 Welcome to Sheboygan County Government, working for you. My name is Adam Payne, Sheboygan County Administrator and co-host of this program with Chairman Mike Banderstein. And as you know, every month we try to focus on a different department. We've got 22 departments in Sheboygan County, tremendous breadth of programs and services. And today we're very pleased to have one of our newest department heads with us, Mr. Tom Eggebrecht, who is now our Health and Human Services Director. Tom, welcome. Thanks, Adam. Appreciate being here. The next seat to his left is also another very important manager in Sheboygan County Government. You may have heard his name because of all the discussions of late about flu symptoms. Mr. Dale Hippenstiel. Dale, welcome. Thank you, Adam. Mike. Dale is our Public Health Manager. Did I get that correct, Dale? Correct. And has been with us now for how many years? Well, nine years in this state, 37 years total in public health. So you may recognize Dale, but you certainly don't recognize Tom and we'll start with him. Brown County is the Health and Human Services Deputy Director there for a while. And I can't tell you how pleased we are to have him aboard. Tom, please start by sharing a little bit about yourself and your background. Sure, Adam. Be happy to. First of all, I am extremely pleased to be here. Brown County was a great place to work, but Sheboygan County is just wonderful for me. I'm a native of the Wausau area, grew up in the Wisconsin River Valley, met my high school sweetheart there and we got married and moved on to Milwaukee where we worked with children and families in the inner city and eventually I got into vocational rehabilitation. Armed with that experience, I served 10 years in Manitowoc County as a Developmental Disabilities Coordinator. That took me to Brown, as you mentioned, spent 10 years there as Director of Community Programs as well as Interim Director. When the opportunity came up in Sheboygan late spring, early summer, it was too good for me to pass up. I've known a number of the staff here, love the communities and so happy to be here. So we both married our high school sweethearts. I didn't know that. There we go. In Wausau, I'm from the Stevens Point area. That's right. We've raised some good people in that part of the state. Absolutely. And that concludes our program today. Well, Tom, it's a good day to have you here today. Please begin. Again, and our viewers are learning today. You haven't been with us that long, but obviously you come here with a lot of experience. What's your initial impression of the Health and Human Services Department and the people working there and the programs and services we're providing? One of the things, Adam, that was non-negotiable for me was to work with and for good people. And as I mentioned, I've had a fair amount of contact with Sheboygan County over the years. I've known a number of the staff that have worked for the county. I'm very familiar with some of the work that's been done in Sheboygan County through the Pepsi process and other initiatives. And I have to tell you that since my arrival, I have not been disappointed. We have about 192 staff members that work for the department. I'm so pleased that their contributions, their effort, I'm in a very good place. I think we're going to be in very good shape for the years to come. Excellent. Excellent. And for our viewers who haven't watched a program like this before, share a little bit about the Health and Human Services Department itself. It's a core issue, core areas. Sure. Well, county departments in Wisconsin under state rules are allowed to organize in accordance with what seems to make sense locally in line with local preferences and needs. So here in Sheboygan, we are organized as a comprehensive health and human services department. And in line with that organizational structure, we have major divisions that carry out that work. So Dale is with us today as manager of our public health division. And in that area, we address communicable disease control, environmental health, maternal and child health. Joan Ketterman leads our division of community programs and aging services, where we provide early intervention for kids with disabilities. We provide mental health and AOVA treatment. We also operate an aging and disability resource center, recently moved to Sheboygan Falls. And that's also the division where we offer senior meals to eligible persons. Social services is led by a manager named Marty Bonk. And in collaboration with law enforcement, schools, other community agencies we respond to, reports of child abuse and neglect and juvenile crime. Liz Malick leads our economic support division, incredibly important in the current economic climate. And through Liz's staff, we determine eligibility and administer benefits such as Medicaid, food share, childcare assistance and employment assistance. And I have to mention to Adam that with our budget being approximately $31 million in size, we couldn't do it without the additional support of our administrative services staff. And I want to recognize Carol Bukovic and Kim Pagel, who work with us in keeping all of that together. You've got a great team and a very nice high-end overview as folks get a better feel for the Health and Human Services Department. And as you said, a number of important programs and services. $31 million budget. But how many people do you think the department serves on an annual basis? I wish I could give you a good composite aggregate total. But what I can tell you, Adam, is that our services are reported in several different state systems. And unfortunately, they don't speak to each other. We're trying to address that. We plan to address that within the next year or two. I can give you a grand total number. But what I can tell you is that our current estimates suggest that we're serving or people are benefiting from those who are receiving services. At about 50 to 70% of the county population at any point in time. I can give you some very specific numbers that help illustrate that. Our Aging Disability Resource Center, for example, receives about 1,000 calls for information and assistance per month. We administer 12,000 immunizations annually, I think under the current H1N1 circumstance that number is likely to grow this year. 17,000 persons every month are receiving economic support assistance in Sheboygan County. We process about 2,300 child welfare and juvenile justice referrals each year. Our crisis line receives 4,000 calls for assistance. So when you consider all of that, absolutely the vast majority of the population does benefit from the services we're providing. I think the most important thing for all residents of the county to remember is that no one is immune to the need for that support or assistance at any point in time. And again, especially with the economic climate being what it is. Excellent. And when you say 50% are better of our population, we've got about 115, 120,000 people living in Sheboygan County. So 60,000 people are better. That's just remarkable. And I don't think a lot of people, unless of course they're one of the individuals who have sought help or need help, are recognized just how important that department is. Excellent overview. Dale, speaking of important topics, you've been very involved with emergency planning and making sure that the county's prepared for H1N1 and things like that. Just emergencies of any kind. And as our public health officer and manager of this division, is Sheboygan County prepared, have preparations in the past, helped us be ready now for H1N1 and flu type issues that people are concerned with? Well, that's a, we could probably spend about two hours on that, Adam. But I think in a nutshell, we've been very fortunate in Sheboygan County. We've had good support from our Health and Human Services Board. There has been an ongoing effort in my entire career to be prepared for what we call traditional emergencies like tornadoes, flooding. You recall the floods of a few years ago in Sheboygan Public Health and Health and Human Services, we're involved with that. Since then though, particularly since 9-11, there's been a ratcheting up of the planning, the need to collaborate, the need to not just work in a shell, don't just do your plan. Your plan needs to work with other folks. And we have really worked, I think our entire planning community, including the medical community, particularly the person you have is Steve Steinhardt, the emergency manager that works in the Sheriff's Department. These plans have been put together right now. We're obviously with the swine flu looking at large clinics, how those work. They don't just open up in the morning, it takes great deal of planning and so forth. So yeah, it's an ongoing effort. We have staff assigned to that. We have responsibilities to the state. We have small grants and we have to fulfill those deliverables. So yeah, it's a lot of fun. It's a fascinating work and it's really helped us as we're moving into this flu campaign with H1. Let's drill down a little bit more. As you said, you, your staff, you have an excellent team in place. Steve Steinhardt, our emergency management director. For years, we've been planning for a disaster of a number of kinds, as you mentioned. You hope it never happens. You hope all that preparation never has to put into action. But with H1N1 of late, that's raised the bar a little bit. And I think the concern throughout the community that we need to be prepared. We need to take action. What more specifically is the role of your department in the Health and Human Services area? Sure, within Health and Human Services and public health, we have an incident command structure for this particular, we call it an event. We write goals and objectives. We started doing that last winter when we knew that this pandemic was liable to take place. And I think it was April 11th of last spring when the pandemic was declared by the World Health Organization. So, as we began seeing this coming, we started putting together people, looking at our partners, figuring out ways to communicate, retesting our systems all the way from the simple things like redundancy and communication with phones, 800 megahertz systems that are used by first responders. Reattaching ourselves, reintroducing ourselves to different people in the medical community, people that you might not think would have a role like the bus services. If we had to run a clinic for smallpox, we would use the bus services. So, the different companies have stepped forward and said, we will participate. The school systems, in this situation, planning with the school systems has been very, very strong, great partners. So yeah, we get down to who's gonna handle which piece of paper and how you move that through the system efficiently. And we're pretty happy so far with what we've been able to do. And final question before I turn it over to Mike. What is the status right now of H1N1? Well, the status now, and we had a briefing. As you may be aware, a couple of months ago, the federal CDC Centers for Disease Control, the federal government and the state government said, there's no need to test every person that has flu-like illness, simply because we know it's there. We know that at least 40% of the people presenting with those symptoms has H1N1 or swine flu. And so right now, we are very fortunate. We have not had a death. I'm keeping my fingers crossed. We have a lot of vaccine out to high-risk people. We had a couple folks that did pass away that the doctor was very concerned. And thank goodness they were not H1N1 related deaths. But they were influenza kinds of things. The schools, last month, we had some schools that had 35% absenteeism. We've worked with them closely. That's gone down. Now the last couple of weeks, the virus has gone through the schools. We still know it's there. We're still getting reports from the doctors, from families, and that kind of thing. So we're still encouraging people to get vaccinated when vaccine becomes available. Very good. Thank you. Dale, as you know, there's a lot of concern. I'm sure your department, as well as our hospitals and clinics, are getting a lot of phone calls about the flu. Could you explain a little bit of the difference between the H1N1 and the seasonal flu? Yeah, sure. The seasonal flu vaccine is developed. It's planned a couple of years ahead of time. And they identify viruses that have gone through the communities. And they grow those viruses. They create vaccine. And that's part of the formula. It's kind of the mixed drink for that immunization. The difference between the swine flu or H1 is they affect different groups of people. Seasonal flu, the high-risk people generally are people with chronic diseases at all ages, people with autoimmune disease, and people that generally are senior citizens. The H1N1 influenza is the opposite. It affects younger people. Our data shows that 80% of the folks that have confirmed H1N1 are under 35 years of age. So, and that's a very big concern for us because there's no immunity in those people. They've not been exposed to a lot of these types of viruses. So if it takes another mutation, it could become much more dangerous than it is. It's kind of interesting the genetics of this particular virus, which kind of who figures that out. There's some pretty smart folks out there. There's actually the result of four viruses, two that come from swine, one that comes from birds, and one that comes from humans that got all gobbled up together and out came H1N1. So it's kind of fascinating science from my perspective. That's my world. So we still are seeing diseases. Last month, God bless the clinics and the doctors and the nurse practitioners and the nurse assistants. They were just deluged. The clinics, the large clinics were running until late at night because so many people were ill. Particularly kids and parents are very concerned because this disease, you really spike high fevers. And there's nothing that scares a mother more than 102, 103 fever in their youngsters because of all they've learned in their parenting efforts. There's been a lot of media attention about the vaccine and the clinics that are being set up for it. Could you give us a little idea about where we are in Sheboygan County with the availability of the vaccine and where we are in doing the priority groups? I certainly can. It seems to change. It seems to be a moving target. But in a nutshell, initially the priority groups were healthcare workers and emergency medical service folks. There became issues as to who those people were. Everyone thinks they're emergency medical responders, but not everybody is. So we wanted to be sure healthcare workers, we wanted to be sure pregnant moms. We wanted to be sure folks that had six month old youngsters and younger, particularly caregivers were vaccinated and there were a number of targeted groups that almost changed on a weekly basis based on the availability of vaccine. As we speak now, on the 19th of November, we have enough vaccine, we have three large clinics planned today and tomorrow and next Tuesday, I believe, at the airport. The airport's opened up its facilities and as you both know, it's spacious, good vaccine, good signage, those kinds of things and we've added folks up to the age of 64 with chronic disease. So if you're a senior citizen and you're close to 64, you can certainly stop out and receive a vaccination if you have something going on. If you're healthy, you probably don't want to do that now. So we're getting vaccine in slow but sure and we have ample supplies now to go through next week. That's good to hear. What kind of advice can you give our constituents about prevention and then treatment just in general for this flu? Well, you know, we get into a little trouble when this all started when you would say, we'll call your doctor if you have a concern and the doctors were saying, we'll call your health department if you have a concern. So I think the telephone lines were about burning off the polls because there were so many calls from folks coming in. The number one preventable thing you can do is when vaccine becomes available, get it. Pay attention. You can call the health department. We have a number 459-3033 that you can call in, call the main number and it will tell you when the clinics are taking place. You can always check with your physician, your medical provider to see if they have vaccine and vaccine comes in different days to different places. So you really need to do your due diligence as a parent or a spouse to be sure that you take advantage of those vaccines. Obviously the second thing, if you're not eligible, pay attention. Good hygiene. Good hand washing. I read a little article this morning about the keys on debit machines, the drive through ATM machines. Now use a pencil, just boom, boom, boom. Push the buttons instead of putting your finger on there. Probably isn't a bad idea anyhow when you look at the condition of some of those. The basic things of if you're sick, stay home. If your kids are sick, stay home. Don't spread the disease. Don't try to hide the disease. And if you have any issues at all and you're concerned about the health of your family members or friends, be sure they talk to their physician. Now originally, Dale, I thought that the H1N1 was going to be a two-stage inoculation, so to speak. Is that still the case? That still is for the younger kids. I think the cutoff age, and I'm going to say it's nine, nine years old, that you would have one dose now, and those kids, the healthy kids, they have a nasal spray, so it's a very simple, quick thing to do. And then at least three weeks later, they come in for the second dose. They're testing folks now on the national level, and they may find that the one single dose is doing a pretty good job, but they don't have enough data now to say stop. So we're scheduling clinics for these folks, for these kids. Okay, well thanks for that information. With the economic downturn that we have right now, that's stressing a lot of our constituents' families, and I'm just wondering what areas is this impacting in our health and human services and how are we responding to that? Hands down, Mike. I think you hit the nail on the head. The economic downturn has really created a large influx of need within our department. Our area of economic support has grown tremendously in the last several months and the last couple of years. The most specific example I can give you would be in the area of food share benefits. I mentioned earlier, we're seeing about 17,000, we're supporting about 17,000 persons each month in Sheboygan County. Our case load in the area of food share benefits has grown by approximately 40% since the same time period last year and about 115% over the last five years. So for our staff that has created a tremendous influx of responsibility without any concurrent increase in administrative funding or increase in staff to manage that case load. So that's a real testament to the work that they're doing. I should mention too that earlier this year that very staff received a special award for 100% payment accuracy and 100% timely processing of applications in the area of food share. So I'd like to tell you that our staff is responding to that influx very, very well. It's good to hear that. And how is your department doing with getting more money in from the state or the federal government to give out these benefits? Well that again becomes a very, very difficult circumstance in the current economy. I need to acknowledge that we've received some small assistance in the form of federal stimulus dollars in the area of our senior meal program. For example, we're seeing an additional $20,000 or so to help us get through this year as well as 2010. In Dale's area we received a new grant allocation to address the H1N1 campaign. So there are some small pockets of assistance that have been received. Those types of assistance are short term time limited. I'll tell you otherwise across the board we have seen at best our funding remain the same and in many cases been reduced. Federal 4E incentive funds which help in our child welfare area for example are slated for elimination in the near future. I can tell you that the state and the current biennium has stopped paying for children's psychiatric inpatient care under the Medicaid program that puts pressure on our department. We've received word that we should not be expecting any continuation of state support for fraud investigation activities in our economic support area in the coming year. Most other programs have seen between a 1% and 2% reduction in funding. So again at a time that need is growing our ability to hold that entire system together is becoming a little more difficult than it used to be. Tom are there any new initiatives or policies that are being put in place to deal with these funding problems? Well I can tell you by way of new initiative it helps on the state level, it doesn't help us so much. I would say that a number of the funding streams that we work with Mike have grown increasingly complicated. The byproduct of the circumstance, an example I can give you is our kinship care program. Kinship care provides support to kids who are no longer able to reside with their natural parents. Extended families for example can receive state funding support, a small stipend each month to provide for the needs of those children in their care. Under the new state biennial budget we're now going to be obligated to license those providers as foster care providers. What that means is additional workload for our staff. It means additional intrusion into the lives of those persons and in all reality some of those households may not meet foster care licensure standards. So that could result in a discontinuation of support for those people. In the worst case scenario it could result in those kids needing to go into traditional foster care which would be a very unfortunate outcome. I can also tell you that the state is leaning strongly toward a regionalized service model. So rather than each county delivering its own service as funding is reduced I think there's pressure on counties to partner with other counties within the region to support services at the level that we may have known them to exist previously. There's increasing demands for efficiency as I said and economic support even though a caseload doubles there's no additional staff to deal with it so you have to work smarter you have to come up with new approaches to how you process that caseload. I'll also tell you that there's demands for increased accountability which I think is good but I also think it's difficult if you don't have good data systems to measure that accountability and the area of human services it's not quite an exact science to say that you achieve the exact outcome you were hoping to achieve but we're seeing some of that evolve as funding grows increasingly tighter. Well thanks for letting us know about those challenges you and the department are facing. With that I'll turn it back over to Adam to wrap up. Covered a lot of ground we only have a couple of minutes remaining and I know with the holidays soon upon us here Thanksgiving and then your future Christmas a month away. The department gets involved in some unique special programming this time of year. Could you touch on a couple of those? Well I'd mention Adam that actually our department is involved throughout the year. Our staff participate in dress down days every two weeks in exchange for a donation toward a county-based non-profit organization charity or special cause. We've supported breast cancer awareness. We got involved in providing some support to Mental Health America by way of their recent Hope Walk and other like activities. I'll also mention that there's many many organizations that step forward this time of year and make donations to our department on behalf of our consumers. I can mention the Sheboygan JC's, the Alks Club, Knights of Columbus, we've got local churches recently Cub Scout Pack 3874 and Plymouth said we want our boys to help put together gift stockings for less fortunate kids during the holidays. Those are great great initiatives. We receive support each year from the Festival of Trees event that helps provide funding support to our child abuse and neglect fund. That pays for things that kids and families wouldn't otherwise be able to receive through our state and federal funding sources and even our county clerk Nan Todd has organized the campaign for county departments to provide gift support to kids and families in need. So very very gratifying. Again it speaks to the good people of the county. It sure does. What an excellent overview and I can't help but just be filled with pride when I think about how much our county employees give. Not only are they working very hard in their respective roles and responsibilities, taking on an additional workload, doing more with less but they're very very giving and thoughtful. The United Way campaign that we run internally this year once again county employees contributed more than they did last year and in fact county employees contributed more every year since 2004. We've had a tremendous run of late. So all the programs and different United Way programs that you mentioned and other activities just very generous and whether it's the two of you or your team at Health and Human Services or countywide we just have some wonderful people working here. We only have a minute remaining and I'd just like to wrap up and ask Dale if you could give that number again that if folks want to get a flu shot or H1N1 shot what number do they call? You can call the 459-3033 that will give you a recorded message on the location of the clinics. You can also go on the county website, just the Sheboygan county website, you can do that, you can put the exact letters in, hit the influenza information and you can find a way to look at every clinic scheduled within whatever number of miles in the state of Wisconsin that are being held in a given month. So go to the county website, hit the influenza, try the 459-3033 number and you will find a great deal of information that will help you and your family. Outstanding. Wonderful overview, Tom. I know you're never going to leave us because you're surrounded by good people. Tom Eggebrek, Health and Human Services Director, Dale Hippenstiel, Public Health Officer. Thanks for joining us today. Thank you. Thank you. Highway Commissioner here, Greg Schnell, to talk a little bit about the difficult task key and his team have keeping our roads safe and also providing some tips to make sure you stay safe as well. So until then, have a wonderful holiday season. Thanks for joining us.