and long-term care so now the participation of that staff at our ADRC has been very much welcome very much appreciated and that's a great great model for us to continue pursuing we've also I think looked at vacancies quite critically we've got supervisors now that have broader spans of control we've got case managers that are carrying larger case loads and kudos to them so Dale talked about the quality of staff that we have and in all honesty without them and their buy-in and their motivation and commitment that wouldn't be possible so a variety of approaches are helping us and health and human services like many of our county departments mandated programs that we mandated by the state that we need to administer and as just part of the exercise of preparing for today you know we all kind of looked at our history a little bit and it caught me off guard a little bit that literally the health and human services department has 15 million dollars less coming into it today in 2012 than it did in 2007 predominantly state and federal funds but please touch on that a little bit what's happened with with the funding that you rely on and of course what is that meant for the programs that those funds used to used to help keep going yeah you're right adam i think the the delivery of service on the local level is undergoing major changes part of that is due to state and federal policy shifts part of that is also due to erosion of state and federal funding that previously may have been directed our way as you mentioned as recently as 2007 our department budget was nearly 47 million dollars for 2013 we're going to be under 29 million dollars so there's several you know explanations for that in the area of long-term care counties had a role in terms of arranging and providing and coordinating care for vulnerable populations for many many years in 2008 the state went to a private managed care contract model that moved those dollars from county government to private entities this year we received funding reduction for income maintenance programs in our county along with nine others partnered to create a regional collaboration to try to hold those programs together next year we're going to lose our w2 funding from the state that'll also go to a private regional management entity and the funds state and federal funds that we were using in the arena of children's long-term support services are now going to be managed through a new third-party entity so we've seen significant erosion of those funds in our budget and as that happens it puts increasing pressure on local property taxes to to hold baseline services together our contribution toward corporation council doesn't change our contribution toward building services doesn't change our contribution toward information services within the county doesn't change but what does change is the share of state and federal funds that helped to support that previously are no longer available to us so levy contribution has remained actually quite steadfast has grown a little bit since 2007 i looked at that and i think we've seen about a one percent per year increase over that interval but over the last four years our levy contribution has decreased by about one percent each year so and when you say levy the property tax the property tax absolutely right so again as dale mentioned and i will reiterate it the support the contribution the embrace from the county board and the taxpayers has been tremendous so i know that the people in need of service appreciate that we as a staff appreciate that so very much but as you as you're pointing out changes in inevitable the state was in a situation a world of hurt needed to make some changes changes have occurred are occurring we do see less state and federal funding just trying to hold the the line on property taxes and the county board's been very successful with that departments have either had the line held or seen modest decreases as you said in the time when there's demand for more services so the viewers may thinking okay that's all finding good we're hearing there's less money coming from the state and federal government the county property taxpayers may be picking up the difference or struggle the board struggling to hold the line but what does this mean for the people we serve what what are you hearing from the people we traditionally serve that in the past may have relied on county staffing or programs and now we're relying on other forms of assistance how's it worked okay it's funny we we annually by statute are required to have public hearings as part of our budget planning and and one of the comments that stood out for me this past summer as we were planning for 2013 we had a an individual i don't even know if he's a department consumer in all honesty but he was aware of the fact that we're going to these regional models he understands that there's new service delivery mechanisms and he urged us to to try to resist that to try to prevent that because as he said it was so important for people to have local access and local voice this past monday i sat in on a listening session related to this new state long-term care delivery program called family care it was arranged for our legislators and it was interesting for me because a number of the folks who showed up for that listening session were previous consumers of services through our department and their message was they mourn the loss of relationship with the staff members that they knew they they mourn the loss of quality of service that they felt that they had and i think most importantly they felt like their voice was no longer as as heard as it may have been in the past because as services shift into private non-governmental entities access isn't the same responsiveness may not be the same and one of the common messages i heard was we don't know who to go to with our concerns anymore and i'm i'm sure that will improve over time but it it made a big impression on me just how valuable the service that we have provided has been in the lives of so many people nice to get that kind of feedback absolutely roger i'm going to turn it over to you sure as you know earlier this year the united way and other community contributors shared some exciting news about the health care access to people that didn't have health insurance before or are uninsured completely uh dale would you please tell us a few things about lakeshore community health care center that's a topic that's like public health we could go a couple of meetings but i'll i'll try to focus for you yeah we we were awarded a new access point grant through health resources services administration of the federal government and we'll talk in a couple of minutes about how that came about what it what it does is it allows us and we're in our infancy just starting it allowed us to affect services for folks that are uninsured or underinsured and that could be medicaid that could be people large large deductibles a good example is is the dental services we're now providing if we think about the shoreline if you there there's an area all the way from green bay down to milwaukee where very few dentists except medicaid as a payment source so anyone that was on medicaid or uninsured simply could not access a dentist unless they went out of town and and that was still difficult so so the the clinic itself will be partially funded by the federal government partially funded by it's not a free clinic as i i iterate to to folks you know you have to pay your copay there's a sliding fee scale if you don't have insurance those kinds of things it's not a and it's meant to be a a medical home for these folks there will be dental services there will be primary care services in other words your family practice pediatric kinds of things and there will be some behavioral health services all integrated in this in this program thank you i was pleased to be able to attend the initial meeting with some of the background of the people who helped collaborate and start the clinic can you give us a little background on how some of the initiatives started and collaborated with us to make it happen sure yeah that again that's a that's a bit of a that's a six-year story and i'll do it in one minute because i practice this one the united way did a needs assessment community needs assessment a number of years ago trying to focus on impact projects where they could put money where they could steer their resources to actually see change in the community one of the things that popped right to the top was access to health care for folks that are they have no insurance or are underinsured and you know through that process which was very it was gruesome almost because you really had to get people to agree on what they were doing so after that happened both of our hospital system stepped forward with st nixon aurora and our medical systems and united way they pulled their money we were able to go out and write a fairly detailed grant for this new access point program and the first round we were not funded this was two years ago and then we found out this year this summer we were funded so we're really excited about it we're partnering with connoisseur community health center we're we're seeing a lot of excitement within the community so we have lots of partners interesting thing about the center is the board of directors and it is nonprofit the board of directors of the center has to be made up of a majority of people that use the clinic so that voice is tom talking about family care that voice has to be heard can you give us your perspective of the overall health of our community oh sure we we are fortunate in wisconsin at the university of wisconsin medical school has a population health program and they have rankings and it's interesting that we are out of 72 counties just overall health we're about 18 okay now there's a number of factors that go into that we won't talk about we we still see access to care we still see this population that needs needs to we can we can create insurance but we still have to have access when you but just to clarify 72 counties we're ranked about 18 about a number one excellent whereas number one is excellent yes i'm sorry yeah very good and that's the 18th out of 72 yes which is so not too bad not too bad we're doing well we we've seen a decrease in teenage smoking that's really good we have not affected obesity and binge drinking too well that's that's a tough one in this community so we're you know the the healthy shaboy in 2020 group has a number of committees and again collaborations that that are doing lots of programming to clarify that question you asked earlier mr chairman you know the need for the lakeshore clinic you said under insured individuals or folks that have no insurance so when you look at the health of the community the by and large we're pretty healthy room for improvement but how many people in this community how many people in this community have no insurance or under insured and are going to utilize that new lakeshore clinic as a godsend for them you have nearly 18 000 people in this community that are on some sort of medical assistance program or under insured or have no insurance that's incredible that's a lot of folks out of 112 000 people right right and deal i understand acuity was one of the major donors to get us ramped up absolutely and they have offered $100 000 to help us this year can you explain about some of that funding sure how people can help toward that yeah that's a great question last year they did provide us a a grant $100 000 grant to to begin our nurse practitioner mid-level program and we now have a nurse practitioner and so that that worked well this year they threw a little little curve at us a little zinger and their foundation said they they thought about it and said let's let's challenge that community health center board you know they they talk a pretty good story let's see what they can do so they came back last month and and said yeah we will we will fund you in 2013 through the foundation up to $100 000 but only of which you can match so theoretically if we can raise $100 000 in addition to that you double your money so we have a pretty intensive as adam knows a pretty intensive effort taking place beginning to take place on obtaining new funds from individuals from other foundations from corporations and i think people will will step up when they when they understand the need we'll deal thank you for your leadership and and the county board did provide a one-time purchase of the dental equipment and it was a collaborative effort is there any other information you would be able to give to some of our viewers sure the the clinic phone number and if you obviously some people aren't going to have a pencil in front of them and they call my office at public health just call the health department or health and human services we can provide you more information the the clinic number just to talk to people to get a dental appointment or a medical appointment that number is 7-8-3-6633 again 7-8-3-6633 and and or they could call our office and we certainly can help folks with that on the acuity side on the fundraising if people are interested in in offering it could be ten dollars it could be a hundred dollars whatever people were willing to to part with if you may they could call the clinic at the same number 7-8-3-6633 or they could call united way at 458-3425 as this is a collaborative project and we do those are those are tax deductible we have forms that people can fill out that they would be available for folks to to engage and get back to us thank you deal and tom thank you so a lot going on and for our time is pretty limited already here but tom i'll turn it back to you for a couple of minutes any new initiative new initiatives in the health and human services department kind of in line with what dale is addressing adam for state and federal governments the same thing is true for us hospitalization inpatient care is a huge cost driver for us so that shows up in our department largely in the arena of behavioral health so we have a number of things in place planned for the new year number one we're going to take a therapist position and redeploy it in the form of case management so that we can work more closely with persons who have been hospitalized make certain that after care is being provided make certain that it's working we're going to expand psychiatric hours so that if folks are being hospitalized because they can't gain access to a psychiatrist or necessary medications we're going to try to fix that we're training our staff on new therapy approaches that have been proven through research to be effective in reducing re-hospitalizations this year we've actually trained consumers to start supporting other consumers in the interest of providing a better safety net and after care and in the new year we're going to start deploying those consumers in that interest um earlier this year i participated on an ad hoc study committee related to our juvenile detention center and i'm pleased to say we're going to continue to offer juvenile detention services in sheboygan county one of the things that that came out through that study process is that we need to do a better job of getting treatment to kids as a component of that program so in 2013 for the first time we're going to introduce some mental health treatment as a component of juvenile detention and then lastly i'll mention too that sometimes we end up with kids in tough spots uh who uh for whatever reasons are in situations that don't allow them to be safe or to achieve permanency so we're going to expand some legal services in the interest of trying to get those cases through the court process and promote better outcomes for those kids so a lot of things in the hopper adam a lot of things to keep us busy yeah and what's encouraging is a lot of those new initiatives aren't as a result of new money it's a result of excellent management and teamwork amongst your staff to streamline and establish priorities and and make adjustments and that's a real credit to you and your team again it takes everyone on the team to make that happen so i'm really fortunate to be in the spot that i'm in and fortunate to have guys like dale and the rest of our staff to assist with that yeah well fantastic and and if you want to learn more about the health and human services department because trust me we just touched on it there are a number of very important programs services helping a lot of people in great need here and if you need more information or want to learn more don't hesitate to contact either two of these individuals either of these individuals or contact the county clerk's office or the health and human services department and we'll get you the hands of people who can help you but on that note i'd like to transition just briefly to another and that is in government we can't be all things to all people the health and human services department as we all know in this room and you certainly know we can't do it all government can't do it all and that's why united way and the new lakeshore clinic and collaborative efforts to help the neediest of the needy in this community are so critically important as these gentlemen know this year i have the honor of co-chairing the united way campaign and we have a we have a a goal of raising two and a half million dollars about two percent more than last year and we lost our county our united way executive bill wiser recently which is a blow to all of us the united way family but what's so wonderful about being part of this family is how many people step up and work together to help make good things happen and to help people in need and when you hear about literally not hundreds but thousands of people that don't have any insurance imagine having a toothache or your son or daughter having a toothache and not being able to go to the dentist to take care of that pain people are in that situation so if you have a chance if you haven't participated or would like to learn more and how you can help the clinic be successful give the united way a call and and we'll certainly i'll be glad to talk to you if you're someone watching this and you have no insurance and you're suffering right now you're in pain from a toothache or something like that contact our new clinic i mean there's there's a lot of demand right now but certainly we'll do our best to see as soon as we can so on behalf of the four of us here and shaboydon county thank you for your support toward the united way towards shaboydon county government and also a shout out to acuity and their incredibly generous offer of another another a hundred thousand dollars to match to raise funds to ramp up this new clinic so thank you and thank you gentlemen for being here today tom eggebrecht health and human services director dale hippensfield public health manager and of course our fearless leader roger distrudi county board chairman chairman next month we'll have our planning director here erin brault and until then happy holidays