 Hello, good morning everybody, and we are going to reconvene our budget hearings From this week and today is June 18th 2019 today is our health and human services day and I'll begin with item number 25 Which is a presentation on the health and human services budget category as provided in the proposed budget pages 145 to 147 and outlined in a memorandum of the CAO Sorry Morning Members of the board Christina Mallory the county budget manager I'll be providing you an overview of the health and human services category great So here you can see the departments that make up our health and human services category everything from child support our core investments Human services health services and our homeless services coordination The health and human services category expenditures are approximately 340 million for the upcoming fiscal year This represents 41% of all the budget expenditures for fiscal year 1920 and is a 5% increase from the previous fiscal year Which is the increased cost to maintain current operations and the development or expansion of some programs Including drug Medi-Cal IHSS whole-person care and increased support for homeless services This chart shows the share of expenditures by department and agency You can see there that health and human services make up the majority For fiscal year 1920 the largest expenditures of course salaries and benefits which comprises a hundred and fifty eight million of the total and Supports eleven hundred and fifty three and a half positions an increase of thirty two Plus positions from the previous fiscal year Primarily adding about 25 positions mid-year for the whole-person care and fit program Additional expenditures include services and supplies of 99 million other charges of 85 million and other Financing except the remainder of the expenditures at 15 million fiscal year 2021 estimated expenditures are anticipated to increase by 2.4 million or 1% and will be updated as more information is known The health and human services category includes 308 million dollars in revenues this year or 91% of their total financing And other funds make up the difference or 9% to meet the necessary expenditures These revenues represent 40% of the total budgeted revenues This chart shows the share financing by department and agency and note that core investments are not represented as they are Totally supported by the general fund The 2019-20 revenues are comprised of $214 million in intergovernmental revenues 52 million comes from charges for services 25 million another financing and 17 million in other revenues including the use of money and taxes and licenses and permits Additional financing includes 31 million from the general fund contribution and less than a million dollars in other funds Fiscal year 2021 estimated revenues are status quo at this time and will be updated the following year when more information is known So this chart shows the departmental and agency share of funding supported by the general fund For a total of 31 million dollars, which represents about 19 million 19% excuse me of the total general fund net cost Further details will be provided in each budget proposal And this will give you a few highlights of the operational plan for the next two years the health and human services departments contributed 47 objectives to the 1921 operational plan major projects include reducing clinic wait times increasing access to withdrawal management services Doubling the number of low-income families participating and thrived by three and an initiative to increase the number of individuals Experiencing homelessness moving into permanent housing Critical unmet needs in the health and human services arena remain Including the navigation center to provide services for the homeless population Expanded behavioral health services supports to our aging population and permanent supportive housing However, we would like to leave you with just a few of the accomplishments health and human services Had this year Clinics have gone through extensive remodel And have added various exam rooms and completed remodel at the Watsonville Health Center and at the Amaline Clinic Drug Medi-Cal Program continues to expand capacity and over the next two years this program will Double the number of withdrawal management service days, which is currently the largest obstacles to clients entering treatment Adult protective services has added a long-term care management team called transforming lives with care Housing received an additional three million dollars to support low-income individuals and families to obtain and maintain permanent housing employment and training Human services expanded the CalFresh employment and training services through a partnership With downtown streets team to provide job readiness and work experience in the city of Santa Cruz Along also along the coast and north Santa Cruz and in the sands of Valley Thrive by three investments Continue to improve coordination and increased capacity of home visiting programs and all four home visiting programs Experienced increases in enrollments and wait lists for these services declined by 85% So the majority of our health and human services budgets will provide more information on the regular agenda today Child support is listed on the consent agenda as a status quo budget proposal and Jamie Murray our Department head is here today if you have any questions Great. Are there any questions board members? We'll get into more detail later with the with the next items Okay, seeing none. Are there any members of public who like to speak to us about what you just heard? I've number 25 Seeing none, we'll move back to our agenda, which is item number 26 Which is action on the consent agenda? This is item 31. This is the Homeless services Coordinated or sorry, it's the Department of Child Department of yes to the Department of Child support services outlined in the reference budget documents and schedule continuing Agreement list items for the final day on last budget hearings June 25th 2019 as recommended by the CAF First is there any public comment? Oh, yeah, yeah Regarding the Human Services Department my empirical on this is we're talking about the Department of Child support services Okay, my bet Any other comment? Okay, I'll bring it back to the board. I would move the consent agenda Motion by Leopold second by friend all those in favor, please say aye aye opposed that passes unanimously Thank you for your work. Thank you Now we'll move on to item number 27, which is to consider the 2019 2021 proposed budgets for the homeless services Coordination office as outlined in a referenced budget documents and recommended by the CAO Miss Mar and miss Benson. Thank you for coming today. Good morning. Good morning. I can click through Good morning chair Coonerty and members of the board I'm rainy Mar the county's homeless services coordinator and with me this morning is Elisa Benson our assistant county Administrative officer who has been working extensively with me on this issue Yeah, sorry, my chair won't let me move Before I begin my presentation I would like to extend my immense appreciation to your board to our county administrative officer and our in our CAO's office and To our county departments are many non-profit providers faith community and local jurisdictions for their very excellent work on this issue For their partnership and their support in our collective work on addressing the issue of homelessness in our community This morning I'm going to provide you with an overview of the various elements of coordination our office is leading some key accomplishments from the past year The proposed budget and some key areas where our work in the coming year will be focused I will also provide you with a brief update on the state's proposal for homelessness funding and on the 2019 point-in-time count The role of this office has been very systems level engaging with the many key people and Organizations working on this issue to collaborate on implementing service improvements and expansion To bring new resources to bear and to drive systems change All with the ultimate goals of reducing homelessness and assisting our unsheltered residents to return to permanent housing This past year marked a significant expansion of work for this office Our team worked internally with county departments to implement smart path coordinated entry intake and assessment processes in Department serving homeless individuals and families and I would mention that this was with the key partnership of the human services department We worked with the homeless action partnership and the human services department to plan for the transition of the smart path lead agency from homeless services center where it was Germinated to the human services department where it is thriving at this point the transition took effect October 1st 2018 we also worked with the homeless action partnership to establish new sustainable sources of funding for smart path and that included Applying to HUD for an expansion grant for coordinated entry and implementing new user participation fees for HMIS We worked with the South County homeless steering committee and the city of Watsonville and Salvation Army And we're able to launch the new South County Navigation Center down there What opened in August was a day services program and then in November the winter shelter program came online and through the heap funding we've been able to extend that program so that it will now be 365 days a year of services and Day and nights, so they'll be now providing day services seven days a week and shelter overnight and this is a key accomplishment of For the all-in plan with regard to South County, so we're very proud of that work Worked with the homeless action partnership the city of Santa Cruz and numerous partners to expand sheltering in North County I'm sure you're aware of all the very many contracts that have come before your board for sheltering at River Street Laurel Street vfw We initiated a comprehensive homeless services investments analysis and baseline systems assessment through a contract with focused strategies And the goal here is to develop a data-driven crisis response system that aligns our resources more effectively And I'll talk more about that a little bit later in my presentation We worked with the homeless action partnership and local jurisdictions to plan for and apply for the homeless emergency aid program and the California emergency solutions and housing grant programs bringing in $10.6 million for our community and We embedded in that work was a significant amount of community planning. We had extensive community meetings South County Mid County North County to establish the priorities for that funding and then we oversaw the process for the RFP a development of the RFP the selection process and now we're managing the work of Implementing all of those contracts Through though these were some of the key accomplishments the proposed budget document contains more detail on the fiscal year 2018-19 goals and accomplishments Since the establishment of this office in fiscal year 1516 there's been a steady expansion of our total bed nights of emergency shelter and I say bed nights because in some cases We haven't been able to expand the number of beds But we've been able to extend the number of nights for which services are provided So our expansion includes both some additional beds or in the case of you know The River Street camp or the AFC safe spaces parking program. We've added tents or we've added Safe parking areas, but we've also added a substantial number of additional nights of service at our various sheltering programs The total capacity of these programs you're seeing the total bed nights on this chart but the total capacity includes a hundred and forty year-round beds and 30 year-round safe parking spaces and additionally there are 60 tent sites available for nine months of the coming year and 55 additional winter shelter beds I would like to make a specific note that these are the programs that this office is working on and there are extensive other Sheltering programs available in the community Power Valley shelter services for example or the homeless services centers Reboly shelter There's this is not all of the emergency shelter, but what this office has been working on This year marked a substantial increase in the scope and responsibility of this office the budget has doubled An additional staff position has been added and with the influx of measure G and state funds the Responsibility of this office has expanded from oversight of a single winter shelter contract to $10.6 million in contracts for all of the various heap and cash programming There will be significant work to be done in this coming year with the local awardees and the state on both Reporting and evaluation and I'll keep your board updated as we go along And the measure G funds included in this budget will be supporting navigation center and services some of that Is going to be allocated to South County some of it will work in North County And then additionally a significant new responsibility of this office will be assuming Responsibility for the homeless action partnership lead agency, which will transition July 1st from the planning department to the CAO's office And as the lead agency there will be critical work to do supporting our homeless Management information system processes as well as our youth homelessness demonstration project These are some areas where there hasn't been really sufficient staffing to provide the level of support needed and we're going to take that to a higher level And then through the work of focus strategies It's anticipated that by the end of the coming year we'll have some recommendations on The governance model for optimal engagement of all of our partners The 2019-20 recommended budget provides for two full-time staff positions It includes an increase of nine hundred and seventy thousand four hundred ninety four a ninety six percent increase in expenditures It includes an increase of three hundred and seventy three thousand four thirty eight in revenues and resulting five hundred ninety seven Thousand dollar increase in general fund contributions these increases are primarily attributed to the additional Revenue from measure G and the state heap and cash funding And I would mention that as we continue to accept and appropriate those funds and bring contracts to your board this budget will Will be growing The estimates included in the 2021 projected budget assume a status quo operation and reflect known changes with a 67,448 Decrease to the general fund contribution. This is the year when the heap and cash funds are anticipated to taper off So primarily this is due to an anticipated reduction in those revenues and related expenditures in This next section of the presentation I'll be discussing our county operational plan objectives and additional work that this office will be focusing on in the coming year As mentioned there will be another substantial increase in the scope of responsibility of this office as we take on the the work of the lead agency for the continuum of care known locally as the Homeless action partnership and again will include key increases in support for our homeless management information system and the youth demonstration project There will be significant ongoing work Implementing and overseeing the 10.6 million state investment in homeless services and there will be substantial work I believe planning and implementing the next round which I will talk about later in the presentation So this office will continue to work with all of our providers on implementing those contracts and preparing for the next round of funding The office will also be working closely with focus strategies providing overall oversight and project management for their work and Working at the local level assisting with the data collection and working with the local providers We will also continue to work with key stakeholders To expand and improve homeless services with an emphasis on housing resolution services Which we believe are going to be the key to really getting people out of homelessness and into permanent housing And this marks a move from these kind of housing resolution services being available on an ad hoc basis Depending on what kind of a program you're in to a more systemized Way of providing these services across all programs where we're able to do so The first of the operational plan strategies and objectives includes that by June 2021 We would work with the homeless action partnership to increase total emergency shelter and or emergency bridge housing bed capacity by 2019 by 20% each year over the 2019 baseline And as you saw in the earlier slide, we've already done a substantial amount of expansion in this area and we will continue to do this however one of the things that we will also do is work carefully with focus strategies to identify an appropriate target how much Emergency shelter do we really need? How how much length of stay should we design our programs with given the realities of our local housing market? And how do we you know use those shelters most efficiently and get people through them as quickly as possible? You know up until this point at least the winter shelter program and the programs that our office has been funding are really just Shelter, you know, they've been providing health and human services, but not the tools and resources needed to actually move people into housing On this next slide you can see the distribution of those bed nights that I spoke of earlier in the presentation We've got about 86,000 bed nights that will be provided And I would say that the big wins from my perspective are that we've got year-round sheltering now at the Salvation Army in Watsonville Which is very exciting and they're also going to expand from 38 beds to 50 beds And additionally we have the Laurel Street shelter operated by the Salvation Army in downtown Santa Cruz and they're going to move to a year-round model AFC's programs, which are the safe parking program and the faith community shelter program are also going to operate year-round and This year-round shift is important in that it provides that year-round stability people really need to stay Stable and access services and ultimately get out of homelessness So our current operational plan objective is to work with the homeless action partnership to increase that capacity But as I mentioned, we will work with focus strategies to determine what really is the right level that we need The next objective is around planning an opening year-round homeless services centers in North and South County Our community has been discussing navigation centers since 2017 when San Francisco's navigation center sort of gained attention and everyone got real curious about what is a navigation center How does that work? And we've spent a lot of time working on it talking about it, but it's been very difficult to cite a navigation center here in North County As mentioned earlier the new South County Navigation Center was launched in August 2018 and marks a significant success For the South County Homeless Steering Committee in the city of Watsonville A key objective of this office will be to continue working here in North County to implement the navigation center that we envision The funding for this is included in the budget includes heap funds allocated by the HAP and county measure G funds in the amount of 590,000 To date we have stabilized provision of emergency shelters, so we know what that's going to look like this coming year We won't have to spend as much time and of scrambling and working with providers to make sure we have that shelter in place and the next step is we're going to work on Introducing those housing resolution services But one of the things that we've really started to realize is that not everybody knows really what a navigation center is And we thought a little bit of time to talk about that would be helpful So, you know all navigation centers are focused on getting clients out of homelessness and into housing They're typically very low barrier. They typically serve the most chronically homeless and Some of the key elements include outreach continuous engagement case management and housing navigation In discussion with the HAP we've determined that some of these elements can be planned for and implemented while we continue To work to secure a permanent site for the navigation center We plan to move quickly to focus resources on those housing resolution services the types of supports That will actually move people out of homelessness and into permanent housing We will move from providing those services on an ad hoc basis to providing them in a systematic way This slide provides a look at a maturity model where we've been where we are now and where we are headed And in the past couple of years, we have really enriched our emergency winter shelter program by bringing in a variety of health and human services and supports In a pre previous years we had an emergency shelter program that operated, you know November through April There were no additional services particularly attached to that no services coming into the shelter environment From 2016 to 2018. We've introduced new services including health checkups immunizations harm reduction assistance in enrolling and benefits and so forth But in the coming year, we will introduce those new housing resolution resources and additional mobile hygiene in The following year shown as year two We anticipate having a permanent site and we will keep your board updated with the HAPS progress on this planning work Earlier in the presentation. I mentioned focus strategies whom we have hired to evaluate our homeless crisis response system this office is providing the oversight and project management for this work and key areas of the evaluation they will be doing include a baseline systems assessment review of our data systems performance overall investment in homeless services and Identifying areas where we can make specific improvements. They will also be making a recommendation on governance for us So by the end of the coming fiscal year the evaluation will be completed We will have our recommendations from them for aligning and improving our local response to homelessness and An implementation plan for a set of actions that we can take their focus is on building a Well-aligned Well, sorry well oiled crisis response system with an emphasis on systems that we get out of silos And we work cohesively and across all providers in similar ways With lots of you know support and training provided so that people can Provide the services that are needed in all of the programming that we have In the next slide I will talk briefly about some key data points, but I plan to return later this year With an updated system performance measurement report last fall in October I provided you with an initial look at that But the the new data will be available soon, and I'll I'll be updating that report for your board This slide is from focus strategies They've given us just an overview of what they think about performance measurement And you so I would say that our initial work with them reinforces that work that we started with with the board last fall and in That system performance measures report that was provided The important thing about the system performance measurements is that they measure our progress over time and not just at a moment in time The point in time count that is the thing that most people pay attention to is a moment in time And it measures how many people are homeless on a given day the system performance measures which are based on our HMIS data Look at things over over time They assess whether homelessness is rare brief and non-occurring They measure performance at both a program level and a systems level They can inform us whether or not programs are actually helping households experiencing homelessness to secure housing and not return to homelessness And the key measures that we want to look at include exits to permanent housing Lengths of stay and programs and returns to homelessness, and these are data points that I've provided to you guys last fall As this office will be assuming responsibility for the homeless action partnership beginning July 1st One of the goals that we have is to increase the use of program and systems level data by the HAP and to use that data To function at a higher level focus strategies will certainly be helping us with that This will include using the data to guide learning collaboratives that will improve both data and outcomes You know we need to increase our data quality. We need to increase our HMIS participation rate So that more programs are participating and when we look at the data We're getting a better picture of what's really happening right now Our participation rates are moderately low and therefore we don't have a true picture of everything that's being done As I said earlier an updated system performance measures report will be provided once HUD has approved and Published all of the data for all of the COCs that we need to report on I've presented three of the four homeless services coordination objectives There's a fourth objective to implement the state emergency homelessness funding I mean I've talked about that a little bit in terms of the contracts that are coming before your board and the planning work that was done There's also a fifth objective on system performance, which is included in the supplemental objectives for the operational plan The supplemental objectives will be included in the final plan that will be presented to your board on Tuesday June 25th The state homelessness funding as you know We've already received an allocation on the heap and cash funding There is a new program that's been introduced as part of the next year's state budget It's the they're calling it the homeless aid planning and shelter or HAPS program just to make life easy for our local community We'll now have the HAP and the HAPS The state budget includes 650 million in grants for cities and counties to build and maintain emergency shelters It also includes Are there permitting communities to use this money starting July 1st for some of the planning work involved including? Strategic planning HMIS and sort of systems things that might be needed in order to support the work It's not yet clear. However, who's going to actually get the money. There's a proposal By kind of the big city mayors and lawmakers that they want most of the money directed towards the 13 big cities and to the Continuums of care Governor governor Newsom wants to spread it out to include the counties So that's being kind of hashed out at the state level the current trailer bill language calls for the 13 large cities to receive 275 million for counties to receive a direct allocation of 275 million and Continuums of care to receive a hundred million and that will all be based on the 2019 point in time count We will update your board when the state has reached their final decision on how that funding will be allocated and We do anticipate that the planning and implementation of that new state grant will be another significant body of work for this office Given that the states tying our allocation of that money to the 2019 point in time count we wanted to be sure to get this information out to you Yesterday, we released the 2019 point in time count total homeless and total unsheltered numbers For the count that was completed in January The full report which you're used to seeing which will include a breakdown of the data by jurisdiction by subpopulations We'll tell us about you know where people were when they became homeless or what kind of you know profile of mental health or Substance use of health issues. They have that information is not complete that information is being worked on right now by applied survey Research that does this report. It's in draft form It's going to be completed by the end of this month and published in early July We'll probably have a press event for that and we'll update your board when that data is available so The numbers as you can see from the chart are down slightly from 2249 in 2017 to 2167 for the 2019 point in time count. That's a 3.6 percent reduction Many communities across the state have seen really substantial increases so We are very very pleased that our number is down However, it does stand to hurt us ever so slightly with the 2019 point-in-time count allocation being By the number being used for the allocation from the state funding Our unsheltered count is also down slightly from 1799 to 1700 and I do we believe that the expansion of available emergency shelter will have improved that number a little bit We really didn't know what to expect with this count Since the numbers are down, you know as we try to make sense of it We're attributing the slight decrease to a number of things including expansions in a number of key areas eviction prevention services rapid rehousing More section 8 Vash and DMV vouchers DMV vouchers are disabled medically vulnerable vouchers that the housing authority issues Excuse me to homeless clients The success of the housing authorities landlord outreach efforts opening the doors to folks that do have those vouchers and helping them get into housing Implementation of smart path coordinated entry and a shift among some of our service providers to that housing focus sheltering that I was speaking about earlier Last year we adopted eight comparison counties as a cohort against which to compare ourselves on our progress addressing homelessness This slide shows those cohort counties that have already published their information as you can see Marin and Santa Barbara are also slightly down humble is really up a lot by 94 percent Across the state among other communities that have reported their numbers San Diego County has the largest decrease at 11 and a half percent and the largest increase is the central Sierra CoC That's Twalamee Amador Calaveras and Mariposa County. They're up 130 percent Among our neighboring counties Contra Costa San Francisco Alameda and Santa Clara counties Increases have ranged from sixteen point eight to forty two point eight percent. So the Bay Area has really been hit very hard with all of the reporting CoC's combined the state has a 15 percent increase that number will change once all of the CoC's have reported their numbers So our three point six decrease Point six percent decreases very good news But it's by no means a victory and we will remain committed to helping households experiencing homelessness To find secure housing and not return to homelessness Homelessness is a tragedy for every person every family and every community that it impacts It is one of the most difficult issues Communities are facing here in Santa Cruz County across the state of California and indeed across the nation The many leaders funders service providers Faith community members and advocates working on this issue are incredibly dedicated to solving homelessness one person one family at a time And I want to thank all of those in our community who are working on this issue who are dedicating their lives to helping those less fortunate Our work continues, and I appreciate your board for your continued support This concludes my remarks, and I would be happy to take your questions at this time. Sure. Do we have any questions? supervisor McPherson Wow, that was Mouthful that was something else. I want to thank you Randy Maher and Lisa Benson for all the work that you have done It's a very complex issue. It's all around us. It's a sad Situation, but it's everywhere in this state and throughout and more big bigger numbers Throughout the state and the nation too But we know that it's going to be take more investment and even to really make a dent in this my question is if the 270 million dollars 75 million dollars for in the state budget were to be approved What do you don't have any idea what fraction of that might come to Santa Cruz County? I know that there's it could change with the legislative process That's going to be finalized here pretty soon in the next week. I guess about this Yes, it's difficult to estimate it until all of the COC's have reported their data Because we will be a percentage of The total and we don't have a total yet. So it's it's really impossible to estimate it at this point I will I will provide your board with an update ads absolutely as soon as we know Okay, and you know with a new new program new crisis that we've experienced as I said throughout the state and nation Comes all these acronyms, you know heap and kish and hap and what hap was the only one haps you've got it haps It's no wonder that people are confused about what's going where and what programs are trying to address what but Basically just to put it in perspective, you know, I guess people have said that Housing is the key to ending homelessness and if you look at what we have issued in building permits in this county It hasn't been 2,200 I bet in the last two decades and so and then what if you even take three people in a house? It's probably not even 700 so It's it's difficult to see how we're going to be able to build our way out of it So to speak that we're going to have to just have this coordinated effort which you've overseen and Appreciate more than anything because trying to get your arms around the program that'll work. I mean San Diego has done Comparatively well to other counties and it's great. I know you're taking a look at that We're all looking for others solutions, but each individual county or city is a little different and I think one thing that we need to make sure is that we we don't Really have people get into one camp so to speak and we know the terrible experience we had in Santa Cruz We don't want to let that happen, but to try to provide those opportunities for those who need a house and Or a bed night, I guess is way probably the best way to put it at this point, but I really appreciate your efforts that we have all been really Twirling our twiddling our thumbs about what do we do with this and how do we get you know a real grip on it? So Thank you for your efforts. I hope that we can really do this In a very humane way, and I know we will But there's there's also the factor that some of the people who are homeless want to stay that way They just we offer them help and you can't force it So to try to force the program that we all think is indeed is more difficult than most might think So with that, I just want to say thank you again for your efforts We're gonna this is gonna be a long process, but we'll keep at it And I especially want to thank the Salvation Army and the veterans of foreign wars and others who have in some of the Hoteliers who have put up bed nights as well or offered bed nights They're helping us address this issue as quickly as we can. Thank you Thank you, Supervisor. Supervisor Caput Thank you. How you doing? Okay, yeah, currently there's a count going on right now. Is that correct? The count has been completed. It was done. Excuse me in January. That's always done the last week of January every other year The count is complete But the report the the comprehensive report is being worked on right now So we have the total number of people that were counted in January. That's 2167 of which 1700 were unsheltered but the the comprehensive report that gives us the much richer information will be available in July No, and then we're we're showing what we're doing with programs that we're working with There is a teen challenge and there's other programs that are Religious based and they're helping out so they're they're not counted in the Services that we're providing. Is that correct like teen challenge in Pajaro Correct, so they're in the information that I provided on total shelter That is only programs that are being kind of funded and implemented through this office teen challenge does not accept Any kind of government funding so they're not an agency that we contract with but they do provide sheltering in South County Okay, but they're helping out Absolutely with the I think it's called the rescue mission over there on relative rescue mission. Yes And they're trying to open up Shelter for women in Watsonville. That's true. They've got a prior Furniture business that they're trying to convert to a shelter But they're I don't know what the timeline of their project is. I know they're they're still working on okay I think they're mired in planning We're working with them. We're we're not We're not giving him money. They don't want money. They're doing it on their own, but correct when you combine everybody working together and trying to you know confront this Situation that's it's nice to see that we're that we have people moving on all fronts trying to you know help out Thank you. Thank you a Quick question two quick questions one is when we get the data on the comparable counties We get it to us in a report because that'd be it's very helpful to see Sort of how we're doing versus other similar sized counties that the data that you're referring to is that the Code point-and-time count or the system performance measures well both But I mean I'm planning to report to you on the system performance measures at a later date when that data is available Get us a memo Those numbers so happy to do that and then the second thing is so one of the most and Let me just preface this by saying I totally recognize that you've been running around putting out fires and Establishing shelters and dealing with state money and everything else. So this is and this is this hasn't been on the forefront But if we're want to talk about Families that are at risk of homelessness How do we establish what that baseline number is? How do we know what success looks like? I know we have we have some security deposit programs and you know first month's rent programs evictions, but how do we know How much of the population we're helping at the right time? Etc. Etc for that for for prevention people who aren't even Who hopefully never experience homelessness, but are very much at risk That's a really good question right now Families that are at risk of homelessness would never be entered into our homeless management information system So they're not going to be part of I think that's one of the sort of the the failures of our data If you will is that we can know how many people we've helped into housing if they were homeless But not necessarily how many people we prevented from falling into homelessness or who were homeless And we diverted them away from the homeless systems of care because of home or bound or because we were able to provide some Conflict resolution and they were able to reunite with a family member for example We will be working with focus strategies as well as our lead HMIS agency to look at how we can implement some of these things to capture that kind of data I think it's very important for us to understand both how we're stopping the inflow as well as Dealing with the population that is homeless and how we're exiting them from homelessness because it's all part of the same Continuum if you will absolutely and yeah going forward it would be great. We're making these significant investments in early childhood In order to prevent trauma one of the most important was to prevent trauma obviously as families Who are at risk of homelessness and their kids and so knowing? What how big that population is on what we're doing? And Whether we can increase it would be would be important So we'll see what we can do in terms of finding a way to capture that data But we don't have a great mechanism for it at this time and I would assume so But if we can figure out something going forward that'd be great. Thank you So that's a little thank you chair Thank you for the presentation. Obviously. This is an issue in which there is a considerable amount of public attention Towards and I Appreciate all the efforts that have been going on to address the problem We have here in Santa Cruz and I look forward to getting additional information about the point in time Count because there's always lots of good information in there. It is it we should We should celebrate the fact that the number is is moving in the right direction It doesn't mean the work is over it means that we it means that we have some promising signs of some strategies That may be successful and we need to continue to push on that I'm particularly happy also to see the number of unsheltered People going down because I think you're right that that is the reflection of have creating more emergency shelter space But the idea that there's even a hundred less people who are not sleeping outside tonight Is is it is a good? Measure and something we we should also celebrate. It was interesting looking at the other counties that we compare to and noticing the declines in and two out of the three especially when we saw the the the numbers from most Bay Area counties which were alarming Alameda County at 43 percent and you know others and even Los Angeles I think was up and 20 or 30 percent and they spend hundreds of millions of dollars on On homeless assistance, so We're moving in the right direction Let's let's keep on pushing and I think we have a reasonable strategy To keep on working on that. I wanted to ask about the navigation center last year Remember last year there seemed to be There was an initially agreement about a location for a temporary navigation center in which staff put time into Then it didn't move forward And we reopened the winter shelter at the VFW and later at Laurel Street Are we still going to try to work to get that that interim navigation center open or Should we expect that the the winter shelter program will operate again? next fall This coming winter we do expect the winter shelter program to operate We've as I mentioned Extended some of our programs to operate year-round and but the VFW shelter program would not be one of them We would only do that during the winter season It's very likely. This would be the last year. We would need to do that. We hope that next year We really will have a site It was also the case that right now the Armory Excuse me is under construction and that has been a traditional winter sheltering location at some point in the future It will become available again, and that's a larger facility that we could potentially use I'd like to add one thing to that as Rainey mentioned we have them all around a navigation a navigation center and a particular kind of sheltering operators operation Some of those beds would probably be emergency basis But most of those would be referral basis beds where folks might be staying there with an expectation of you know 3045 60 days on a path to housing It's very likely we will continue to need some kind of supplementary Emergency shelter so whether it's an at the Armory and particularly in the winter So I do want to make sure that we're clear that Emergency shelter sort of that walk-in shelter We may still need to be doing that as well as a navigation center both in North County and South County We will work through some of those numbers with focus strategies as we better understand the flow through our system sure And I think that It will be important for us going forward to figure out you know what? What other programs we could be using to keep people in their houses? I'll be looking forward to the To the point in time Information to see what percentage of people have been homeless for less than a year that number has traditionally been 40% or greater and those to be able to target that group to keep them in housing would be Could make a huge difference in the number of homeless People experiencing homelessness in our community One of the thing that's not reflected in the operational Plan in the homeless category, but as part of the health services piece is about doing an anti-stigma campaign And I'm wondering sort of what your role or will you have a role in that or the hap or the heap or the you know all the Alphabet soup I can't even figure it out anymore keep track of it anymore, but it's it seems to me that's an important part of Our efforts especially as we look at citing facilities Increasing programs looking for new strategies. Yeah No specific plans at this moment, but certainly a conversation that I would have with Mimi and and her staff I think they're it's interesting that you should mention that because I was just talking with someone about the importance of anti-stigma Training in schools and and so forth and how effective it is in the area of mental health and other LGBTQ issues and I think homelessness is one of those issues that you know people face Substantial stigma and we need to get past that Related to that is the need to work with our local school districts It's the when I've seen the statistics in the live oak school district There's there's maybe as many as a hundred kids who are homeless or housing insecure Yeah, I to me that's that's a huge Challenge and really important that we be reaching out to help people keep in their housing or or Find housing because you know middle schooler who's homeless I mean, it's it's just hard to fathom what that's like for that kid to be successful in life Do we have outreach to the local schools? So we have a new project called the it's part of the youth homeless demonstration project But also has received some heat funding. It's the youth homeless response team It's operated by a community action board in partnership with county office of education and their goal is to do you know in reach into schools and other institutional settings where youth may be at risk and You know try to intervene and assist them, you know before they become homeless and on the street and You know be excited to report on the outcomes of that program to you at a later date Yeah, I'd be look forward to hearing that the last thing about the about the how the funding would work and the fact that our our modest success in Reducing the number of people experiencing homelessness in Santa Cruz County could actually work against us in terms of funding I Think that that we would be wise to advocate at a state level that it should also be Look at that per capita, you know because we hear that that our community has a Larger number of homeless than as than some of our neighboring counties or or even our the counties that we match against and We face this in a lot of different ways that the way formulas are They work against Programs that are actually proving success and if we're being successful like at moving people into housing or Limiting the number of people who would experience homelessness We shouldn't be penalized with our funding and I think it's important for legislators to know that that These promising efforts Shouldn't go without funding we should actually be investing in them so they could be models for others fair points At the state level as you said it probably will hurt us It is possible. However, that it will help us with our HUD funding that we will be more competitive as a COC because we've Reduced our number and also because we have reduced our unsheltered number and we've increased our emergency shelter capacity Those are all things that will improve our scores with HUD and potentially lead to more funding there. Thank you I Supervisor McPherson get one more question Is there any measurement that's been? You know following up on the stigma issue about how many of the homeless have been involved with substance abuse? I mean and Behavioral health issues does that get into the formula at all or I mean it's out there people think that everybody That's homeless is on drugs. I mean a lot of people think that way So is there any kind of a measurement and if not, I don't know if there could be I think it would be a good thing to have so There will be a report the full report for the point-in-time count will include metrics of The folks that have been surveyed, which is usually a roughly 25% of the total population They survey and they will get data on things like substance use or mental health issues I think those numbers typically run around 35 percent Each of the population surveyed typically about 35 percent have those types of problems that they're they're addressing You mentioned a formula, so I'm not sure if you meant does that number tie into the allocation formula in some way or if that was Not sure about that question. Well, no, I just I just wanted to know more about just the percentages And it's going to be coming in the report. So that yeah, so it will be the current I believe it was something in the neighborhood of 35 percent in the 2017 point-in-time count and We'll know more once the final report for this year is published. Thank you Any other questions I would if there any public comment, please line up Gary Richard Arnold's I think it was clear when McPherson and Leopold talked about the Confusion and not being able to keep track. I think what we heard here is just a house of mirrors and suck-a-tash We've been told about stakeholders. We don't know who they are We've been talked about government Private partnerships which in any dictionary is fascism. We don't know if money is going to these people are from these people are making a circle We know that there's a haps program by Governor Newsom whose right-hand man Is Lenny Mendoca who was Leon Panetta's co-chair for California forward their last newsletter by the way mentions regional At least a dozen times they don't mention city or county because Lenny Mendoca Belongs to a group that wants to get rid of 80% of the cities and counties when you're looking at homeless And we've got an open border that's taking in a hundred thousand people Across the border and we have sanctuary cities, which you declare here You're jeopardizing every voter and and taxpayer in this county. It's Unconscionable you're taking away their services. You're adding taxes to them When McPherson was running the Sentinel as an editor he reported vote harvesting by Michael Rotkin and Gary Patton by going to people that are in trouble And of course those ballots would be filled out the same thing is being done by large farmers like Driscoll and they have farms around the world and they rotate people Ballots are handed out and they're marked by the The head of the gangs also. We know that Ickley has contracts with this county They are a front for both the World Bank and the United Nations And this seems exactly what we're doing here to make us more vulnerable and to collapse the cities and move the authority to the regions Yeah, I appreciate that public common Gary. That was really good I want to be able to share remembers the public Bruce McPherson And John Leopold kind of hints that that is kind of confusing Doing the political arithmetic. They just seem out of touch because everybody knows if you want to end homelessness It requires effective government government effective government that's not coming from a privileged point of view I mean, I've just seen hearing her it just she's out of touch Homelessness got to deal with with three prongs and I deal with a lot of homeless people I know a lot of people struggling living from paycheck to paycheck. You got the the people living from paycheck to paycheck You got the people that are mentally ill and on drugs These this is what a homelessness is all about people that do fall on hard times They take about a year before they get out of homelessness You know, I'm not afraid to be friend people that are homeless that are living in the car So I know them I hang out with them, right? But I would say that I would say is that they need some type of Support team from Social worker someone that deals with drugs Drug addiction and someone that a counselor and someone that deals with mentally ill a lot of them are out there and When you when you talk about you know, the rates are you know, the the people and you know, the homeless rate is decreasing It's a lie. It's a lie because people when they're dealing with ineffective government. They stop showing up They start doing things totally different. They go to adjacent County Effective government and the only way we're going to be able to dig our way out of this Like you said or build our way out of it is effective government We need a reordering at the human service department talking Starting with the top down the Allen Timberlake she needs to go and we need people are going to come in here and be sensitive And not window dress and not create this healing illusion that you're helping the American public the American public deserves better Thank you Ray can't see no CEO can be bridges I'd like to just commend the team that actually has been working on the homeless issue. It's been a partnership Thanks to the faith community the nonprofits that have been really cheerleading This project forward and doing the hands-on work to make it effective and efficient I think you guys hit on some major points that I think need to be part of this plan Which is the narrative change, you know that narrative we see the data. We know the data is there We see that that's going to downward trend the last three Point-in-times show that But that's not the reality that people are feeling which is something that Bruce is kind of hinting at and the reality is that With the need to invest more we're going to need the public to be behind These solutions and seeing the results of these solutions and so I really urge you to carry that message During your blogs and during your own messaging in your own districts to ensure people are aware that the Results are happening and that they're slow and they're ongoing, but we need further investment Number two, I think that there's something for you all to know the no place like home did do a study and did actually Analyze the family homelessness component of it of people that are in danger of losing housing That's only one aspect the second aspect is that the COE uses a McKinney-Vento Definition which includes doubling up which is a different definition of what we're talking about today So it's important that you really talk to the county office of education and use that number as well So it's a combination of housing affordability or percentage towards the housing as well as people living in situations that are doubling up That wouldn't be considered in that those two totalities give you a total number that can be used to kind of baseline your analysis and your Double-pronged approach or multiple-prong approach. So those are just some things that are already available So you don't have to reinvent the wheel. Thank you. Thanks you So if that closes public comment if there are no more questions from the board I'd entertain a motion. I would move the recommended actions for our homeless service coordination office So motion by Leopold second by McPherson all those in favor, please say aye. Aye opposed that passes unanimously and thank you for your work Thank You supervisors Moving on to item number 28 This is to consider the 2019-21 proposed budgets for core investments as outlined in the reference budget document approved an infusion of $30,000 from the local innovation trust approved the recommendations for the set-aside award And schedule the continuing agreements list items for final approval on last-day budget hearings June 25th as outlined in the memorandum of the director of human services Good morning chair Coonerty members of the board I'm Ellen Timberlake the director of the human services department and this morning Emily Bali our deputy director will be presenting to you the budget for core Good morning chair Coonerty members of the board as Ellen mentioned I will be presenting the budget for the collective of results and evidence-based investments better known as core That's the last time I'm going to say the entire name This morning's presentation Will you click for me? This morning present this morning's presentation includes a brief overview of core investments We just have to wait and get the Left There we go. Thank you. Okay a brief overview of core investments that proposed fiscal year 1920 budget as well as the projected budget for fiscal year 2021 a review of the recommend recommendations for the annual set-aside awards and a review of the operational plan objectives related to core investments in fiscal year 1617 the board approved a transition from the historical community programs funding model to the core investments model for funding safety net services a Joint request for proposal was issued in partnership with the city of Santa Cruz with approval of three-year contract awards effective fiscal year 1718 through fiscal year 1920 the core model identifies collective results and promotes the use of evidence-based practices and outcome measurement Over the last two years core has evolved beyond a funding model to also become a movement to achieve equitable health and well-being in Santa Cruz County using a results-based collective impact approach that is responsive to the community as You know fiscal year 1920 will be the third year of the core investments contracts in December of last year your board approved the extension of core contracts through fiscal year 2021 to align with the county's two-year budget cycle The work on core has been achieved in phases with the last update on phase three being submitted to the board last week HSD will return in October of this year to provide your board with the summary of the progress and outcomes of the second year of core contracts In order to achieve the core vision and mission across the lifespan and throughout the county There must be equitable opportunities to experience the eight core conditions noted on this slide And in addition to community stakeholders the CAO's office provided input on the core conditions Creating alignment with the county's strategic plan focus areas The core conditions have created a framework for aligning initiatives funding priorities strategic plans programs and practices. I Want to take this opportunity to thank Nicole young and Nicole Lezen aka the Nicole's For their work on leading the phases of core and thank the core steering committee and all the community Stakeholders that have participated in core conversations for their commitment to this movement Now I will review the proposed and projected budgets for core the proposed fiscal year 1920 core investments budget is comprised of just under four point two million in base funding Which includes the eighty five thousand dollar augmentation for meals on wheels? A hundred and fifty thousand dollars in set-aside funds Carry forward of a hundred fourteen thousand five hundred and twenty five This carry forward funding is a result of actions taken by the board earlier this year forty four thousand five hundred and twenty five Dollars in one-time funding for technical assistance and seventy thousand dollars from rebudded budgeted eighteen nineteen funds will go towards substance use disorder services As in past years there is a supplemental request from probation to bring in thirty thousand dollars from the local innovation trust fund To be incorporated into the following three core agreements at ten thousand dollars each Santa Cruz barrios unidos education outreach program Community action board Alcance Street outreach program and encompass PAPA supporting father involvement program The total core investments projected budget for fiscal year twenty twenty one is slightly over four point four million and also includes seventy thousand dollars in carry forward funding for substance use disorder services But is reduced by the amount of the one-time technical assistance funds and innovation trust funds Next I will review the recommendations for the core set-aside funds on March 12th of this year The board approved the release of solicitation of a solicitation for letters of interest for fiscal year 1920 core set-aside funds in the total amount of one hundred and fifty thousand dollars The purpose of this funding is to address emerging or otherwise unmet safety net needs in the community The solicitation for the set-aside funds was broadly distributed and outlined a brief and simple application process as Requested by local nonprofits and directed by the board This year HSD received 27 applications Representing 31 programs requesting a total of over 687 thousand dollars more than four times the hundred and fifty thousand dollars allocated The applications demonstrated a great need for services and the recommendations were developed with the understanding that all needs presented Could not be met by this fund The recommendations for award represent a distribution of funds across service type target population and geographic area The allocation of the recommended awards by service type is shown on this slide 44% of recommended funding will go to support behavioral health and physical health services and 37% will go towards services supporting seniors and the disabled as well as children and youth This chart shows the funding awards by target population Almost half of funding is being recommended for services provided to adults including seniors and 27% is directed to services for families and children The remaining 25% will go towards youth services The chart on this slide shows the awards by geographic location Almost half of the set-aside funds are recommended for programs that provide services throughout the county with the remainder almost evenly divided between north and south county as Reflected on pages 16 and 17 of the supplemental budget and on the next two slides Staff recommends awarding funding to 19 agencies in amounts ranging from 2,000 to 15,000 dollars If approved by your board staff will negotiate purchase order agreements with the recommended awardees. I Want to thank HSD staff as well as staff from the health services agency Probation and homeless services coordination for lending their expertise in developing the recommendations Finally, I will review the three operational plan objectives that impact core investments All three objectives related to core fall under the focus area of operational excellence The goal of continuous improvement and the strategy of providing nonprofit technical assistance to support services collaboration and impact We view our nonprofit partners as an extension of us and are committed to supporting their continued development For the community impact objective an online menu of community and program level results associated with the core conditions will be developed this tool will guide consistency among funders as well as providers in Identifying the outcomes they want to achieve from programs and services provided As I noted earlier the county strategic plan aligns with the core investments framework Strategic plan indicators will be derived from the core results menu Which allows for greater alignment in long-term community-wide goals and measurement to demonstrate collective impact At the broad level the menu starts with the core condition and then moves through specific options for community indicators Local data about gaps or inequities and strategies to create equitable opportunities and outcomes over the longer term At the program level outcomes are measured at the participant level and can be achieved in the short and or intermediate term The next objective involves the development of an online library of evidence-based programs and practices associated with the core conditions The ebp library will be incorporated into the promising practices module within data share Santa Cruz County and will be tied to the core results menu Data share is an interactive web-based tool that integrates local state and national data Providing a one-stop resource to explore and understand information about our community The tool was launched in March of this year with support from the health services agency Community foundation of Santa Cruz County and the health improvement partnership Additionally the core continuum of results and evidence that was shared in the report to your board last week is a matrix that can increase Capacity to select implement and evaluate programs and practices along the continuum of evidence The final core related objective is a joint effort between the human services department and the health services agency To support technical assistance for our nonprofit and community partners to foster collaboration and results based collective impact investments Areas of technical assistance to be provided over the next two years include Using an equity lens in all aspects of planning service delivery and evaluation Implementing methods of data collection and evaluation Selecting implementing and evaluating evident evidence-based programs and practices and Identifying and accessing new and leveraged revenue sources such as medical administrative activities and Cal fresh employment and training funding as I mentioned earlier over $44,000 in funds carried forward into fiscal year 1920 will be used to provide technical assistance for nonprofits in In addition both hsd and hsa have included funding for this purpose in their proposed budgets and Hsd has budgeted funds to support equity training that will be available to all county departments Before I end my presentation I want to thank our nonprofit partners for the important work They do in the community to achieve the vision of core which is that which is that Santa Cruz County is an equitable Thriving resilient community where everyone shares responsibility for ensuring the health and well-being of all people at every stage of life This concludes my presentation and at this time I ask that the board approve the recommended budget for core investments Including supplemental items. So thank you for your support and I'm happy to answer any questions Thank you and thank you for the thoughtful work you put in over the last couple years to really develop a system that's Coherent and making sure that the public's dollars are invested in a way that serves the community in the best way possible So was really a bullet. Sure. Thank you chair. Just a Brief question first. Thank you for the presentation and I echo the the words of my colleague about the about the way in which the department has worked to change system of funding that was in place for a long time and required a lot of thoughtfulness a lot of collaboration and Communication and I think you've been doing excellent jobs in those areas and I like that you always know that It's a continually improvement improving Program, it's not a static of peace and That shows wisdom if nothing else I had a question about the operational our goals with the project and it's really about timing if we're I'm trying to figure out when the the Menu of community and program level results and the online library of evidence-based programs Will be done in time in preparation for the next round of applications It seems me it's important to have that done beforehand and I'm just if you could help me figure that out. That would be great sure the Results menu and the EBP library will be incorporated by the time we release the next RFP They will be fully complete by June of 2021, which is the date. That's in the operational plan. So the The next RFP would come out when in the fall of 2020 so the fall of 2020 and And we'll have some of this work done and it'll be it'll be Fully done By the time we actually make the awards When you say some of it will be done. I'm just trying to think of it as a resource I know that you've been holding technical assistance workshops and I like the idea of providing training for organizations about equity and and All those pieces and it seemed like this is an important piece of the core framework That that we'd be able to see what the information is and know what kind of difference we're making in our investments The community level indicators and the program level Outcomes that we've talked about and Emily alluded to in her presentation will be done And I think the other thing I want to acknowledge is that the evidence-based online practices tool as you mentioned earlier We will have a substantial part of that done, but I think that also will be an evolving. It's not a one-stop You know system will need to continuously be updating those practices as they emerge So I feel pretty confident by the time that we release an RFP Probably around November of 2020 that we will have a substantial a number of tools in place that will make it More a friendly for the applicants as well as more. I think clear and transparent for your board. Okay. Thank you Supervisor friend Thank you And this is a pretty significant shift from the way that the county's done business historically And I think that it's definitely moving toward a better Outcome-based system and I think I'm actually very excited about having this tool and being able to look at The results affected these programs and I did have a question regarding just sort of the structure Of the set-aside program that the board created it as we were doing a transition It was created as a transitionary sort of safety net And I'm not I'm not convinced that moving forward It's the best structure for the board to continue to have a set-aside program per se. I think that All these are funded at a 15,000 or less and I just wanted to get kind of your thoughts from I imagine a significant amount of of work is put into reviewing contracts that are basically $6,000 Both on both sides both even though you've streamlined the application process There's a lot of work And it seems like it would might be a better structural design to have the the board just fold that money into core but with a carve out that specific to Programs that would be applying for something under $15,000 So there's a greater understanding that For these programs, they don't have to meet the same reporting requirements same application requirements. It's a de minimis amount but that What I think is tough is that you now have small programs competing with sort of emerging needs In a way that makes it difficult both for you to judge which is better and also creates an expectation Within programs that may be receiving a million dollars and other core funding as to what they can compete for again So now would be a time for us to consider this modification in advance of two years from now And so I just wanted to get your feedback on the set-aside in that process Okay, you were right that when we moved to the core model that we did recommend the set-aside to your board To try and accomplish three things One is to recognize that the new core model Was looking at contracts and applications over $15,000 So we did not want the shift to core to exclude smaller types of requests that traditionally had been Supported under community programs. So that was one of our primary reasons and secondarily with a move to three-year contract We wanted to acknowledge that over time there would be potentially emerging needs in one time only request Moving forward into the next cycle. We defer to your board's You know wish in that regard, but I think we could do that in such a way that we would retain Some of the primary purposes of the funding and simply integrate it into the base if that's your Preference and we could certainly stipulate with that Uh level of funding a sort of a different application as well as you know continue to support Some of our organizations that have smaller requests That would be easier to administer on the staff side, correct? It would be okay And I mean to me, I think that that the goals Well, this was a transition period and we needed time to learn what was the best process, but I just don't I don't think it serves the community's best interest to have you know, $100,000 in staff time Dedicate i'm just making this up to allocate $150,000 And then you have six times the amount of requested when realistically what we're trying to do Is also allow these smaller programs In equal opportunity to compete and I think if they knew that they were in a Their own world that they would actually have an even better opportunity for some of these applications That are $3,000 or $6,000. So I think when it comes back for action I mean, I think that it's something the board should consider having come back as What that would look like and just folding this into the base with a carve out specific to these small programs As a person Yeah, I first of all, I think the you and your office is to be congratulated and this county too for setting aside Including 4.4 million dollars for this purpose We made a big bump in this a couple of three years ago And I'm glad to see that going on and I think that The ongoing approach that we've had to course services that might be in line for some improvements though have Really been able to present a predictable way of what we're going to be funding for our partners with more transparency and integrity and I'm especially excited to see the $85,000 augmentation for meals on wheels included As far as the The set of sides, it's really important. I think that we have the $15,000 for the seniors council We mentioned yesterday about in the programs for the objectives and the operational plan that we're going to have some policies that Improve our healthy communities for our senior citizens in the county and I think that it's about It's it's really Proper that we really devote some special attention to that Could you describe you've described the outreach process and we know that there's Four or five times the amount of proposals Is there any assistance in helping them apply and maybe this will follow up with supervisor friends Question and I'm wondering specifically on the outreach and to some of the isolated parts of the county And of course i'm talking about center in zoe valley So are there any ways that for the outreach? I just saw there was five percent going to the center in zoe valley and so I just Want to know if there's an effort to try to Increase that we have extensive lists of over 800 names that this goes out to it's also Placed in the sentinel for approximately two weeks under public notices And we also publish it on our county website As well so and we're always as we learn of new programs and agencies we add them to the list I think many agencies get multiple notices But we're always, you know, yeah, thank you for your efforts, but I'd just like to Invigorate them a little more and I just also want to note that As we approach the next period we we will also reach out And make sure that if there are any organizations that don't show up in the 800 list of nonprofits that we have that will definitely increase our outreach In that regard so and also I think in terms of the san lorenzo valley just to underscore that we Have a lot of organizations the bulk of them who are receiving funding through the set aside provide services countywide So the breakout by region is a little deceptive in that regard because those just represent exclusive service in those areas Yeah, I know that the meals and wheels program up there is great and and just so many others too So thank you very much for your efforts Supervisor Caput Yeah, thank you We're doing a lot here and I appreciate everything you're doing What we what I'm trying to figure out here is At the last minute when we're looking at this if there's some money we can actually increase with The meals on wheels and also the watsonville senior center Okay, they're both connected in a way the meals on wheels does deliver Lunches at the senior center in watsonville And the senior center in watsonville. I believe has the staff of two Paid employees and that's it So when it comes to grant writing and paperwork They don't have a staff that can do that Uh, but we as People in the community see what's going on. We see how good a program that they're running on a shoestring budget So the the problem we're having with the uh Senior center in watsonville, which has a huge number of seniors a growing number of seniors to go there for lunch And also companionship and friendship and whatever There they did lose some funding From a city source Because the city's having financial problems And what i'm what i'm worried about is i'm not going to watch uh watsonville senior center closed down Because the city at large is having a problem balancing their budget And We're not we're not talking about a whole lot of money because they don't have a lot of employees and a lot of staff But they the ones that they that are down there with their volunteers are doing a tremendous job So what i'm what i'm asking for is another 15 000 for the Watsonville senior center And then also we've all been I think approached and we're all aware of a request for another 35 000 for the meals on wheels Again a very important program And a lot of volunteers not getting paid But actually putting in their time so I know we have the set aside here, but uh The set aside is uh, I think we need to find some money Some of the set aside goes to other programs that are getting A lot of money from us for other parts that are underneath their umbrella of their programs, right And and I understand that so i'm i'm not knocking one big Organization when we're giving them extra set aside for another program what i'm getting at is We have to watch out for some of Smaller programs like the senior center in watsonville And I know meals on wheels is a bigger program But they're also faced with a growing population That is requesting more and more help so With my colleagues here, I what i'm saying is let's find some money here Can we find 15 000 extra to the 6 000 that we give to the watsonville senior center To keep their doors open They did lose like I said funding and I don't want to see those doors close And then the meals on wheels were all aware of that, right? uh, so I would I would go with anything with That the other supervisors would recommend that we Help out with the meals on wheels For the chair, I think we're going to go down a slippery slope if we we do this I mean we we establish this program to get some certainty and assurity of How we're going to face this and I think what a supervisor friend said we we need to take a new look at it I think we should and if there's improvements to how the application process goes then we should follow that um, but I I agree and I'm I could I could give you three things that I want to have added to so I just don't want to go there. I think that's where we got away from and I think we should just stick with it Yeah, I'm not sure uh a different process is a better process uh my uh to my colleagues concerns I mean, I think we the idea of having money for emerging needs or emergency needs to me makes sense and the fact that um That people can apply for it Also makes sense to me because we can find out about new programs or new things that That we didn't know about that the staff didn't know about that's that's that's a good way for something A new strategy to come up as well um I'm comfortable looking at Additional funding for programs that ask for amount that are being an awarded amount. I mean the watsonville senior center Asked for six and they're getting six or did they ask for more and they're I believe they may have asked for 10. Yeah Yeah, sure We can't hear you. Yeah, you want to hear your microphone. You want to speak into the microphone? Yeah, yeah because They did lose some funding from the city because the city has problems trying to balance their budget Yeah, and I know the meals on wheels program actually put in a request for funding that didn't get funded I don't know how much their request was for 35 000 35 000 Yeah, and I recognize the value of that program Yeah Supervisor prime Well just building off of what my colleagues said If when you read the programs that applied and you read the programs that funded they're disproportionately not emerging needs They're disproportionately small programs. You could look at them though Either way as long as it's a 15 000 I'm just saying structurally it could fit into something that would save a significant Amount of staff time and allow say the diversity center, which may have an emerging need But it's really just applying for a small program grant to actually be able to Know where that carve out would come from specifically I mean and I to supervisor McPherson's point. I'm in agreement about that about what the board has been trying to do Is avoid sort of these earmarks at the end, but what I would encourage my colleagues who want to potentially move money to To then look at the 150 000 here and say what you're going to defund. I mean that's that's why we did this So if there's a program here For example, if you want to Fund the Watsonville senior center for additional funds Then go through the list here and say which program Won't be funded as a result. That's what we ask staff to do I mean we challenge them when they get these applications. We give them a hundred and fifty thousand dollar cap Um They look and make a very difficult decision based on the board's priorities and direction that we gave them to fit Uh 600 plus thousand dollars into 150 thousand dollar box. So it's strange that we then would not Do the same thing. This is what we are supposed to do during a budget time and I think that that's what a budget is it's a world of competing priorities that means that You know hard decisions are made and it's not a statement of of an individual value of a program as much as the macro reality of what this is so if there are programs supervisor cap it that you that you Would prefer to move the money from then that's your welcome to in my opinion make that Motion to do that. I think that in regards at least to the set aside if there's something over 15 000 dollars I think that that's that's a different discussion in general, but but that that would be how We would generally do it you would have A certain budget number and you would work within that budget number and these are just recommendations I mean, they're not this isn't written in stone. I mean if you don't want a program that's being proposed for funding Or maybe you do but you have a program that you prefer to be funded. I think that that's this would be the time to actually propose that going through this list I don't I don't completely agree With your reasoning because I think at the end of the day we set an we set an amount arbitrary as it was and and that's what we asked them to go out and Seek applications and we could see that there's a lot more needs out there than there are Then then the arbitrary amount we set up about and so here at the budget hearings the we should talk about that And if there is support to put more money into that then that's one way we can go and if there's support to say The hundred and fifty is the hundred and fifty and we're gonna Move money around then that's another way we can go to but they're not it's At the end the five of us are the decision makers We've asked the staff with the process and they and they've honored that process And if we and and we get to choose we have to make sure that there's money, but we have to choose What we would do So just like anything Yeah Again we we have some that we're always helping out with hundreds of thousands of And uh I noticed in the supplemental we're actually giving them more And then what i'm getting at is those are I'm not mentioning names because uh They're good programs. We we have to look out for the small programs too And they're the ones that fall through the cracks they don't have Like I said somebody with college degrees sitting there and writing grants for We're talking about a program at least with the watsville senior center that Again has really no staffing other than volunteers So and at the same time something unexpected came up where they lost funding From the uh from the city And so there's That's that's what we do we represent people in our area and we know what's going on if you were to tell me That something's happening up in uh north county or santa cruz or aptos or whatever I would go with what you're seeing because you live there So i'm looking at a senior program That definitely needs some help and we're talking about really not a whole lot of money I I can't you know sit on their staff as a volunteer and write grants for them But what I see is the work that they are doing And all you have to do is go down there About a half an hour from now when they're they have the lunch program going they have music there They have fellowship and then they have meals on wheels showing up At noon to uh, you know And we're talking about a growing population in santa cruz county, which is the senior population A couple of us up here are approaching that age real quick. We're actually in it So I I'd like to see these Hang around for a while in order for the younger colleagues to be able to enjoy Thank you So I'm I'm making a motion. I'll make first we have to have public comment, but um, I guess I'd say the following thing which is um to supervisor McPherson's point $50,000 That are your priorities Four more of us could easily come up with $50,000 That are our priorities in our district From the 31 groups that applied and most of whom didn't get funded Or or outside that That's a $250,000 expenditure, which gets gets serious over time. What so there's So let me just make this We make the following proposal which is I think that The smaller Programs that supervisor friend mentioned and the amount of time and staff and some of the disadvantage that may be some of the programs That you're talking about where they don't have the staff I think supervisor friend is offering a potential solution down the road to make it easier for people to apply and easier On our staff and uh for these smaller grants for the $50,000 that you're asking for now That's uh 15 plus 35 right correct Okay, so if we could separate them I'd do that too, right? So I don't think we're going to make any decision about the small programs right now And the and the 35 is actually countywide that is countywide But I guess what I'd say is this is it's it's my understanding that there's some money Uh potentially in the last day for each district for some capital projects and maybe you could work with uh the cao um to allocate your money uh to these programs as as the thing that you want to spend spend the funds on um, so we don't get into a situation where uh during this core process each of us is um We ask the staff as people mentioned staff to do the hard work make hard choices And next year I think if if if these programs got funded What's going to stop 25 programs from being here saying We do good work and we're really important and we didn't get funded and we're going to be back to where we were the first time So what I would recommend is that you will figure out this the small programs will be a program Will be a change potential change going forward, but that you work with the cao uh between now and uh and and next tuesday To to figure out how you can um get get that allocation All right All right. Well, it looks like uh, I don't know if There's two separate ones here. Do I have the support when i'm talking to the cao About the meals on wheels 35 000 which is county-wide And then the other one the smaller one because of a crisis in watsonville with the senior center Uh 15 000 that one would be my That's the one. I know real closely. I think you're bringing this forward, but I think the cao has something he wants to offer Well, I was I was actually going to state that I think there's separate issues. I was going to bring Talk to the board about the potential of funding for some capital projects in your districts regarding Capital one-time items like parks for examples in your districts I'm reluctant to use this of the money that we are that I am going to suggest on last day Out of continuancies for ongoing costs because these are really ongoing costs. They're not really one time And I'm worried once you put them there then they become part of the base and now the 150 000 becomes 200 000 Because then you have to cut them next year, right? And then they're in and the money that I'm talking about is potentially one-time money and therefore um Would be more comfortable using that money for capital projects like parks or other One-time uses Yeah, I would try I would like to keep that sure. Let me let me just say that I meant it to be a one-time use That if if that's where it wasn't meant to to add to the base or add to the but if Supervisor Caput wanted to instead of doing a capital project Allocate the money It comes up every year. I'm always arguing for the senior center in Watsonville because of again, they're they don't They don't have somebody that's actually writing up grants and they're they're too busy Working and you know rolling up their sleeves and Doing all the work at the senior center. Okay so so Now it's an opportunity for public comment anyone who would like to speak to us, please Line up Gary Richard Arnold It's very hard for people to participate. There's under this agenda item There's 28 different pages somebody would have to review. It's not in the back of the auditorium one has to walk you know 25 yards in order to Go through to see what you guys are even talking about and to rename it core investments instead of a community programs is sneaky way that the CAO and other people do I wonder how many of you could tell me right now what smart path was In the audience are you here that was part of the previous presentation? But the people here work hard in the community. They budget their money They're capable of making their own charities The people you should let them make the charities you go out and tax them Take their money away and then offer this charity thing. This is nothing more than politicking and you know it Uh organizations like community action board all they are they're filled with political activists and your friends and you know it A homeless action partnership. You use the same words. You're not even that smart I agree with Zach friend this time. I seldom agree with him But that's slush fund you have there of $150,000 portrayed year after year's outrageous That's the most outrageous thing here and you guys didn't even agree with him on that I think uh, I think this is a scam Uh, you need to break your contracts with the uan and world bank Which is ickly and this county has contracts with them You need to break your contracts with ambag which is stealing our authority and self government And you need to break your contracts with the county for illegal cities Which is no more than a political lobby taken away citizens rights and able to talk to you under the rosin bird act Which you adopted which is fascist Hi, i'm diana zachery from the diversity center of the lgbt q center in town I first want to say thank you for moving to the core process because uh while we got some small funding For for years from you the core process Opened it up so that we could get a little more funding and so it's really helped us with our youth program and our senior program So I wanted to say thank you to ellen timberlake and also emily bolly for the whole core process because it It really was a game changer for us Just to say a little bit, you know, we're able we have about 600 youth that we serve lgbtq youth And I think it was really important that you were talking about homelessness right before this Because I wanted to mention every day we get kids lgbt youth coming to our center And they've been kicked out of their homes and they're homeless because of being gay and so You know it's something that we face every day And I think I really wanted to bring to our consciousness The data shows about 41 of young people 18 to 25 who are homeless are gay So homelessness is a really a gay issue also the core set aside has been really important for us also The the department has recommended that we get core set aside funding for latinx youth in watsonville and young adults And also transgender folks and those are emerging needs for us. We're getting Constant calls and people walking in that are transgender that are homeless that need support And we have 18 now we have 18 support groups a month for transgender people That you know can be funded by this this core set aside Same thing with latinx youth in watsonville. We've been serving kids ages 12 to 18 who can't be out to their family Maybe they're not out as gay in school But they come to our youth group and they get support And then they asked us for further support From ages 18 to 25. So this money helps us support them. Thank you Morning, my name is joe herd and I do want to speak supporting meals and wheels Being a senior. I know I look young, but I'm 66 and I go there and Just to give you a little facts about things in perspective San Francisco, Seattle Is more expensive Except for food cost of living Santa Cruz is six percent less than hawaii The thing is, you know People the food is cheaper here But a lot of these people I think they have to put their for their rent and their other things They have to pay they have to put some of the money for their food that they have Being a trainer and a coach I enjoy going and seeing that these people they have a very safe place They have a very healthy good meal And um, you know being older it's hard To get a good meal. So there I can be guaranteed. I'm going to get a good meal I'm going to go in safe place Where it's run great and the Gentlemen that runs it back here. He's uh, he's great at keeping things nice and in order So I hope that that it continues to go. So The seniors they don't have to go to sleep in without a healthy good meal at least one guaranteed a day Um, so thank you Hi, good morning board of supervisors. Lisa berkowitz community bridges meals on wheels I'm here today to ask you to please consider our request for set-aside funds for senior meals In the past meals on wheels has been very fortunate in having Wonderful support from the board of supervisors and that has helped us to provide Thousands and thousands of seniors with millions of meals Making a huge difference in their ability to stay independent We are also doing very important work when we advocate for the seniors we serve We're ensuring that they have a voice that is heard There are lots of seniors here today. There are staff. There's volunteers behind me that want to share some thoughts and feelings with you About senior issues about seniors who can't be here to express their thoughts So please listen with your hearts and consider our request. Thank you hello I volunteer at the ben loman meals on wheels. My name is pennie drew I am 96 years old I have been eating meals on wheels lunches for 21 years I hope with your help it goes on for another 21. Thank you Thank you Got a lover I'd like to read a letter from mr. Hernandez He is a caregiver for his mother This letter to whom it may concern this later letter is to state the tremendous life-saving service meals on wheels program has given us We are both extremely low income residents of santa cruz county My mother is a 95 year old bedridden extremely infirm woman who is incapable of caring for herself I am a cancer patient and her caretaker It is nearly overwhelming on most days to cope with simple daily activities Thank god that meals on wheels provides us with their lifeline So we can have something solid and nutritious to eat when otherwise we would have to do without Please understand and Please understand how valuable and necessary the service they provide for folks like us truly is and continue to help fund their great work One more letter from a woman who's also a caregiver for an elderly parent I just want to express my appreciation for the muchly needed help we have received from meals on wheels Without your help these would have been many rough days We don't have transportation. So we are thankful for the delivery service I'm a caregiver for my mother who is 91 and with full dementia with her health issues in my own We get overwhelmed your service is makes life so much easier Thank you First time for me being up here. I'm mike reos Meals on wheels loud nelson site. I brought you guys some plates read them. I have some artists over there Thank you My name is thomas and I attend the senior meals on wheels lunch program as a senior citizen of america and also As a homeless. No a houseless person Um, this is one of the best programs there ever has been It needs to be refunded because for many of us At least for three hours a day. We have a little bit of home there Thank you Hi, i'm robbie shoemaker and i'm at live oak And this is a letter for Supervisor friend It's from somebody that gets meals served at home says dear zack. I'm 92 years old Male that lives alone my wife died three years ago And I find it difficult to get out to get food I find it difficult to cook Or get out to get food the meals on wheels program is very important To me because it is hard for me to get out with all the traffic And aptos And it's signed george dep Thank you Good morning. Excuse me. My name is kathy currents and i'm a 30 year Program manager with meals on wheels working primarily with the homebound seniors and supervisor kunity. I have A letter from mary. She says my name is mary and i'm 104 going on 105 And have been on meals on wheels for the last 20 years I live alone and depend upon my meals and the volunteer chris who brings them Please help meals on wheels as they have always been there for me And supervisor leopold. I have one for you from john dear supervisor. Thank you for your support I had a stroke six years ago. I am unable to cook for myself I called meals on wheels and they came to my rescue I have received meals for six years now and have always relied on their support and aid Thank you for listening best wishes john fraser Thank you I think i've been to his house Good morning. My name is alma mollina. I am also with meals on wheels And I have a letter from a watsonville home delivered participant Dear supervisor meals on wheels is personal to me as I am on dialysis and must have The protein the meals provide me with Since my wife has rheumatoid arthritis and we are in low income We need the meals for our well-being Please support the program And then I have another letter from a scotch valley participant I would like to take this time To thank those who have been helping me What what i've been doing is saving the milk for breakfast with a box of cereal By bread lunch meat. There's lunch and dinner One of and there's one of my dinners. So there you go Carol has been great She makes herself available to her clients. My delivery is Ernie and his wife Lou And they are just great. Thank you So ray cancino from community bridges again So thank the board of supervisors for the continued partnership and helping to address the needs of our community Your partnership not only shows the community your commitment to meet growing needs But allows us to leverage funds to attract donors funders and leverage state dollars Today i'm here to discuss the growing concern around the arbitrary fixed investment in social services Throughout these last four years the proposed total investment has been recommended at the same level The additional funds have been fixed at 150 000 and the set aside at 30 000 for emerging needs These budget constraints in no way taken to consideration the massively growing Income inequality nor the massive growing total county revenues over the last several years It doesn't address the housing crisis or the growing demographics in our community I'm here to ask that we look to increase these total social service sector investments to be tied to growth And decline of the overall county budget allowing the county to better meet the needs of our community I ask that you take a look at the process that has determined that those fixed amounts Um be worked on and that we work together to find a solution Today we're asking for an additional 35 000 for meals on wheels to ensure that we're meeting the current demands of our community In 2015 we received hundreds of thousands more and uh or thousands more in 2009 We received hundreds of thousands more even when the total budget was far less than today's current budget The trend is growing and a growing disproportionate gap between the people we can serve and those that need our services That is why every single hungry child family and every single senior in our community is a failed policy decision And we have the opportunity today to rectify it We urge you to invest more in social service sector and that you begin locally by investing 35 000 more to meals on wheels Which will help to feed 3 500 more seniors in this community My name is tony crane uh resident of aptos My only concern about core and I talked about this uh your previous presentation is that the key proponent or Part of it is that it's evidence-based So that means that feedback has to be honest and transparent So you all know who I am and why I've been here a lot And that's because my experience is that um things are not honest and necessarily transparent And that some maybe some of the People who get the larger donations have the ability and the propensity to tweak numbers and do things like that in order to make it seem as if the things are working I'm just asking if there is some way that you make sure that the information that you get Is checked to make sure that The information you're getting is true and correct so that the money can then be Allocated properly so that's just my concern and I imagine it's a part of what you do But I didn't see it as part of the presentation and how that is taken care of so that's my concern. Thank you Good morning. My name is Betsy Clark and I'm here today to represent NAMI national alliance mental illness And mostly just to thank the board and the department For the support and providing funding for NAMI through the core investments I also have a letter And this is a person who had received some services from NAMI and was not able to make it this morning Um, her name is leslie politas and she lives in capitol. She says thank you respected board of supervisors for your time I was born and raised in the county never expected to find myself in need of health and human services When my 27 year old son experienced a mental break last october NAMI as a national organization hit my radar quickly in conversation with friends across the country And our outreach to the local chapter was life changing for our family The professional approach cost course availability and quality content of the course has helped us immensely to be involved in our son's care We were so impressed with the program. We signed up to become certified teachers for future Community members who will have the same needs as we do. Thank you for your ongoing Compassion and support of this world-class organization and I also wanted to take another minute to Kind of just remind people of what NAMI does And also to let people Know that they can go to our website and you know find out about services. They might not have known about So we're not a treatment organization But we do provide education and support for families Also for people who are experiencing mental health symptoms And we also do a lot of presentations at high schools at The community college UCSC For teachers parents and then just various ones in churches and trailer parks or wherever And we also do some advocacy as many of you know with our advocacy on the telecare and also on second story So that's what we do and actually i'd like to timing perfect. Thank you And i'd like to um, this is just a list To remind board members Hi, my name is mary howe and i'm one of the founders and on the planning team of village santa cruz county Which is a national model for Peer support to help each other Stay in our homes and stay engaged in the community as we age And i'm really just here to Say if you have any questions, i'm happy to answer them and talk to you about it So okay. Thank you Good morning board of supervisors. My name is paulina moreno. I'm one of the project directors of the thriving immigrants initiative in the 2020 census project with cab We know these are difficult and important decisions. So we thank you for the opportunity to address you this morning I'd like to thank you for your continued support of cab and our multiple programs And we thank you for your vision to support youth families and immigrants to thrive in this community This morning. I'd like to briefly speak on three points The first one being our concern that a reduction and set aside funding For cabs case management and support services to immigrants who have been impacted by ice enforcement ultimately means a reduction in services We know that this administration has focused greatly on expanding immigration enforcement efforts And we recently saw in the news the president vowing to remove millions of undocumented immigrants starting next week So we are greatly concerned that a reduction in 13 000 means that we will need to reduce our services That have been established to address an emergent growing and unmet need Last year cab received 23 000 from county set aside to provide education and outreach and intense case management to seven to 12 families And um our case manager has been able to serve over 30 families who have come to cab for services beyond referrals We urge you To please consider fully funding our request for our case management work The second point is regarding the nonprofit technical assistance. We understand this is an important Support for us. However, the 45 000 should not be coming from direct services This money should be reinvested in community programs And we respectfully request that funding to support technical assistance comes from another line item in the budget And lastly, we're concerned that we have another contract with flatline funding Um While multi-year funding is greatly appreciated when it does not include cost escalators It creates an additional financial burden on already stretched nonprofits nonprofit employees Are twice as likely than the general population to qualify for public services. So we are We need to stop the cycle and adjust for cola. Thank you Hi board of supervisors. I want to start by thanking you all and the staff My name is Jenna Rodriguez and i'm the director of development for youth now We are being recommended for funding for the first time this year And youth now is an after school center based out of watsonville at service middle school and high school youth But this set aside funding is specific to our five week summer program So with your support, we are able to provide um The minimum of 45 maximum of 50 watsonville youth a memorable summer experience And specific to transportation needs. So we'll be taking our youth every week on a field trip Our big one this year is the san francisco exploratorium. We do a lot of volunteer service We'll be volunteering at the senior center Joining them in their friday night dances. And so we're really excited and I just want to thank you all for that support Hi, my name is carol and I want to thank the staff and the board for all your hard work On all these issues. I'm here to add my voice to those Asking for additional funding for the meals on wheels Can't say enough great things about that program and also it seems like such a Small amount that you're asking for for the watsonville senior center And I know that the spaces that are available that are safe for seniors to go and eat and have Some sense of community are are Just hugely important. So thank you very much Okay Yeah, I want to be able to share with members of the public that I do appreciate your political reasoning Zach friend I do appreciate your leadership on this issue trying to streamline the whole procedure That's good uh, politic and in terms of just expressing that but I want to be able to share with members of the public, you know, just all these Programs, I mean we had to go back there 60 feet away to try to ascertain this Right. Look at all these programs. A lot of these are just bundogal expenditures that a lot of them are not even existence Come on, you know, the hustle is real Right the board Directed and told allen timberlake To do certain things and she didn't report back to the board during this budget and she totally bypassed that that shows disrespect Right when you look at uh transparency california She's making a quarter of a million dollars and if we're going to save any type of cost It starts with the top on down. We need new leadership from the outside We need to reorder the human service department and uh, uh bringing new leadership from the outside. Thank you Thank you. That concludes public comment um Can I just ask In our when we created this new round of core funding in addition to the set aside and the emerging needs What was the increase over the previous core funding from the year before? Remember that number I want to say it was uh 300,000 three to 400 we'd have to go back in and we can certainly do that and bring that number back I don't have it. Yeah, I mean, I think My point is that if we're gonna say we can't say we want three-year budgets and then when we do a three-year Uh budget cycle in order to give people certainty that it's flat funding So we can take that 300,000 dollars and cut it up into a hundred thousand dollars per year and then we're increasing it But it's the same net It's the same money at the end So in the next core, I guess we can break up if they're assuming the budget's okay This what we were planning to give into three different chunks so that people can experience an increase But I think it's really important that we be honest with each other and with the public that we are increasing money This is not flat funding. We just increased it earlier so that the programs could have more money up front as a way to to better address the needs and so um It's I think I think that's an important it's important to recognize that going forward Do people have do any supervisors have any questions? Uh as a result okay, I'll bring it back to the to the board for a motion. Yeah, I'll uh comment We're we're talking about the human side here. That's why we uh, we represent the community that we're from and I don't think we're so rigid that we can't uh We can't move something here When we're we're talking about public input and we're saying we're doing this out in the open in the public And people are showing up and they're telling you what they've been telling us for months in the past Especially with meals on wheels We we have to respect their opinion and they're they're coming down here and telling us that there is a problem And we need to address it Otherwise, why even have public input? Why even have people come up here? So what I do appreciate with core is that we have in a way, uh A great number of these programs that are pretty much set so we don't have them coming every year And uh saying we want more what we're looking at today is we have two that are asking for more and uh one Is uh The watserville senior center that's 15,000 and then we have the meals on wheels Asking for an additional 35,000 so they're really two different requests Again, what i'm getting at is the human side. We're asking we're trying to represent the people that we uh The communities we come from And the people that show up for public input. We can't just ignore them. We can't just say Okay, you came here. You said your peace and uh go home We we we've got to have a heart. We got a we got to be able to listen to them And I think uh, I think all of us realize how important our programs are from our certain areas So I'm I'm standing up for south county right now But if somebody from the other part of the county, which uh Meals on wheels is really a county wide request Uh, I would I would support them because I know that they live in that community and they know how important something is So i'm going to make a motion that we uh We approve this but we add an additional 15,000 dollars for the Watsonville senior center And i'll make it an additional proposal that we have 35,000 Or any number that a colleague would want to uh compromise on for the Meals on wheels program county wide And if I get a second on either one, I guess it's two different ones Then we can vote on it So you want to have One motion or two motions Uh, two we'll make them two motions Okay, what are the two motions then okay first one 15,000 for the uh Watsonville senior center And second motion is uh 35,000 or any number That can be amended from uh Another supervisor for meals on wheels Well, uh the the question about the meals on wheels is very clear to me. It's it's it's an outstanding program I've seen in the benefit of my family the the difference it makes for for seniors to be able to stay in their homes and live independently um and to support families And support individuals with the basic Food security, which is critical Uh ensure that they eat well, so I would support more funding for the the meals on wheels uh program Okay, so we have that's a second on that motion And one last thing Uh We're dealing a lot of times. We're spending a lot of money on reaction reactive Programs were homeless. They're they're homeless. They're out there That costs a lot of money to try to help them I'm talking about something that's preventative It's actually something that we're doing for people before They either become Incapacitated or they become homeless or they become Lost in the system when they get older So this what I'm we're I'm talking about a small amount of money that's preventative We're actually going to save money in the long run because we don't have to help somebody that Nobody went to the house And uh saw that they were Failing and that's what meals on wheels does. They're more than just a meal. They're actually a personal contract contact The senior center is actually a place also that's preventative because it's dealing with seniors And it's combating loneliness and it has programs for them And uh again, they're a small program. So I think we're saving money. So let me just okay Let me let me just say so we had 27 applications for almost 700 000 dollars Every one of those applications Would be a benefit to the community. I agree, right? But we're not funding 700 000 dollars. We had cab here today We had the village program here today if we fund this program I would imagine next year any organization that's smart will turn out 20 people Uh for their organization asking us to fund it So we have to have fidelity to a program. So I would have I'm encouraging you to do is I I don't think you have three votes I think I recognize your commitment to this program and I think you can work with the CAO to find one time money Um from another source so that it's not so we have some respect for this program and we aren't back to every year Um, whatever community programs turn out the most people Can get funded Uh, so I think that's I don't know I might have three votes. Okay, that's fine If you got three votes, I'm I'm happy for you Program, all right, then assuming that that was a motion even though technically I'm not sure it meets the qualification of a motion in a second. I didn't actually hear you second Supervisor Leopold, but are you second? I would second the recommended actions plus the additional Funding $35,000 for the meals on wheels program So then I'll speak about a couple things here because I think that um It wasn't just two programs that spoke to me. I mean it was I received a number of phone calls And emails and these aren't these aren't easy conversations to have I mean you got to recognize that like the easiest vote to cast is a vote where you're just adding money on to something I mean, it's not like we ran for office here because we wanted to cut programs For seniors. It's not like we ran for office because we wanted to not fund our parks or not have Safe streets, or we not I mean this is not why any of us are serving up here, but it is You know, it's easy to create a sort of villain standpoint when you're saying that I'm standing for Some sort of fidelity with a process program and financing Um, and it's really hard in the conversations. I've had with some of the executive directors of some of these programs to say This isn't a judgment on your program. This is a reality of Where we are just like you would with a home budget or anything else you would do Um, so it's unfortunate just sort of the The way that you're presenting it. Um, and I know you don't intend to in that way supervisor Caput because your heart is always in the right place when it comes to Uh, your approach to these things It's just it is more complex than what you're actually presenting right now in this situation Not just in the message it sends but in the reality of where it is And it's inconsistent with some of the things that the board has done on other elements I've heard you be more so than any other board member by the way the one who starts the speeches with We're talking taxpayer money here and then you vote against an item And we have a respect for a process and then you vote against an item so I just wanted to be known that that these that it's not like there isn't thoughtful process up here It's not like there isn't a care for programs Um, it isn't we've had this discussion year after year after year where the need is increasing Things are changing. We just received an entire budget presentation yesterday about Our own budget deficit that we have Best case scenario six million worst case scenario double to triple that Um, a recession is going to mean that there's going to be a greater responsibility on these community programs That don't have the financing for it and an inability for the county to provide the funding for it This is where we're headed. I mean, this is the reality of of where we are It's not an ideal situation to be in but I can't support the motion in irrespective of how it's presented. It has nothing to do with a judgment on either the watsonville senior center or Meals on wheels, which is a program that does remarkable things as is the senior center by the way, but i'm gonna As a result of this i'm going to introduce a substitute motion, which is for the recommended actions And i'm going to provide additional direction that staff come back when you provide your Quarterly updates. I think they are on the core program That that talks about how what would be a best way to Move from a set aside program into Uh, the core program. It doesn't mean that Doesn't mean it doesn't allow for emergent needs Doesn't mean that it isn't for small dollars just to streamline that process so that we're actually Dedicating more time on things that actually should be done than what they are So this is for the recommended actions with additional direction Uh for that to come back in the next report I'll second that and agree with you that You know all these programs. I love every one of them Meals on wheels is most important. We all participate in the program, but I In i'm confident. I feel That there's are going to be An opportunity before this budget closes a week from today That we can address that program, but i will second the motion and Appreciate every program that's made an application to us. All right, so we have a substitute motion on the floor Yeah so The one that had a second has now been replaced by a substitute motion that we need to vote on first The substitute motion is to establish the set the staff recommend or to approve the staff recommended recommended actions As well as bring forward a proposal for these smaller programs If that if this yeah if this motion fails Correct because we have a substitute motion And so we're we're going to be voting on that motion, which is the parliamentarian is going to come into play here Well that standard parliamentary procedure and part of the rules Is that when there's a substitute motion you vote on that or an amendment to motion you vote on that first before the main motion It's a substitute motion Right, so there's a substitute motion So the rules are that you vote on a substitute motion first before the main motion Supervisor you major You made your motion You had a second Supervisor friend made his motion, which is substitute to your motion That we're going to vote on first As a substitute amendment motion Okay Chair I just like to add I agree with the parliamentary procedure And What supervisor friend proposes is not a is is not a bad thing But i'm not going to vote for it because One of the things that is it it's a disturbing trend to me Is the We've shortened our budget process from 10 days to four days. We don't even look at every budget We don't even look at the and talk about each department in which we fund here And to continually take away choices that the board can make and turn it over to staff is Is is not a criticism of the staff, but we have to retain the power of the of the board and on one small part Which is a rounding error in the 827 million dollar budget I think we can retain some control over that And be able to listen to community concerns when they come forward, especially for critical programs like providing food to seniors so so I understand your desire and I don't and I don't mean to I don't place a value judgment. I just say for me I would say I care about the the elected board making decisions about funding on an annual basis And we shouldn't continue to limit our opportunities to do that. We should We should look to take those opportunities where they exist I mean, I guess I'll just answer it because I think it's important to be answered I don't understand how this changes this we still vote on core We still get to say whether we support that on a multi-year process This just changes it administratively of where it goes. So we still we still make all the decisions We still do our fiduciary responsibility under the state constitution. We still pass the budget Line by line on the core component. It'll outline what this will be And we'll see what comes back In a few months, whether that's something that you think is reasonable at that time I just felt that it was unreasonable to have a significant amount of time and money spent on something Where that money could then actually be Placed back into something if it weren't used this way, but we still will have the same controls Okay, uh, so we have a motion and we have a second. This is super what just for the record This is supervisor's friend substitute Motion and so all those in favor, please say I I Sorry, no. Oh, okay. So that passes three to two Thank you very much So, uh, that we now move on to item number 29 This is to consider the 2019 to 21 proposed budgets for the human services department HSD is outlined in the reference budget documents and schedule the proposed Uh, continuing agreements list items and amendments to the unified fee schedule for final final approval on last day budget hearings June 25 2019 as outlined in a memorandum of the director of human, uh services Good morning chair community members of the board I'd like to start by thanking our ceo and his staff for their assistance in developing our proposed 2019 through 21 budget As noted yesterday the fiscal stewardship of your board and the ceo For next fiscal year has put the county on solid financial ground However with projected revenue shortfalls and rising cost ahead I want to assure you that the human services department will continue to exercise that same fiscal prudence in our budget I'd also like to take this moment to thank my fellow colleagues in other county departments and our nonprofit sector As reflected in our county vision statement making santa cruz county a healthy safe and more affordable community depends on strong partnerships Fortunately in this county. This is one of our greatest assets Our proposed budget is a reflection of the hard work and dedication of our leadership team who are present today And every member of our fiscal staff who are simply top notch They're talented and committed to the work and care deeply about supporting our programs This care for the greater good extends to all members of the human services staff Whether they're working on the front lines or supporting Our services through critical administrative support and they show up every day dedicated to missing making a difference Turning now to our budget presentation Before I take your questions I'd like to give you an overview of our department and our current year accomplishments Followed by a review of our proposed two-year budget and several state and federal issues that we're tracking Additionally, I'll describe how the human services department will support the county's operational plan By highlighting three objectives and the partnerships that we rely on to achieve them To complement our proposed budget We've provided your board with a preliminary copy of our annual report Which provides more detailed information on our programs and services The final published version of this report will be posted to our website in july Everything we do is grounded and informed by our mission as a government steward of critical public safety net programs The human services department aspires to strengthen our community by protecting the vulnerable promoting self-sufficiency alleviating poverty and improving quality of life In support of this mission We offer a variety of mandated programs and services all of which are designed to help us achieve these four overarching goals The annual number of individuals receiving services differs depending on the program But taken in whole our department serves approximately one in three county residents As reflected in this list of sample accomplishments Whether we're helping those who are homeless find employment or secure housing Or facilitating access to home-based visiting for families with young children Our staff always strive to improve and expand services for our fellow community members The recent opening of the we're still here exhibit on senior isolation is an example of this striving spirit Nationally at the local level we're experiencing an epidemic of loneliness More than one in five people in the united states report feeling lonely isolated or lacking in companionship This isolation has an adverse impact on people's physical health and mental health Especially among the elderly who are often hardest hit by social isolation In santa cruz county the problem has become extreme with 36 of surveyed seniors reporting that they feel lonely on a regular basis To address this issue and in partnership with the maw local artists and over 180 older adults in our community The human services department is sponsoring the we're still here exhibit stories of seniors and senior isolation The exhibit opened in april and will run through january By the time it closes over 75 000 people will experience the range of impacts that social isolation can have on our life as we age They'll be reminded by the voices of people like joys Talk to elders get together with someone Talk to your elders and your family. You have a grandmother or maybe your mother is an elder Sit down and talk to them and and ask them. Well, tell me something you haven't told me They'll receive sage advice and wisdom from community members like mickey When I was growing up my father's book plate Which said the beginning of doubt is the beginning of wisdom Was a talisman for me and it continues to be and it is what I hope young people will understand that Having curiosity is the most important thing in life The energy and momentum of this exhibit is already making an impact We've had seniors in high school engaged in story slams with seniors in the community Next week we're holding a companion cafe event Where ihss recipients will come to the exhibit to meet and interview prospective providers Seniors who help design the exhibit are now serving as docents We've even had an executive manager from amazon alexa commit to bringing her team down from seattle To experience the exhibit and explore The possibility of launching a beta project with this community geared at improving the accessibility of technology for seniors I'm also pleased to announce that the exhibit will travel to other counties in the next couple of years We've secured commitments from san francisco marin and sonoma and our in conversation with monorail and alameda I want to thank stacey garcia the maw's director of community engagement for her leadership in taking this exhibit And actually the platform itself on the road Later this year your board holds a meeting at this exhibit You'll hear directly from seniors who created we're still here You'll hear their stories and hopefully their recommendations of steps You can take to help address social isolation When all is said and done those accomplishments and our effectiveness as a department is a reflection of our staff's commitment to operational excellence We set our sets set our sites high in this area The examples of customer messages you see before you are just a sampling of the phone calls emails and personal notes I received throughout the year I'm proud to say that our department was selected this year by the federal administration For children and families as one of six national sites that demonstrate exemplary organizational culture As evidenced by our client-centered practices investments in innovation And focus on staff engagement Being intentional about our culture is our most effective tool in creating positive outcomes for those we serve One example i'd like to highlight is our voluntary mentoring program Our roots in mentoring go back almost 20 years when we started our first formal program At that time we were only able to provide half day shadowing Two years ago we doubled down our commitment to creating a more robust program Which moves from half day shadowing to a six month relationship between mentor and mentee And since 2018 i'm pleased to report that 15 percent of our workforce Has either participated as a mentor or mentee I'll let their impressions speak for themselves In support of the county's commitment to operational excellence will continue to support this expanded professional development opportunity over the next two years Now i'll move to an overview of our budget Our proposed department of budget for fiscal year 1920 is approximately 140 million dollars As you can see from this pie chart our budget is highly leveraged with the lion's share of financing provided by federal and state funds We also receive realignment or sales tax-based revenue Which is allocated to our county to support a number of social services program This other revenue category makes up 11 percent of our budget The general fund contribution is a required share of cost that differs by program But taken together also represents 11 percent of our overall budget Over the last five years our financing sources continue to remain fairly constant The 4.8 million dollar increase in intergovernmental revenue for fiscal year 1920 is primarily associated With the federal and state financing that we leverage To support rising cost as well as new state funding for our housing programs Let's take a closer look at the distribution of general fund investment in our proposed fiscal year 1920 budget and our projected 2021 budget In fiscal year 1920 78 percent of the county's general contribution in our budget supports entitlements Which are direct cash payments to recipients in programs like cal works foster care and adoptions assistance general assistance or ga As well as provider wages for our in-home supportive services or ihss program The most notable development in this area is the successful effort to address escalating county cost in ihss As your board may recall two years ago. This was the single greatest issue facing counties across the state Some of our early predictions estimated by fiscal year 2021 That we would see a three million dollar increase in ihss at the local level In large part due to the leadership of cesac the governor and the legislature have reached a deal which significantly mitigates our county's exposure The result of these efforts has left our overall general fund investment and entitlement stable for next fiscal year The second year projected increase of 586 thousand dollars is associated with a new required 4 annual inflation factor Proposed general fund increases in social services budget are necessary to cover Salary and benefit increases for existing staff It should be noted that across all programs hsd leverages approximately 43 percent in federal and state financing to offset these costs For our projected fiscal year 2021 budget the general fund increases shown here for both social services and veterans Represents the required county share of cost for these increases The largest expenditures in our budget are our staffing cost followed by other charges Which include these direct payments to clients and providers that i just discussed The services and supplies expenditure category includes all of our professional services with nonprofits as well as other vendors Our telecom charges leases utilities and office and supply cost This chart gives you a 10-year look back on our staffing trends as you note in fiscal year 2011 we begin our gradual ascent from the great the devastation of the great recession In fiscal year 12 13 you'll see the significant three-year surge in staffing associated with the implementation of the affordable care act In santa cruz county we're proud to say that we more than doubled our enrollments in medicow as a result of aca and our staff's hard work Since fiscal year 1516 we've gradually recalibrated our staffing to levels necessary to keep people enrolled in programs across all public assistance Now i'd like to review some of the strategic investments we've made in our proposed budget that support the county operational plan For fiscal year 1920 the total number of staff which includes unfunded positions remains unchanged in our budget However by funding some positions that were previously unfunded and adding others We've been able to strategically increase our capacity to meet several department objectives The middle column on this chart identifies the focus areas that are supported by these investments as well as the unique objective number Last week lawmakers adopted the state budget for fiscal year 1920 although we still await the governor's final signature I am pleased to report that the breadth and depth of investments in health and human services is unprecedented This chart summarizes the opportunities in the state budget that will help end deep poverty increase access to health care and food security And advance a portfolio of whole child upstream investments that will most certainly improve Short and long-term outcomes for some of our most vulnerable children and families As evidenced in the thrive by three report we reported to your provided to your board last week These bold statewide investments in young children and their families Mirror your board's leadership in establishing the thrive by three fund Passage of this budget will help our local thrive by three efforts continue to reach more children and families I've already mentioned the importance of the state budget on our current and future iHSS cost We applaud this state investment in a critical program that keeps older adults and individuals with disabilities safely in their homes We also welcome the governor's convening of a work group to create a master plan on aging and hope that it will lead to recommended Actions to strengthen the state's overall investment in adult and aging services With a divided congress many legislative proposals at the federal level directed at restricting access to public assistance programs have stalled or failed However, we continue to monitor proposed administrative changes that impact key safety net programs The most recent example is a proposed change to the way the federal poverty level is adjusted each year For a cost of living If adopted this change would reduce the growth measure and over time in high cost states like california This would lower the number of residents eligible for assistance The administration also continues to put forth a barrage of other proposals that are having a chilling effect on immigrants Public charge policies govern how the use of public benefits may affect an individual's future immigration status continued efforts to add Non-cash benefits such as health and nutrition in public charge Now include punitive members measures against the sponsors of immigrants who receive those benefits These targeted public charge efforts have been expanded To include proposed restrictions and federal housing assistance for any citizen or legal permanent resident Who lives with an undocumented friend or family member? Additionally by the end of june the supreme court will decide on the administration's request To add a question on citizenship to the upcoming 2020 census Which if upheld will negatively impact participation in the census and ultimately reduce critical funding for our community The cumulative effect of these proposals on immigrants is chilling Chilling across all levels over time Regardless of immigration status and across all sectors The fear is real the toxic stress associated with these policies affect the daily life Well-being and health of families and children and most certainly come with lifelong consequences The urban institute recently published a new study showing that about one in five adults in low-income immigrant families report that they did not participate in non-cash benefit programs for fear of risking future green card status This quote from a parent leader in live oaks cradle to career initiative Supports the research and is consistent with trends. We're seeing locally Since 2018 undocumented and legal permanent residents have been disenrolling in cal fresh at a rate three times that of citizens Our department will continue to support our community partners in efforts to mitigate Educate and support members of our community affected by these policies Before I conclude my presentation, I want to focus your attention on just three of the 16 strategic objectives that our department has identified in the support of the two-year operational plan In any given month approximately 23,500 individuals representing 14,000 households are receiving cal fresh assistance of this number 4,800 are senior seniors and disabled single adults Last year assembly bill 1811 reversed the policy known as cash out that had restricted ssi recipients from receiving cal fresh effective june 1st of this year recipients of ssi are now eligible to receive cal fresh for the first time since 1974 With this change, we anticipate enrolling up to 2200 new cal fresh cases with the remaining eligible ssi recipients being added to existing cases Our objective over the next two years is to increase the number of low-income seniors and disabled single adults enrolled in cal fresh by 50 Since the operational plan was published we've received new data from the state on the number of individuals eligible under this expansion And based on the information we've made revisions to our objective Which are shown in red this change will be included in the report to your board by the seo on on the 25th By leveraging as new as well as existing partnerships. We expect to replicate the success. We've had with other expansion efforts Through our cal fresh employment and training or cfet program We assist providers who serve cal fresh individuals By leveraging additional federal funding to support both their current operations and their expand their capacity to provide more By june 2021 we hope to increase the number of cal fresh recipients being from these services By 30 percent This year through our partnership with the downtown streets team We've already expanded these efforts to the north coast and to felton And we're exploring expansion efforts in south county with the community action board Next goal is to increase the employment and training support for youth A key partner in this effort will be fresh success, which is affiliated with the foundation for community colleges They provide critical technical assistance and training for anyone who bounced and wants to become a cfet provider And beginning in october 2019 Both food what and community action board are expected to become cfet providers With cabrio college and digital nests joining next year We also continue to make great strides in providing permanent housing for those individuals in our programs Who are either homeless or at risk of homelessness? Our two-year objective here is to house a hundred and eighty seven hundred and eighty seven Families and individuals who are experiencing homeless. Yeah. Well, that's a big objective By june 2021 before we talk about our local partners who help us accomplish this. Let me just briefly Share with you the state programs that support this Over the last four years the california department of social services has implemented a number of new programs That directly benefit those individuals we serve Three of them the cal works housing support program are known locally as champ Bringing families home and the housing and disability advocate program are up and running Together they've successfully housed over 200 families and individuals Our newest program is called home safe and effective next year It will provide funds to support the safety and housing stability of clients in the adult protective services program Who are either homeless or at risk of homelessness? At the local level this slide showcases the critical partners that are helping us reduce homelessness and increasing housing stability Finally, you might be wondering how we'll measure progress in achieving these objectives over the next two years This slide provides an overview of the major in-house systems that we've built over the years to ensure that our programs and practices Are making a meaningful difference in the lives we serve I won't review them all but I do want to draw your attention to two things First the operational excellence icon from our county strategic plan You see it placed after each of these systems because it represents our alignment with both your boards and the ceo's interest In continuing to enhance the county's ability to focus on performance outcomes The second thing I want to spot to point out is the last system on the list called spotlight With the implementation of the two-year county operational plan Our business analytics team is hard at work developing a new tool Which will allow us to measure incremental progress toward meeting all of our objectives This slide shows an example of how this new spotlight system will help us measure performance In this housing assistance objective, we want to house permanently house 187 people by june of 2021 To meet this goal our first step is to establish performance targets for each year These targets are represented in the maroon bar The blue bar it reflects our internal optimism that will exceed the targets Through a combination of data sources like access to the hMIS system Contractor reports in our internal data systems Spotlight will help us answer these questions from all of our department objectives How much service are we providing? How well are we providing it? And is anyone better off? Consistent with the strategic plan values our performance metrics will also apply an equity lens In an analysis and include descriptive data like gender race age and ethnicity Ultimately being able to answer these questions across all programs holds us accountable to our mission And gives us the critical information we need to consistently get better at what we do So with that, I want to echo again my earlier comments and thank both the ceo's office and your board for your continuing support and ask that you Approve the proposed fiscal year 20 19 20 budget with all the supplemental materials listed on the chart Thank you. And and I've set up a forum. I'll say again Thank you for the leadership that your department shows and really setting goals and being data driven but with that data Also, it's really held in fundamental values and concern for our community and Some of the issues you raise around this administration's fear and intimidation tactics Any impact it's having on the health and well-being of our families is is shocking but um But I think we're better prepared to fight because because we're setting up the systems And the goals and aligning the outcomes in such a way that that'll be meaningful to those families Are there any questions from my colleagues? Supervisor Leopold. Thank you chair Thank you for the presentation and all the ongoing work I know that it it's not just the two of you that I see many of your program staff here today I sometimes get a chance to work with them But I've was fortunate enough to be invited to one of your meetings to look how you look at the dashboard to measure your progress on not only v 16 operational exact Uh initiatives, but uh, so many different other ways that you're looking to improve the quality of service to people in our community And when we look at the numbers, uh, you know with one and three Members of our communities receiving assistance in some way a medicow or or or cow fresh or something else um, it's We have a responsibility to make sure that uh That we're providing the best service that we can to the most vulnerable in our community And I know that to a person in your department that that's a value that you carry forward um as I looked at your, uh Uh objective, I thought they were very good. There was uh one that I had Uh a question about, uh, it seemed unusual to me on the children well-being Uh where it said, uh by june 2021 human services will ensure 75 of the children entering care will receive at least one child and family meeting and um That made me think why is it why isn't it a hundred percent? What are the barriers? uh to that because uh When a child is being placed out of home And into another a care situation and we're trying to do this for stability Um, it seems to me that that would be something that would go on with everyone I think that the 100 percent that you mentioned is our ultimate goal I think what you see reflected in the objective is some of the startup issues that have um continued to unfold around the continuum of care reform And so uh in our proposed budget as you know, we um are Requesting that we get dedicated support for child and family teaming In our division through the um wonderful partnership of the health services agency. So some of this will be ramp up But I can guarantee you that we will most likely come to your board next year with a corrected objective and have Our sites um set on a much higher number once we see how all this rolls out with the State's um implementation You were not putting pressure on the new guy, you know No, no, I I know your uh, I know that he completely echoes this so No, the the support that you offered for children and families is extraordinary When I saw uh in your annual report, which I really appreciated that you shared with us The number of in uh out-of-home care placements with relatives Was so high uh comparatively You know, it's something that I know that department has focused on for many years and You know you you the more you do it the the better you become at it and the the better networks you build so Those numbers are impressive and uh will be really important for the future of our community And the future lives of these children. So, uh, thank you for that work At regard with regards to children. I also want to recognize uh leslie good friend from your Staff who plays a role as a as a co-chair of the steering community for the live vote creative to career program That program now is several years old But we're already seeing positive benefits in the live oak elementary where the Where the program started has seen the biggest increase in test scores By a third grade of I think any school in santa cruz county And so the investments that we're making are you could start seeing that collective impact Making a difference in the metrics that we're using and as as we expanded to a second school this year um, the support of hsd and also hsa Has been critical to success of the program and leslie has been a a tireless supporter for it. So thank you for that leslie On the on the workforce development work, uh, mr. Stone's, uh A program there's a lot of good news here, uh, you know, uh, I understand the challenges of Trying to get more people in apprenticeship programs and The how the economy sort of works for you and against you and something like that Recently at a labor event where people really sang the praises of the partnership that they have Here in santa cruz county. So congratulations on that work It was interesting to me in the annual report that the large number of adults The the big jump in the number of adults that we saw in the 18 19 year With the economy being the way it is it it seemed counter-intuitive and I and I didn't know whether that was the reflection that we're doing better outreach or we're counting numbers differently or um I haven't a good economy people wouldn't be seeking services from the I actually have an answer for that I figured The spike in the number of adults served in and the workforce investment at programs is Related to a change made by the workforce investment board last year Where they recognized that based on the high cost of living in this community They needed to increase the threshold of eligibility up to individuals who are up to 250 of the federal poverty level So it was a very conscious and smart and strategic decision By our workforce board to bring more people under the umbrella of service And so that was a very conscious result of a smart decision made last year Well, I think that uh that board uh for that awareness and We know here in Santa Cruz the high cost of living Um, if you're fortunate enough to only work one job That's a good thing, but there are a lot of people who need multiple Jobs in order to make it the last thing I'll just talk about is the adult protective services The work you do there is incredibly important. I've seen it firsthand I've had the chance to work with some of the staff I think this is going to be a growing part of the work of the department as we look at the demographic change in Santa Cruz county And we know that uh seniors are a fast growing part of the homeless population We know that the that the the cost of living here is squeezing Families squeezing seniors into in order to be able to make it And we know that that seniors are vulnerable and we we hear about it all the time And we see it at all the different ways in which people target Seniors in our community. So adult protective services, you know, I I wrote some questions to you and I appreciated the responses back Well, we don't have a particular specific operational goal around adult protective services, but we have a number of them which Capture that work, but I would just want to recognize the staff for their work on adult protective services because People in the community are really counting on on those members of your staff. So thank you. Thank you Anyone else? Surveys are yeah, I um, I'm gonna say this when we talk with Health services too. I just can't tell you how much I appreciate The human services department working with the health services agency I have not seen this partnership or coordination of effort Better in my seven years here on the board and it's paying dividends literally for human beings in Santa Cruz county It can't be overstated. So I want to thank everybody being on the same same page And I think having a strategic plan an operational plan Really kind of forced this issue in some respects, but you were ready to take it and I appreciate that very much I think it's invaluable for Our people in Santa Cruz county I especially want to thank you, Mr. Timberlake and Your your whole team for staying on top of state and federal changes that are taking place because there's plenty of them It seemed week to week And making Maximizing the resources we have to reduce our general fund contributions that we might have to make It's really It's really a benefit to our overall budget And I appreciate your sense of innovation that in tapping cal fresh employment and training funding which has been mentioned on Which a page 204 here first time in 40 years and it's going to impact 2,200 people in this county Significant improvement for what we've done there and for the training the very popular effective downtown streets program that It's just gotten underway in Felton as well as Davenport and has been in place what for almost two years in Santa Cruz um Really important. It's it's just a huge win-win situation and I was up there Walking under the the bridges and the rivers with the downtown streets team They feel good about themselves. It's a win-win. It's just a great program and they're going to be on their way to being really significant Members of our society as they are to begin with but contributing to it. They feel really good about it So that's the best part about it and I know that is mentioned you've done so much to increase the participation in the cal fresh program And coordinating again a coordinated effort with second harvest and community bridges For making more ssi participants being eligible It's just really Tremendous that what you've done I think it's nothing short of remarkable also that there's no no new net cost to the county for the in-home support services That we have talked a lot about um And thanks to your leadership in the years in the last few years that have really been really critical and maintaining this maintenance of effort And as a member of the subcommittee with the with c-sac the california state association of counties The subcommittee there I can tell you this is one place where the value of Being a part of a team or an organization A statewide organization with the 58 counties paid dividends because it was a top priority for c-sac and for this county And it's going to be just provide many more services for everyone throughout this county and throughout the state of california And in addition to doing more for seniors, I know you've done A lot of improvement in the cost for our veterans and supporting our veterans Needs to be a legislative priority not only here, but in sacramento and washington dc as well um I uh, there's one question that I did have On page 211. It looks like there's a 303 increase in overall general fund Expenditures for social services, and I think you've probably Explained somewhat, but can you summarize that huge increase that some people say wow may say wow When they look at right that increase over fiscal year 1819 represents approximately 2.1 million dollars in general fund And about 1.9 million of that increase is associated with the county required share of cost for the salary And benefit increases for existing staff when I said earlier that we leveraged 46 of 43 percent on federal and state financing to support rising staffing cost That 1.9 of that 2.1 million represents it's all about the Just the county share for salary and benefit increases. Okay, very good. Again. Thank you very much. Thank you everybody in the staff Thank you Surveys are capped I want to thank all of you for everything you're doing And uh, I the one question I have is the Adult in long-term care Uh facility is that you're dealing with people with in long-term care facilities and and also at home Uh, are you talking? I'm not sure I understand your question. It's under social services adult in long-term care Oh adult long-term care services is a division within the human services department and that division It oversees Three programs the in-home supportive services program the adult protective services program and our veteran services So adult in long-term care services is just a division within our department that administers those three programs Okay. All right, uh, because it does refer to it's under a page here 202 Yeah, okay, and then uh, that, uh What what exactly do they do with the long-term care as far as uh, uh, let's say somebody has alzheimer's or whatever Well, there's a couple of things first of all remember that the in-home supportive services program Is a program specifically designed to assist in our continuum of services offering long-term care because it's primarily dedicated to trying to ensure that Seniors who can remain safely in their homes without having to move into a long-term care facility So that's the focus of that program and our adult protective services arena We provide that service in order to respond to allegations of neglect or abuse Sometimes those can be self-neglect issues associated with the persons, you know, where they are in the continuum of their You know physical and mental capacities, so adult protective services is also supporting Sort of the provision of longer-term care services by intervening when there's a risk to an adult But we don't you know, we don't run facilities per se Right. Yeah, there are a lot of people actually homeless people that if they if they got into this earlier They might have right not ended up on the street And that's one of um as I was mentioning earlier about our home safe program in our adult protective services area homeless Seniors or seniors who are at risk of homelessness is our second highest Um referral in the last year So we are very excited to finally have some resources to be able to try to address those needs But it is a growing concern and I believe overall in the county that seniors represent the second fastest growing Component of our homeless population About okay. Thank you Make you do any other questions. Do we have any public comment? Please come forward Hi, my name is Stacy Garcia And I'm the director of community engagement at the Santa Cruz museum of art and history And I just wanted to take a moment to thank you all and Thank ellen and the human services department and all of the staff for all of their support And producing the we're still here exhibition that you all will see soon And I just really wanted to commend you all for your innovative collaboration that makes these things possible I think when you collaborate with organizations Like the ma and other organizations You're able to expand the impact of your work in creative ways that you may not otherwise be able to With the help of the human services department We were able to connect with over 86 different organizations that serve seniors in our community And over the past seven months we've been working with 186 seniors to co-create an exhibition together And this exhibition is um having a huge impact here in our community It's not only raising awareness about the issues that seniors face But it's inviting our community to take action in creative ways by donating to meals on wheels or volunteering to lead a Gardening group or signing up to be a home check-in buddy with seniors in our community So thank you for your support and thank you for the staff for your never-ending commitment to seniors and Our creative community. Thank you. Thank you. Thank you for the work you do Yeah, thank you for providing the space to this collaboration to take place and a dedication of staff time To work with so many different people who were part of the group to help put together this exhibition and even the previous The exhibition it's a really it's a great community resource and helps educate people about issues. So thank you Hi, tony crane uh resident of aptos So I really appreciate everything that's going on here today And this is a lot of hard work and what you do is obviously very difficult I do need to bring up the fact that again, it's about Honesty and transparency and making sure that these programs are implemented correctly Um, and they're effective And my personal experience is that it's not that way. So then I look at every other program that way and say Where did where did something go wrong? Where was somebody not honest? Where was there a lack of integrity? Um that allowed a program to get more funds or any funds at all So I see that there's a big a large number for encompassed community services that you provide and again, they're a huge Provider and they provide a lot of services. However, the one program That i'm aware of Second story uh was an abject failure in its implementation There was a complete lack of honesty and transparency in the implementation of that program um, and that's I've provided Evidence and I speak about it all the time here Um, and so I that just needs to be put in the record that I just believe that Uh encompass and specifically And I know you can't defund them totally. They're they're too big to fail is what I've been told So, but in certain ways like that program Should not get funding It is uh, there's evidence out there of the lack of transparency dishonesty might I say fraud And so that is on the record And so I I hope that you do take that into consideration And maybe some of those funds that uh, and and it's been admitted that the program is not effective as it's being run right now Um, maybe some of that money can go to Meals on Wheels. Thank you. Thank you Buenos dias my name is nanny alejandres and director santa cruz barris unidos And I just wanted to I wanted to want to thank everybody for all the work Everybody's we're trying to deal with issue that we have here in santa cruz county and not only violence, but uh, the homeless And barris unidos were going on over 40 years here in santa cruz and A lot of people still don't even know that we exist here and and many department heads don't even know that whether we own one of the largest Plots of land here and so we invite people to come up and I want to thank the those supervisors that I've been working with throughout the years and turns the support that you've gotten given barris unidos and not only here, but statewide and national But I just wanted to bring something up on the the homeless and And then there's there's uh, there's a lot of our people that they kind of get Uh forgotten and those that are sleeping in cars and and uh, you know other areas for our La latinos they're not on the street. They're not they weren't in the camp and in the ross camp They weren't but they're homeless. They're houseless And they sleep in people's anti yards and stuff like that. So we we handle that a little bit different But I also want to you know, and we're trying to deal with that But I also want to just bring up the issue of alternative housing like tiny houses sros You know, we're trying to deal with a tiny house village here in santa cruz And it's it's it's people give support But it's a lot of lip service and so I just want to want you all of you because it's it's hard to get all five year at one time But if you just take a minute and look at what other cities are doing with tiny houses and alternative housing And I think that we can provide for homegrown santa cruz young people Santa Cruz county young people that we could provide them a house. So thank you very much Thank you That concludes public comment. I'll bring it back to the board for deliberation action I would move the recommended actions for the human services department So we got a motion by mcpherson and sorry a motion by leopold the second by mcpherson All those in favor, please say aye. I Oppose that passage unanimously. We're going to take a lunch break and return at 1 30 for our Our final item this afternoon, which is the health services agency And then this evening we'll have our 7 p.m. Continue public hearing Here as well for public comment All right Well, good afternoon everybody. We're going to reconvene to hear the final item this afternoon, which is item number 30 Consider the 2019 21 proposed budgets for the health services agency is outlined in the reference budget documents And and schedule the continuing agreements list items and amendments to the unified fee schedule for final approval on last day budget hearings June 25th 2019 as outlined in a memorandum of the health services director And we have miss hall here to present to us today. Thank you. Good afternoon chair. Kennedy honorable members of the board I'm joined here. You might want to get closer Okay, let's try this How's that I'm joined here today by director of administrative services who was appointed approximately three months ago jessica randolph and I'd like to welcome her as well and We're so pleased to be here to discuss the health services agency budget First off. I wanted to note that this budget and its development Is truly a collective effort of many many parties And that it's framed by two guiding principles First our mission is best reached through collaboration Since the county health services agency alone doesn't have the resources or capacity To serve all of our community's problems The budget was developed in partnership with and informed by other county departments community partners as well as those that we serve And we understand that our work together Complements each other and also intersects in many areas for the most chances of success In particular, I'd like to thank the human services department In the entire hsa staff as well as some of our community partners who have contributed Considerably to this effort Together, I know that we are all clearly committed To the ongoing alignment of our programmatic efforts as well as optimizing our shared resources for the good of the overall community And for that i'm grateful Our second overarching guiding principle is that making progress in addressing our health priorities Requires an organizational nexus Between our community health needs as well as the allocation of resources So in that pursuit Enhancing and safeguarding the health and well-being of all santa cruz county residents requires That we fund efficient and effective health policy and services Supported and informed by data and science And it is with those principles that we move forward So today we'll be providing a general overview of the health services agency who we serve and what we do We'll also talk a little bit about the street strategic framework, which is a part of our strategic planning process We'll also provide a high-level budget overview Discuss division highlights and their operational plan objectives And then also Have a discussion about the fiscal landscape moving forward So health services agency who we are and what we do I felt like this was really important because i've heard in the last few months More than ever that a lot of people don't understand who we serve Why we serve different folks and what we're charged with doing So for some background in california counties are the local health jurisdictions And counties are responsible for meeting the basic health care needs of low income and uninsured residents who have no other sources of care The county obligation is codified in welfare and institutions code section 17 000 And as a result the populations that we serve through health services agency are the medically indigent Those who are medical beneficiaries and then the general public through our population based prevention preparedness and policy work So we do this through a number of divisions And our behavioral health and our clinic services divisions Primarily serve the medical and the indigent populations through direct services In the behavioral health division, we have mental health services publicly funded that are available to medical or uninsured children or adults and The population we serve are those with serious and chronic mental illness We also serve in the behavioral health division as the safety net to uninsured individuals who meet diagnostic criteria Is seriously emotionally disturbed or with serious mental illness We have crisis services available to the extent that we have resources to provide them to the general population And likewise we have substance use disorder services that are primarily serving the medical population Through the drug medical organized delivery system of services The very basic health care needs of our low income individuals are met through our benefits division And our benefits division houses a program called medicrews, which is the county's indigent care health care coverage system And the benefits division is also home to our whole whole person care pilot project Our public health divisions and environmental health divisions address population health through various programs and services that address health promotion disease prevention And other efforts to preserve and protect the public's health And then finally our administration division serves as our programmatic and direct service division That ensures to support to our programmatic and direct service divisions by ensuring supportive organizational infrastructure and management This year is the year that hsa embarked on its first ever effort towards strategic planning So as a department that represents Nearly 25 percent of the entire county budget and over 55 percent of the county health and human services budget It was really important that We ensure That the health and well-being of our county's most vulnerable populations was served through organizational excellence In addition, we wanted to have a process that was aligned with the county strategic plan process as plan as well And ensure that we set our priorities and allocate resources to properly achieve our shared goals Our strategic planning work has been guided by the principles of inclusion and engagement And we were very very deliberate in ensuring that every single staff member of hsa have Multiple reiterative opportunities to take part in it So we started in march 2019 with a series of virtual presentations I facilitated five of these virtual presentations that could each house 100 people in a meeting and these were virtual meetings that allowed for folks to Provide input through chat boxes We also had mission vision and values workshops in which we included all 100 supervisors and managers over the course of four eight hour days In april and may What we did was we took all of the work That was done in march And spit it back out to all 600 staff through a staff online survey to see if what we came up with together through these iterative processes Resonated with staff We also held 10 virtual focus groups of 10 individuals each From various places in the organization both line staff all the way on to leadership What we did more recently in may and june was We had Priority focus focus area workshops So we took the feedback from all of the prior work that we had done to develop our priority focus areas One of the questions that we got from staff throughout this process was We already have plans. We have a community health improvement plan. We have a countywide strategic plan We don't understand what this does for us So it was clear for us to articulate to staff that this was an organizational strategic plan inward facing for our department So that we had the organizational structures the management processes the infrastructure that we needed to be successful in our larger tasks So, um, we're almost done with our Strategic framework, which is our mission vision and value setting as well as our priority areas To work on and the last step this uh month is to do an online survey to all the staff and get their feedback Again on our priority focus areas In june through december, we're going to finalize our strategic framework and start developing a strategic plan that reflects the input of each of our divisions So these are the new health services agency mission vision and values They'll come as no surprise to anybody and they're very much in line With what you'll find in the county strategic plan as well Our mission is to promote and ensure a healthy community environment by providing education outreach and comprehensive health services In an inclusive and accessible manner And our vision is that santa cruz county is a healthy safe and thriving community for all You can see our values that align with those as well So moving into the numbers Our health services agency proposed budget for fiscal year 1920 is 187 million and some change and um as with many of the other departments our projected budget for 2021 is A flat projection and I expect that we will come back In between the two fiscal years with changes that have happened during the year When you look at the graph here, um, the top blue line in the bottom green line Are the differences between our expenditures and our revenues So as you can see our expenditures for the total budget of 187 39 863 is um Is more than our revenues and that revenue gap is closed by the county general fund Or what we also call net county cost One of the things that I wanted to point out Is that as you see our health services agency revenues and expenditures rising as a trend You also see our staffing rising as a trend as well and um It's important to note that net county cost this year is about 5.7 percent of our total Health services agency budget and that's Almost exactly the trend for the last several years So moving along to sources of revenue The bulk of our revenue is intergovernmental funds, which are basically state and federal funds either public or through grants We also have other revenue through Licenses permits fees fines assessments and the next largest bulk of our revenue comes from our clinics which charge for services And as you can see the general fund contribution there at about at 5.7 percent of our budget In terms of expenditures, um, this is what this pie should look like We should be investing the largest portion of our Of our expenditures in the people who provide and deliver services on our behalf Because that is the nature of our business. So as you can see almost 40 of our expenditures are salary and benefits The next lion's share of our expenses go to services and supplies and then Other charges such as supporting our space overhead to the county fixed assets and other financing So here's another clearer look at the five-year trend of the health services agency budget And you can see that there has been a slight upward trend over the years from 1516 Part of that trend Is primarily due to the increase in the number of of services that we provide in our primary care clinics and part of our plan for the future is really to optimize utilization of and access to our primary care clinics in order to Number one better serve the safety net, but number two use those revenues that we earn to reinvest back into other services So you can see that as our Gross budget has risen our non-county revenues have also risen in Because of the bulk of our budget and you can see also the gray line at the bottom, which is the county general fund The other five-year trend I wanted to share with the supervisors Is that as our revenues have increased as well as our company expenditures We've been able to slowly increase our staff over time and you'll see that for 1819 our approved budgeted positions were 568 20 and It looks like quite a large jump to 601.85 proposed for 1920 But I would note that 24 of those positions were actually approved and added mid-year from a variety of different new sources of funding and different kinds of initiatives such as additional grants The fit initiative that's funded by measure g and increased revenues in clinic funding So next I wanted to talk a little bit about each division the breakdown of the budget and highlight Highlight at least one operational objective in the strategic plan So our administration division Has a budget of almost 20 million dollars, which represents about 10.5 percent of the entire Agency budget Our administration division is supported by 12 percent of our general fund allocation and Um, one of the objectives that we wanted to highlight today was number 75 optimizing resources So by june 2021 the health services agency will increase federal revenue for medical administrative activities by 25 percent over fiscal year 2017 2018 I will note that uh, a lot of these revenues are pass-through revenues They're not for hsa to hold on to to provide additional services from us as an agency But they're they're funds that we are seeking to leverage for all of our community partners and other departments So um in future budgets, you won't see them added to our budget But you'll see them included as revenue and included as expenditures because they will go out in contracts to all of the participating nonprofits so the clinic services division is our second largest division and As you may know our clinic services are federally qualified health centers That enjoy an enhanced rate of reimbursement for the services that we provide due to federal grants And some of the highlights for our clinic services division Um, actually the most exciting highlight is that we are able to dramatically expand services Um, we're just about done with adding 14 exam rooms at our emeline clinic and four watsonville exam rooms We're also in next fiscal year proposing to add one exam room to the homeless persons health project Um across all of our clinic services We have really optimized integrated behavioral health being able to provide behavioral health In a primary care setting We have completely ramped up medication assisted treatment, which is the gold standard in treating opioid addiction And um, we are seeking to fund new power exam tables at both of our Emeline and watsonville clinic locations and adding a vision screener in watsonville So i'm going to go back just for a second what I wanted to note is that our clinics division is supported by 1 percent of The hsa general fund allocation as I go through the proportion of general fund allocation to each of our divisions The reason i'm highlighting this Is that before I got here we kind of used to take our general fund allocation and divvy up across our divisions but Every single one of our divisions is financed differently and because our clinics division earns revenue It actually earns more revenue than it expends We're not putting general fund Contribution there just because it's a spot to put the dollars So instead what we did was we deliberately invested our general fund dollars In the divisions that need local match in local public dollars to draw down even more federal revenue So one of the uh operational plan strategies and objectives that we wanted to highlight for the clinics division is that Given the fact that we've increased our medication assisted treatment given the fact that we've done a lot of work in Diabetes education and management We hope to by june 2021 promote services such as mat and diabetes health management education by engaging at least 20 percent Of our patient population in those services So the public health division the public health division is um the budget consists of almost 17 million dollars And uh this division is supported by 14 percent of the health services general fund allocation Um public health is always a head scratcher for a lot of folks They're not quite sure what it does people often think immunizations emergency preparedness both are correct Uh, but public health is really um the core foundational Population based protection and safety for our population So we have our communicable disease unit. We have an hiv care team. This is also where we have um vital statistics Our nurse family partnership community health education and our syringe services program So some of the highlights for this coming year are that the way we've organized our budget Has been with an eye towards increasing our epidemiological capacity to address communicable disease outbreaks as well as ongoing surveillance Increased emergency medical services capacity, which we have not addressed Perhaps since the inception of the ems agency Uh transfer of substance use disorder prevention So um in the past our prevention work Belonged in the division where it received funding But what we realized is that when you're working on population based prevention People benefit from doing that work together And it's a really good fit in community health education And so we're working on um a transition plan now that we've shifted the funds over to include the staff in How they might better optimize their shared work working as a prevention team um Another big change is that all of our birth and death Birth and death records our vital records are now online And this is the year that we intend to apply for national public health accreditation uh, so I know this morning. Um, there is when uh homeless services presented their budget as well. Um, they had uh They had some work that they were doing around community education and there were some questions about this So we also have a operational plan objective to by june 2020 develop a community education and outreach campaign Across the issues of homelessness mental health and substance use disorders as well as health equity And this is an objective that grew over time and the reason is that we understood that homeless services was uh pursuing resources to provide much needed community education marketing about homelessness, but it's not something um that any one entity was able to fund ongoing so, um, we put this in here because it started out as a public health objective But we decided that everything falls under public health And if we're going to do marketing if we're going to be do community outreach and public education That while we're going through the planning process of reaching out to different communities on different subjects We may as well use our resources to support the work of our community partners be at homeless services hsd um, non-profits or schools. So that's the the Thought process behind this objective So moving on to behavioral health services division Our behavioral health division is the lion's share of our budget it, um Represents nearly half of the health services agency budget and it's supported by 62 of our general fund contribution And as I mentioned a little bit earlier That is decisively Because in our behavioral health services division we draw down a 50 federal match for every local dollar that we put into services So by design we try to take all of the available public dollars that we can to leverage another Medi-Cal dollar to provide community services I think I talked in the beginning of the presentation about what populations that we serve and I think that that's probably One of the biggest areas of misunderstanding or mystery about our behavioral health services is who we serve So just to emphasize again We do serve the Medi-Cal population as well as the uninsured and underinsured And um, we have something called criteria where you have to Have reached the diagnostic criteria to be severely mentally ill severely emotionally disturbed and What we also do is we have funds called Mental health services act funds and those funds really act as the glue to allow us to do Much more than our direct services and act in a way that um, we strive to be responsive to the community And so you can look at our mental health services and our substance abuse services And as you can see, um, there's a wide complexity of services that we provide And um, I'm not going to get into it today, but I will guarantee you There's a complex complex patchwork of funding that comes together to make all of this happen So some of the behavioral health budget highlights that I'd like to share with you Is as you are all aware measure g has helped fund a focused intervention team pilot This is a pilot project that the sheriff's office leads in partnership with hsa And we work closely both in the field and in custody with the sheriff's office with the goal of moving high frequency criminal offenders into treatment Another highlight that I'd like to share our is our increase in services for public guardian So our objective in this area is by june 2021 Health services public guardian will increase capacity to investigate four new probate referrals per month The board recently approved us as adding several positions to our public guardian Prior to now, we didn't have the capacity to take probate referrals and we struggled with the lps cases that we had And so we're really looking forward to being able to be responsive to santa cruises aging community Because we know that as time goes by our caseloads will increase Another one of behavioral health objectives in the operational plan is around supported housing by june 2021 Health services agency will increase the number of supported housing beds for homeless adults with mental illness By 20 beds from the baseline calendar year in 2018 And then finally on the substance use disorder side We are going to strive by june 2020 to maintain utilization to substance use disorder services at 150 From the baseline calendar year of 2017, which is when we first launched the drug medical organized delivery system So one of our smaller divisions that many people don't often hear about is our benefits division Our benefits division has the Medicareers program that Offers health care coverage for the medically indigent But it also is the place where we organize our whole person care program And in whole person care as you all know, it's a pilot project grant from the state and federal government And our deliverable has a goal of either serving 20 625 unique individuals or 1 000 unduplicated individuals So year to date we're at 90 of that goal And some key figures for the calendar year Are that in 2018 we enrolled 205 Unduplicated new enrollees 56 received housing navigation services 70 secured housing 39 received housing supports 18 secured who secured housing received tenancy supports And um over 40 almost 50 received pure support coaching services as well as integrated behavioral health case management services We have 18 more months of this pilot project And finally the environmental health services division The environmental health services division It has a budget of just over 10 million dollars And it's supported by 6 of the health services agency general fund allocation And some of the key highlights for the work that we do in environmental health are that The staff is working on a groundwater sustainability study. That's going to be completed by december 2020 They're now able to use the citizen connect application to have community members view local restaurant inspections As well as report cases of foodborne illness and um The local area management plan for onsite wastewater treatment systems will be completed in 2019 The other thing is that this the environmental health division coordinated closely with the city of santa cruz county cannabis licensing office And county planning to review cannabis manufacturing applications and have begun to inspect and issue hazardous material permits for cannabis inspector or cannabis manufacturers For environmental health the operational objective we wanted to highlight was um number 77 water recharge So by june 2020 health services will work with natural resources agencies to complete one additional project To capture and recharge storm water and implement additional managed groundwater recharge projects Today before you we also have a 1920 supplemental budget request of almost four million dollars The first item that we're asking for Is a 2.8 million dollars to become the medicall administrative activities targeted case management host county for california and so what that means is Counties who want to participate in leveraging federal funds for administrative activities around medicall Have to participate through a host county And they all deposit their participation fees in that host county that serves as the middleman to the state department of health care services So we are doing that serving as the pass through and we also receive some funds to do that And um, and we hope that it'll also bolster our ability to have a seat at the table with the state to help inform future policy For the benefit of santa cruz county residents in all of california In the clinics, we'll we'll be remodeling a medical room at the homeless persons health project We also have rollover of the prop 56 funds tobacco slash oral health funds in public health and Our behavioral health division supervisor cap it this might make you happy We have a new california health facilities financing grant and it's meant for mobile crisis services for children mental health Crisis services for children in the watsonville area The total ask that we have for our supplemental budget is 3.94 million dollars This slide shows a summary of our capital projects. They reflect one time investments that we're making As you may know the emeline building is just over 50 years old and so we're investing in the hvac system and the roof We also have the harbour that building that is located near our psychiatric health facility And we've set aside a considerable amount of funds for the exploration of that use the use of that building for For a couple of different objectives and one is that we would like to Have at least one floor of the building. We're looking at a two floor two-story Facility and we'd like to have the bottom floor serve as a children's crisis center And then the top floor we have a few different options for but we know we have several needs for Withdrawal management beds. We also have several needs for supported housing and other things. So I think that the the uses will be able to be responsive to the many needs that we have And I do believe that you'll hear a little bit more about capital projects when Is it general services will be presenting on this? Yeah, thank you Okay, so our fiscal landscape challenges um I actually don't think that we have that many challenges that are so difficult to overcome from a fiscal standpoint We all got a great surprise when we got the governor's budget this year. Nevertheless, we still have challenges And um, I believe that the budget that you have before you does its due diligence to address those challenges For a long time, uh, not just santa cruz county, but all california counties have struggled with core infrastructure for public health and ems And we worked hard in this budget to expand that infrastructure We also are experiencing ongoing increases in placements for Inpatient institutes for medical disease and public guardian And again, we expect that to increase because we have a population that's increasing in age and it's just a function of our demographics We also have a lot of capital improvement needs, which as you see we've Done the planning to address And we have a reliance on a very fragile nonprofit system of services I'm going to move on to the fiscal landscape opportunities One of the things that we're doing to uh in terms of seizing momentum and opportunities Um, and I will say this is where I most appreciate the partnership that we have from hsd From all of our community partners the nonprofit system our internal staff I feel like the way we are approaching our budget uh for the next two-year budget cycle Shows great organizational courage one of the things that we're doing is we are investing Making a one-time investment of public funds Into community organizations and our partner departments that serve the medical community And the reason for this is that we have bolstered our own internal capacity to help each of these organizations and departments Maximize the federal revenue that they can leverage through their Medical administrative activities which include things like outreach application assistance Monitoring services referral program planning and policy development. It's all things that we do every single day But we're currently leaving federal dollars on the table And we want to churn that around in santa Cruz for the benefit of the whole community Um, some of the things that I wanted to talk about that are happening in the state is um behavioral health and public health are finally seeing a little bit of restoration In our realignment funding And because of the current governor's budget that's before us We have a lot of positives for health and human services and we get to benefit from that and so to our communities Some of the federal opportunities are that um The aca was not dismantled and um, that's really really good news And uh, the federal government along with the state has an effort to eliminate new hiv transmission in the state by In the federal government by 2030 and I think the state has a different date But the other great thing that's happened at the federal level is a lot of um energy and effort around the opioid crisis And there has been funding that we've applied for through samsa through hersa through other federal funding opportunities for complex care Addiction and medication assisted treatment So what are some of the strategic innovations that we're doing? I think you've heard about them all already, but I'd like to summarize them on this slide We have really really focused on expanding our clinic capacity The way that we are different as a department from any other county department is that we have federally qualified health centers That serve the underserved and what that means is That we receive a rate for providing services that more than covers our cost And if we're smart about how we want to serve the community in the next 10 and 20 years What we will do is expand our clinic capacity For these kinds of health services now in good times So that when the next recession comes and people lose employer-based health care coverage and lose income and become medical eligible We are ready and poised to serve them The bright side of that is that not only are we ready and poised to serve them But we're also not going to lose funds because we're not reliant on public tax revenues for our clinic services So our intention is to grow our safety net of clinic health services And ensure that the extra revenue that we make from that gets reinvested back Along the continuum of preventive and intermediary services where we never have enough money so, um I guess I I talked about our changing service demands Once we do this what we're really doing is ensuring that we have a funding mechanism to focus Away from treatment treatment treatment really expensive back-end costs and more Even out our investments across the continuum of care Another thing that we're doing is we're making pretty large investments under medical serving partners Both by our medical administrative activities efforts as well as other efforts One of the things that I wanted to point out is that ever since I came here about a year ago I've been talking with community partners and working with those entities that we contract with about the difficulties that nonprofits have in Really straightforward things like foundational services capacity cash flow And so some of the things that we've done this year going into our next year contracts are working with our mental health and substance use disorder providers To change the timing of the payment of all of their contracts to ensure better cash flow for them The other thing that we're doing on the substance use disorder side is that When I got here it seemed like our hands were tied in terms of our rates because the state sets our rates for us It's true the state sets our rates the rate is the rate But it's not competitive when our substance use disorder treatment providers are also getting Private pay patients as well as commercial insurance So one of the things that we're doing this year is we're having these kind of Augmenting or set aside agreements to ensure that we from a different source of funds From our clinics donated over to the substance use disorder side That we're able to match the rates for private pay and commercial pay And that way those who can only access substance use disorder treatment services through medical Have the same amount of access as anyone with private insurance We also feel like this will provide some financial relief for our substance use disorder contractors So some of the issues that we're experiencing from the rapid growth and innovation that we've been undergoing recently Is that We know we have a lot of work to do in workforce infrastructure adequacy and development So that is going to be one of the key areas in our inward facing strategic plan work It's actually risen to the top as one of our priority focus areas The other thing that we know we need to do as an agency is get with the times and then get ahead of the times And I anticipate that we will be investing just as heavily in the future not only on our capital projects But other investments such as data technology and evaluation So amidst all of this we can never lose sight of the fact that we exist Through public mandates To provide some foundational core health services amidst all of this rapid change So we must always ensure that we Serve those foundational core purposes first And not lose sight of them when we try to change and grow rapidly As I mentioned before a lot of how we operate is constrained by a complicated patchwork of funding And restrictions on use but as you can see from some of the details I've shared about our budget We have been incredibly innovative in getting around some of those constraints so that we can better serve the public So our recommendation is that your board approved the proposed budgets of the health services agency for fiscal years 19 to 21 Including our supplemental materials as recommended by the county administrative officer Thank you so much are there questions Professor liable Thank you chair. Thank you for the presentation Glad we waited until after lunch until we could actually hear it and not think about food the entire time You have a lot of heroes in your department Because you're you're on the front lines of a lot of different efforts a lot of efforts that have a lot of scrutiny by the public and so The ability of your agency to authentically collaborate which I which I see very clearly Under your leadership and the commitment from the staff and to deal with Pressing public issues in a way that people feel heard That we use science and that we talk about successful strategies I think is is incredibly admirable and and I just want to acknowledge The good work that everyone does to help make that happen. It's really It's not easy and I I wonder sometimes why people get into those certain lines of work because it's not sometimes it's not fun um I also want to acknowledge the leadership that you've shown in trying to connect Our community-based partners with resources that come from other places other than our treasury So the ma funding is to be able to access that that funds to to bring three million dollars into this community While it may not be our money It's it's into the Santa Cruz economy. It's helping those nonprofits In a way that will make a difference In terms of those services that they can provide And just the way that you've Reconceived that the role that the county can play to help them all access that or is really uh Is really critical and I'm wondering how many Of the 58 counties act as host counties for this activity There's only one At a time It serves as the central Contracting agent on behalf of all the other counties It also serves as the advocate on behalf of all those counties to department of health care services Okay, so so I I misunderstood that I thought that we we were just asking as a host county for this area But we're for the entire state of california. We serve in that role for the entire state of california And who's currently doing it now? Plumas county where I used to come from I'm just bringing along now the plumas county supervisors are going to be on us all over again Never at a at a county supervisors meeting since she's come here. Have they failed to come up to me and say you stole them Oh, I know exactly who that is. Yeah, they like you and they were glad we got you and um And now there's another reason uh the uh the harbor vet building is going to be an important asset uh In terms of figuring out how to best use that spot Um, what's going to be the process to figure out about that second story? At how we're going to use it um I think a lot of it Well for one thing, I think it's going to be quite some time before we actually get construction underway in the building completed And I welcome uh jessica or eric to chime in but you know according to our behavioral health division Um, I think we're going to look at what our most pressing needs are at that time. So for example right now We're looking for space for withdrawal management And it's been very challenging Um, so if we didn't find space by then that could be the use But it could be that over the next 18 months we find some success. So then we'd look at our next priority area So it's hard to say right now exactly what we would use it for And then there are also as you know, the the landscape changes all the time Um, we were recently surprised by a board and care facility in the felton area that had to close and had to do So it really is about what happens in um our service and our fiscal landscape Well, I know the youth crisis stabilization pieces are very well needed and And what do we also need? I mean we we send kids outside the county right now If they're if they have to do residential of some kind is there a possibility to consider that as as one of these options So families don't have to go out of out of county to visit their kids I think that there's a possibility the the difficulty for us is who we can serve and who we get reimbursed for So the biggest problem is if that child is privately insured or a self-pay then it presents more challenges Um, so that those are you know speak I've used the words constraints a lot And I don't like to be a negative person, but we do We have certain constraints in terms of who we can serve and what we can provide And I think that there's definitely a lot of work to do to figure out how we can serve the entire community Beyond the Medi-Cal population, but first things first We still don't have the adequate services that we need for the Medi-Cal population Sure, and I I was unaware of what the What the insurance makeup was for the young people that we've seen an increase of young people coming to the behavioral health center And and just the increased need for behavioral health services for young people in this community We've heard a lot about that over the last we recently had a convening of Of mental health partners for youth that included office of education Several school districts are nonprofits and it's clear to all of us who work in these services that You know mental health problems don't see income. They don't see race. They don't you know, everybody is affected But the positive thing is that we've all come together to try to figure out how we can address this problem Yeah, no, I appreciate that effort of collaborating when the Santa Cruz city schools came forward and said help us Um, you mentioned uh, Jessica and I just want to recognize her for the work on accreditation It's glad to see that we're moving now to 2019 that we're actually going to put that application in I know that's taken a lot of work over a number of years A lot of pieces in that puzzle to put together and so I'm glad to see that we're getting to that stage And I just want to acknowledge you for your ongoing work and I know you're involved with lots of different pieces and uh and health So you were the right person to put on that job But uh, congratulations on getting to that's getting closer to the final square. Yeah The uh I also have the pleasure of working with a number of folks in health services some of whom are here Jennifer Herrera Is she recruited me to help out with something called vision zero about Reducing or eliminated hiv transmission by 2030 in santa cruz county It's great working with her and her staff on that and I'm looking forward to that process I think we're off to a good start in terms of the conversation we have with hip It's going to take some work with all the private providers to play a role in that But I just appreciate that ongoing work and then she she is also attended but Korean Highland Is the primary hsa representative I would say with our livo cradle to career program. It's been super helpful Korean is just a steady support to that program It's really helpful to be able to talk about health issues that has been a primary issue for the parents in the program We have a great partner in the east cliff family health center, but to be able to talk about how Families can maneuver within the health care system Based on their insurance status their immigration status the the availability of services and how to advocate for those services Having some liquor in there has been really Super helpful To that so thank you The You talked about medically assisted treatment as being the gold standard and I think that's that's probably accurate and I know with our drug medic how waiver we have been trying To increase the treatment spaces Places for People here in santa Cruz county and I'm wondering why we don't have an operational goal Trying to get to treatment on demand Because you know that's it seems to me that that that we would our community would be best served If we could if we could build the capacity of our network to be able to meet that need And it seems like something that we should be shooting for And I'm just you know, I I didn't see that in the list of operational goals I would say that we have a lot of goals and objectives that don't appear In there and that is one of our goals is treatment on demand But it's also important for people to understand that the only place we provide substance use disorder treatment Isn't through substance use disorder So we have contracted providers We provide matt and many of our community partners provide matt In many many different settings. So Matt isn't just a health services agency effort It's a community wide effort all of the health system partners have had physicians Gain their x waiver to be able to prescribe Across encompass jannis ourselves all the federally qualified healthcare clinics We are all working on this as an entire community. So no matter what door you come in whether it's a dignity door Um an east cliff door M line clinic door or an ssp door You're going to have access to these services and we'll find a way in the community to provide them with you regardless of Your health care coverage and I think that that's that's really the goal That we should repeat over and over and over again regardless of what the service is is that we're part of a big system We don't own the system. We're not the only player We rely on the rest of the system to properly serve our community No, I I completely recognize that and completely agree with it And I'm just what I'm thinking is the health services agency can play a role to coordinate to make sure that we get to that goal of being able to provide treatment on demand because we know that the issue of Uh successful treatment is directly related to how soon someone's ready for it And if they have to wait for that space it becomes a deciding it could be a deciding factor into the success of of their treatment. So Um That's what made me think about not really not Successing that you actually have to provide all those services But the play a role as a coordinator of those services I did have a couple questions about some of the operational goals here The clinic wait times uh goal. I think is a great one and i'm wondering doesn't the central coast alliance for health Provide in financial incentives to reducing wait times for appointments And is that is that potentially a source of funding? I'm gonna ask our chief of clinics or anyone from the clinics to answer that This is amy peeler. She's our chief of clinics Thank you for the questions supervisor leopold. Um central california alliance for health is One of our biggest supporters and really an amazing asset to our community and they provide us incentives in a number of ways And they do actually call um once a year and they call all of our clinics and they check on our wait times And it's that has helped us to prioritize that as one of our objectives And they do provide incentives great. Well, I mean, I think it's great customer service And it's nice that that the alliance recognize that is a value To incentivize financially because that'll just help it's not much easier to keep it sustainable. Absolutely. Thank you for that On that you mentioned the community education piece and I had brought it up earlier talking about the homeless services and uh I just wanted you to make the connection between you have two goals One about community education around homelessness Behavioral health or mental health the substance use disorder and then you also have A goal about having a communication plant And i'm wondering Are are these Two of the same pieces are they two different pieces? What you know what's I think that they are layers of an effort to Do two things engage the community in the work that we do and then better inform them Not only about the work that we do but the services that we have available um I think I can say that across all of our divisions We could do a whole lot better job Of um providing more clear clarity and transparency about what we do who we serve how we serve it and people shouldn't have to Look through a phone book Go through three or four phone calls, you know That's not the way for us to operate and so I think that this was our stab at um, we know that we have funding And scopes of work piecemealed across mental health services across substance use disorder across community health So it really is how do we try to tie together some of those different scopes of work into one agency wide objective that looks at Communicating back and forth in a feedback loop with a community on everything that we do I think it's very worthwhile It's it's unclear to me because we don't have the budget line detail is not Clear enough to know How much we intend to spend on these two efforts and where the funding is coming from so I would say it's not a Dedicated stream of funding so for example We have our mental health services act plan and that plan Requires that we do stakeholder engagement There is a bunch of stuff in there about reducing stigma and suicide prevention and we fund a coordinator lots of different efforts So it's not like a brand new funding stream just for Stigma work or just for community. It's it's a part of that work But we also have the same kind of funding in other areas such as tobacco prevention and substance use disorder prevention So our idea and this is part of the reason why we're trying to bring in Prevention under one umbrella is it shouldn't matter that the money comes from different places It's doing the same thing for the same community from the same organization So it's our opportunity to start taking the resources we already have Making them work together so that we're just better at what we do Well, that's great, but you don't have an idea of how much of that that that you're thinking that might be I would say I would say across all of our divisions from public health to substance use disorder to the mental health Services Act, which are the three main funding streams that fund these sorts of things. It would be at least At least a half the work of a halftime equivalent of what they're already doing across those three divisions And then other benefits that you get so I don't know maybe hundred and fifty two hundred thousand dollars is the in kind support got it All right, I appreciate that And it's one of the things of connecting this operational plan to the budget And try to figure out how much we're spending where it's coming from um The last area I'll just talk about is environmental health haven't forgotten environmental health Get to work with john ricker on a number of pieces And the the groundwater goal is is a great goal And the work that he's doing to help facilitate the sustainability plans in both the mid county and Um, uh, the valley is are is really excellent And I've seen him at work in those and some of those groups can be Great to work with sometimes difficult to work with so they all seem to like john that that's helpful to for all of us Um, I did have a health inspections question. There's a goal about reducing the number of health violations by 25 And It was since I don't know exactly how that's going to be done Um I'm sorry. What number is that that's a number 68 So, uh, there's a target number of violations and since I don't know the baseline So I'll just assume that that's a 25 percent Reduction, um, but how do we make sure that we're not doing that just by going to fewer places? Well, actually it's the opposite So I'm just taking a stab at this because I didn't develop this objective myself But um, what I understand is that we're because we've been understaffed because we have some data challenges That we haven't been able to do timely inspections when you don't do timely inspections people kind of think oh We're not going to see them for a while. We can slide by on these things. It's the timely inspections that ensure That your uh oh That ensure that help you reduce violations when they're expecting that you're coming They're kind of following the rules and everything. So when we don't have timely violations it kind of You know people get a little bit lax because They're not sure that you're actually going to come at that 12 month mark So that's my understanding of how those two things are related that we'll be able to reduce the number of violations by getting back on track And doing timely inspections. So are we adding positions or are we actually filling vacancies? Well, hopefully we're doing both. We're actually adding one position And it's not uh directly in the consumer protection area But the environmental health division I don't know how many so In order to do the work of these inspectors and also in hazmat and other areas of environmental health You have to be a registered environmental health specialist. It's been incredibly difficult for us to recruit those positions So part of the challenge is that we have in like doing the lamp or doing other things is that We're continually under staffed across all of our environmental health programs. So we are adding Position in environmental health. We're enhancing one position and we're adding a full-time position And we're hoping that that's going to help kind of alleviate things And we also hope that with the addition of our brand new director of environmental health starting july 1 Who is incredibly well respected for her work across the state? That's also going to help in terms of Just having leadership that lends to being a great place to work That's very important. I have one staff member who doesn't go out to eat until they take a look at what's going on They can use the citizen connect app now to the restaurant inspections Anyway, thank you for all your work. Uh, and there's a lot you could talk about with health services because it's a It's a beautifully complex Set of services, but thank you for everyone for their work Thank you Yeah, I'd be remiss if I didn't say As I told our human services director ellen timberlake, thank you for your cooperative effort with human services Um, I think the two things that match the fit these two departments are innovative and collaborative It is and it's really paying huge Positive dividends for the people of santa cruz county. So I just wanted to reiterate that and thank everybody and your staff um And thank you for your the leadership that you've had an outreach to your own staff about What you're trying to get accomplished and how we're going to get there and we want your input staff members And letting us know how the best way to reach those goals Might be what they might be so it's um, it's critically important that Um, we have that cooperative effort continue And I know it will because I think everybody's energized by the results to the to date and some have been quick and that's not easy to get To get that accomplishment on a complicated agency that's so dependent on state and federal Changes of mind sometimes of what we might have so you've really been keeping up on that and I appreciate it very much Um, I'm especially happy to see the five full-time equivalents for the public guardian program that I know our seniors commission has been requesting this for some time and we'll be able to handle probate now So that's going to be very very positive for for us Um, and I know so I know you're looking at the the rates We pay to place Folks in beds in our county so that we can be more competitive with santa clara county And we we just need to increase our local access to those beds for our most vulnerable populations and behavioral health in particular So I appreciate your efforts there And retooling your payment system so it aligns with non-profit budgeting and the other agencies Um, I especially want to congratulate you on the expanding the clinics at the 14 additional beds at mline and the four at Watsonville Really doing something now on that is going to be very positive When the upcoming everybody talks about the upcoming recession, which Is a time when more folks are going to be on medical and we're going to need that The services more than ever and I think we're prepared we're prepared now much better to meet that Challenge when it does come here um I'm also Really pleased about the 24 full-time equivalents made possible by measure g and I Want to thank the the voters of santa cruse county again for Providing that because this means we're going to be able to provide Better services with state and federal funding To people who are in most need of it. Um, and I really do appreciate Again the voters of santa cruse county helping us in that endeavor And you did touch on the the fit initiative But can you give us a little more breakdown on how much those specific funding sources they each provide The the breakdown of how much Well, what what they do provide and the coordinated effort with the sheriff and so forth You did touch on it and I can't remember which slide it was but I don't know if You can get to that right Sure. Well, I mean, it's not super complicated. It funds three positions. Um, so we have Three positions that work in concert and the sheriff's office also had some positions funded I'm sorry. Oh, I got four or something And I don't know if eric you want it. We have our behavioral health director eric riera here if You'd like to expound on that I don't know if he wants I I think that about covers it Um Our three positions we have one supervisor and then two mental health clinicians Who accompany law enforcement out in the community as part of the fit program? So the measure g funding that we received are for those three positions Are there other counties that are addressing or approaching this? Concern like we are in this cooperative effort law enforcement health services and so forth. Are there other examples? There are variations of of what we're doing here in santa cruz county, but ours is a fairly unique program in terms of Our's being an extension of our existing law enforcement liaison program Which has proven very successful and has now become a statewide model In many communities we expanded upon that model with fit to target a specific population of people in the community. So Mm-hmm. Okay. Thank you. Thank you Um specific and there was a On page 174 number seven, uh the under the accomplishments column We they provide permanent supportive housing for 12 people and we talked a lot about Homelessness and and so forth earlier in human services Uh, what is the per unit cost of that and how do we fund it? Is it a specific fund or is it a general type fund that We address You know, it's not a one-size-fits-all approach. We have various Kinds of arrangements with various facilities and each one has their own kinds of cost I hate to pick on you eric, but if you want to provide any more detail Sure So our expansion of supported housing Um services in the community as as Mimi mentioned are supported through various funding streams So we have a partnership with the housing authority Who's provided us housing vouchers for people who? Are being housed through behavioral health programs in the community We have no place like home, which is going to be providing capital funds to purchase properties to expand housing in the community We also have a new opportunity coming up Once the governor signs the budget Additional funds through whole person care, which will also be available to expand housing for whole person care participants We have a competitive no place like home grant that we'll be submitting in the fall to attach to several housing projects in the community and those will create set aside housing units for our our lower income chronically homeless individuals in the community We have mhsa, which also provides rental assistance to individuals that were housing who do not yet have access to a section 8 certificate um, we also use realignment funds and Other funding streams to leverage for federal funds to support the service provision for people who are in those different housing programs so It's a complicated web of different Sources of funds that we use to support individuals in the community And in terms of per unit cost it really varies by the type of program that we're placing people in One of the newer models that we're trying out in the community is a shared housing model So we're placing several individuals within a single home And then providing in-home supports to them through our clinical staff and our partnerships with nonprofits That we're working with and that's turned out to be a Very efficient way to house Larger numbers of people at once and we also have the opportunity to build community within those shared housing programs So that's a model that we're looking to expand with no place like home funds in the future That's an example of your complex Criteria that you have to meet of a fit in particular needs, but congratulations and Reaching out or addressing each We're looking into each one of those to accomplish Something in the end. That's really fantastic Thank you The I also would like to add that we have the Santa margarita groundwater management agency In the The upper valley and part of Santa Cruz as well, which has of course lock loman But the the efforts of john ricker and that has just been fantastic. We're moving along and have that 2022 date. I know so kehl has 2020 and it's going to be upon us upon them before we know it but That is something that of course was state driven And mandated, but it's something that's going to be really a good thing for Predictability and Something that we need to look forward to how we're going to provide that In valuable resource to the people of the county and but john ricker has just been fantastic and in each of those Settings, I know One last question the national health accreditation Do you know when you're going to know when will it be by the end of this year? Or did you do they just say submit it and we'll let you know later It's an incredibly complex process We submit our application and then within two to three months of submitting the application We'll find out if the initial application is approved or not From that time we go to an orientation and we have 12 months to submit our documentation typically public health agencies Submit 800 or so documents to support public health accreditation I I have served as a site reviewer for the public health accreditation board So i'm really intimately familiar with this process After after that year of submitting your documentation Once the public health accreditation board says that everything's complete You'll probably get a site visit in another three to four months sometimes six depending on How many of us are volunteering to be site visitors? And then maybe by In year two towards the end of year two, you'll find out if you're accredited. It's very long You think it was long up to here? Yeah, we still have a couple more years to go. So it's probably going to be at least 2021 before we probably yeah, yeah Okay, and thank you again for your work. Appreciate it Sue us or cap it. Thanks It was uh, it was asked earlier when the human services portion was uh Uh the percentage of homeless people maybe your division would know The homeless population population how much uh, what percentage great percentage? I believe would have drug addiction and mental health problems Yeah, and or I don't know that answer off the top of my head I know that we are going to get more detailed information from the asr point in time count I will say that this past winter our homeless persons health project staff went and did a A survey of those folks who were at the gateway encampment They surveyed about a hundred people who were there at that time. They're about 130 residents And if memory serves me correctly about 40 plus percent of them self reported having a substance use disorder about 60 plus percent of them reported having A mental health disorder. I can't recall the overlap between those two But what's clear is that people who are homeless are also impacted By substance use disorder and mental health issues We shared that data actually reigning mar shared that data that we collected with asr That does the annual whole county count for us And they said that the data that we had collected from that population was pretty representative of what they experience annually for santa criss county Right Yeah, I I would assume I'm just When you get a lot of these problems mixed together, it's very difficult to actually Get someone off the street That's homeless and actually get them independently on their own Yeah, I would say that the key is Interact in as many settings as you can and usually in their setting And I just want to give a shout out to all of our staff that are here today because it's their work That resulted in our operational objectives as well as this budget But particularly a homeless persons health project because they are in the field dealing with our folks Who are homeless they provide field medical services two to three days a week They're often out in the field finding people bringing them to the emergency room following their wound care giving them immunizations and It would be really hard for us to engage with the homeless population and their needs without that team Yeah And thanks a lot for all your help with the mental health advisory board and getting Someone to take minutes and also, you know keep that going. It's a very important commission that we do have and I guess one question I ask every month and it's No fault of our own It's uh, usually uh, right now pg&e has been the big delay opening up the new facility in watsonville When it when we were told back in November or something it looked like it was going to be open within a month Then I started telling people it'll be about two months to give myself a little leeway But uh, is it pretty close right now? Yeah Yeah, it's very close, um We've settled our issues with pg&e. So the building house power gas internet service now Landscaping is being done in the front of the building in the rear of the building And we're just waiting for a fire inspection to be scheduled And once that fire inspection is complete then we have to have a state department of health care services Review of the building so that it can be certified to provide medic health services to our residents once that's done We'll be ready to move in There's a parking lot parking lots ready and uh, you know Parking we have what we've done in the in the rear part of the lot at 1430 is we've striped The existing pavement back there for parking until a decision can be made in terms of a more permanent parking solution You bet Thank you We're looking forward to it. And uh, I know it's uh Out of our hands sometimes what we can get done. I know pg&e has had their own problems And uh, hopefully uh, they can finish it up and we'll get the inspection Yeah, absolutely. And we look forward to having all of you to an open house so that we can show off our new facility Thank you. Thank you Thank you, uh, so, uh, thank you for your presentation. I think it's um, the amount of uh, increased capacity and stabilizing revenue and increased quality that has been Increased in your department over the past couple years Is really remarkable and it's a testament to the hard work of people in the room And you know every increased capacity is People's lives that we're improving or saving and so I just want to thank you for all your work I just have a couple uh smaller questions. So one is I hadn't realized until the Presentation about how in depth this strategic plan Uh processes within your department and I think it's great to align And certainly as you talked about it's it's all we're serving all the same people And so to align across the agency is so important. How will this interact with the operational goals That are going to be adopted on tuesday because it seems like those are a lot of goals They're very ambitious And so are you going to be adding additional goals? Are these just sort of The key steps to get to those goals like what's the what's the difference between the two and How what's the role, you know, I would say the main difference between the two is The county strategic plan is both inward and outward facing There are a lot of goals to improve the health of the community to change something in the environment Our plan is going to be inward facing at our own Operational financial infrastructure personnel workforce development things that we haven't Um, we haven't been able to focus on for a long time to ensure that we're in the best place to achieve our operational goals Because That work has yet to be done. It's happening in the next six months What I imagine is we're going to have a departmental strategic plan that's mainly organizational and that The our own objectives that we choose for ourselves either agency-wide or across all the divisions will appear in the next iteration of the operational plan Great. Um, I'm glad you're doing that. That makes a lot of sense Uh, second question is so the detox beds, which Supervisor Leopold mentioned Uh, and you mentioned, you know, they're just such a critical need and they're kind of a bottleneck Uh, and we've heard several different options When can we get a report on? What the options are what the relative cost per bed is and when the timeline is because Obviously the faster you go in general the more we'll have to pay But that may be worth it To alleviate a need and to create a bigger pipeline for some of our other programs So what's the We have a sense that they're we're heading in a direction. But when do we get the roadmap with dates and times and costs? Um I think well, there's a twofold There's kind of like a two pronged approach to withdrawal management From my understanding and shana isn't here She's our direct alcohol and drug administrator over substance use disorder services But you received a report on the drug medical services not long ago And one of the things that you might have noticed in that report is that the utilization of withdrawal management beds is far below projection And so when I dug in deeper with that program about why that is Part of it was because even the beds that we have available to us That we've contracted for are not being utilized because that contractor can get a better rate So if they have let's say they have 20 beds and All 20, you know, they know that they're going to get a private paying or commercial pay patient then they might not Be motivated to accept our patient So one way to address that specific situation is exactly what we're doing right now Is we're exploring a way to enhance the state rate that we get Similar to what we do for residential beds on the mental health side And we're using our funds that actually our overage funds transferred from the clinic So that we can match rates or have some kind of side agreement to Guarantee the beds were already contracting for are actually utilized as far as the other one I can't tell you what the timeline is because we only have maybe two good options One is to look for a contractor or a facility that's out of county and that's actually not really a good option for me But the other option is Find an operator to expand services here the barrier to that is space And so We were talking about the harbor vet building The second floor of that facility is a potential space It withdrawal management has a medical component to it and it's highly overseen So there's a potential that we could add if we didn't find another place by the time that that building was done that 10 of those there would be 10 beds available for withdrawal management Getting an operator isn't the hard part. It's finding a building And so I think that we could find someone to provide the services for us. The trick is Where do we find a place that accommodates 10 15 16 20 beds? So that that'll and it kind of looks like we have to create it ourselves So if we don't find a place before, you know, the 18 or 24 months that the harbor vet building gets done That's a potential for it right so I didn't really answer your question right so I'm trying to see because I think the goal If I remember correctly the operational goal was to get to double the number of beds Which is a relatively small number, but doubling is is important by 2021 And I'm trying to get a sense. Is this something that's going to happen in 2021 or is this something that's going to happen in 2020 like what's the and are there interim steps we can take? At what cost I'm just trying to get a sense as to like Is this right? So we really work Is the expectation really going to be that may have 2021 these beds come online or is it really expectation? I don't think so our staff are so I already named one interim step Which is increasing our local capacity capacity to use the beds that are available already The second interim our staff have been working really really hard to explore potential contracts with With facilities operators again not all of them are in county so I mean I think that So much is unpredictable But I think that in a year's time we would well in less than a year's time We'll definitely make progress because of our contractual arrangements that we're working on with our existing provider But in a year's time we might know a little bit more about if we're going to have to contract with an outside entity outside the county Or if we have Something really well in you know greased in the pipes for in county It'd be great if we could get a A date at which we could have a report to have us To know what the the timeline and potential options are and when when we can expect those beds to come online Second one is perhaps we could include that when we come with our regular reports for the drug medical organized delivery system Yeah, yeah, that'd be great. That would be that'd be that'd be really helpful The second question is the children's mental health Crisis beds are obviously A huge need in this community our adjacent counties are both expanding their options, which While outside of county are much better than the current options, which are far outside of our county Or or the emergency room our local emergency rooms Have we had any we made any progress with their santa claire or monterey county in terms of Being able to have access to some of those beds for our kids. Yeah, I know that we've had Preliminary communications and I believe eric either either did a site visit or had a meeting with santa claire county And so we are exploring partnerships to see how we can collaborate to increase access for us For our kids here in santa Cruz county, and I believe you put us in touch with the santa claire county folks. Okay. Thank you. Yeah, great I think it's There's just such a need and I don't think I don't know that we'll be able to provide enough locally I know we won't and so Is there an opportunity to partner Going forward. Okay Seeing anyone else is there any member of the public who'd like to speak to us today Only one. All right. Yeah, so again, I appreciate all that's being done. It's a lot of hard work, obviously, but Again, uh, regarding the second story program A complete debacle in its implementation Uh, I've been in front of you now many times providing evidence of I allege criminal activity And things that go up to the state and even on a federal level I I hear a lot of these things integrity equity and justice building capacity operational excellence The word authentic was used And and doing what you are doing requires all of that requires truth and transparency Um in order to get accredited in order to do all these things Yet right in front of you is something that um, it in my opinion spoils everything I hear the words You speak them and then it just kind of floats away Because i'm telling you and i've told you over and over again for two years now That what occurred was absolutely wrong illegal And nobody is stepping up to take care of it the Board here says they can't touch it now. It's out of their hands and I don't believe that I believe that Encompass I've heard from a good source too big to fail And that is not a good position to be in because If we keep going down this path, they are going to fail. And so you you can't you just can't do that So i'm requesting that you defund encompass or at least second story To the point where you can then get them to Acknowledge what has occurred Get them to move out of the program out of that property because it's just improper all the way through Thank you. Thank you That closes public comment. I'll bring it back to the board for the liberation action So i'm just going to ask for just a point of clarification on on that point, which is Do you have a sense of what we continue to fund the second story program in through secondary pots? Recognizing that obviously the building was purchased on things outside of our control recently But do you have any understanding of any sort of programmatic funding that still continues to go from the county to second story I don't know the detail of that for 1920 I know that for this current year We did not provide any funding because They had a donor that was able to provide funds for both the building and The operational services. I don't know how long those funds last. I don't know if you can answer that question eric As part of the mhsa plan that was submitted to the state we did Put in based on the community input that we received Think approximately $270,000 for 1920 to help support the second story program in their contract and that's about the what we estimated the yearly Operational cost to be correct. It's about it's a little less than half Can you quickly explain how the mhsa funding is allocated? I mean, it's not exclusively a county Process, I mean who are members of the organ? It's based on an extensive community stakeholder process And so we held several stakeholder meetings And that was one of the number one funding priorities that was identified by the people participating So we built that into our mhsa plan which we submitted in december To the state and what flexibility does the county have to alter that plan once it goes through that state process? In essence not meaning the state mhsa community stakeholder process We would have to go through another community stakeholder process because that's part of determining what we use those mhsa funds for And so we do that annually I guess all right So so the flexibility if that organ if that group of people which includes their representatives of nami and others If they came back with a funding recommendation How much flexibility does the county have to not accept their funding recommendation is what I meant? Um, I think that would put us in poor standing with the state because they have a very close Focus and priority on what the community is asking for In terms of where we direct that mhsa funds So in essence whatever that or whatever the group of stakeholders comes up with we just in essence pass through is a recommendation from HSA funding to the state It's not quite that simple But I think if we were to go Against what the community was recommending That would go back to the mental health oversight and accountability commission And we would have to be able to respond and defend that decision So for all intents and purposes then we do just sort of just pass through what those recommendations are What I'm I'm just I'm just trying to explain for the community about how that process works We strongly consider yes the recommendations of the community Okay Thanks. Thank you To be clear On the agenda It didn't list the operational plan but on on the information in front of us the operational plan is on there We are voting on the operational plan today You you are but the final adoption will be on next tuesday, so there's still an opportunity By next tuesday if you wanted to make further changes, but you are today voting Yeah, I'm not I'm not looking to make any changes But the other departments had the operational plans listed on the agenda and this one wasn't and I wasn't Exactly sure why that was maybe it was just left off by an error So I I would move the recommendations for all the pieces the proposed budget the line item detail the supplemental budget The unified fee schedule the continuing agreements list the errata and the operational plan So we got a motion We got a motion by leopold the second amendment person. I'd ask that We add the additional direction that uh at the next report on drug medicow We get a a sense of Timeline and cost for expanding detox and withdrawal management services It is a friendly amendment All right friendly with you mr. Second All right Motion and a second all those in favor. Please say aye. Aye Opposed that passes unanimously. Thank you and thank you To the a. Just a team for your good work. Thank you to all of you. You guys have helped put all this together. Thanks So we're gonna recess until our 7 p.m evening session tonight that evening session is an continued public hearing on the proposed budget and it's an opportunity for members of the public To come to speak to us about uh any aspect of the budget that they wish to engage us on I think All right Good evening everybody I'm gonna call our meeting back to order And this is an opportunity for members of the public to speak to us About our budget in general. That's a we're holding a public hearing on the 2019 2021 proposed county budget and We're gonna offer an opportunity for public comment. There's no One in the audience to provide that public comment I'm gonna ask the ceo to provide a very brief overview of our Of our budget and I encourage those who are interested the entire budget is online as well as A more in-depth summary that The ceo offered both on the first budget day and last night in watsonville and if you're interested You can access both those on our website Mr. Palacios, do you want to give us a quick overview for viewers who might be joining us from home? Yes, uh chair cunnerty and members of the board We have started our budget hearings this past monday And we are continuing throughout the week through thursday Morning we had an evening session last night in watsonville and tonight we're in santa cruz As the board chair mentioned I gave an overview of the budget both in our first day and monday and on Monday night in watsonville. So i'll just give a very brief summary of this so I wanted to point out our work plan which is that we have a strategic plan Which is a six-year document that was adopted last year. It has Six focus areas and each focus area has four goals. So there's a total of 24 Goals that are laid out by policy area This year we will be adopting a two-year operational plan and a two-year budget These are the first time the county is is adopting this method The basic premise is that the operation plan links the strategic plan goals To the actual funding decisions made in the tier budget This is our first year. We hope to get better at it. There are 72 172 Objectives in the operation plan soon to increase to 178 And in the following year we will be doing performance evaluation as well as continuous process improvement This is a plan where there will be three Operational plans three two-year budgets within this cycle. I'll just go through I'll go through the fiscal stewardship that the board has showed Over the last number of years. We have tripled our reserves We are now at the board's directed goal of 10 of revenues. We've improved our credit rating Um, we've reduced pension obligations. Um, we have controlled our employee growth having less employees today than we did Um before the great recession in 2009 even though we've greatly expanded services And we're making progress in addressing deferred maintenance So i'm gonna go very quickly through these budget overviews Because we've already spoken about these, um twice but I wanted to just get to um This part right here Which is the 2021 budget. So what this shows is that? The current year Fiscal year 18 19 has been balanced. We had a we anticipate having 6.2 million dollars A fund balance at the end of this year Next year, which is 1920. We also have a balanced budget And so the board will be adopting a balanced budget At the end in the next week next Tuesday And we anticipate having also about 6.2 million dollars of fund balance But in 2021, which is the out year. This is the second year of the two-year budget. We are projecting a 6.2 million 6.4 million dollar deficit. So that's above the anticipated Fund balance is 6.2 on top of that. We would have to Either get more revenue or make cuts of 6.4 million dollars So that is the concern is in the out year and this this chart shows the deficits We're balanced in 20 and then 2021 We have in best case scenario a deficit of about 6 6.4 million But it could be um as high as 12 to 13 million dollars if we were in a recessionary environment This shows you our reserves, which are very healthy, which is good for us in terms of our fiscal stewardness steward ship I'll just say that our in summary that our challenges are that in the out year our costs are rising faster than our revenues We worry about approaching recession We also worry about the housing shortage In the the community which is affecting the entire state And we also worry about the damage from the 2016 17 storm Winter storms which caused a great deal of damage to our roads Those are our biggest concerns in any event that concludes my presentation and i'll turn it back to the chair Thank you very much and again a longer version the entire budget is available online for anyone who wants to access it And a longer version if people want to watch is available at both the monday Morning hearings and the monday evening hearings with that we will continue our Recess to continue our budget hearings, which will begin at 9 a.m. Tomorrow Wednesday june 19th here at the 701 ocean street the governmental center on the fifth floor And tomorrow we'll be planning and public works. Thank you very much