 Welcome to Sheboygan County government working for you. My name is Adam Payne County Administrator and co-host of this program with Chairman Roger Distruti and as you know every month we strive to bring a new department or program or service some information to discuss and hopefully give you a better feel for the very important roles and responsibilities of county government and of our 19 departments one of the largest with a 31 million dollar budget is our Health and Human Services Department and with us today is our Health and Human Services Director Tom Egerbrecht. Welcome Tom. Thanks Adam. Happy holidays by the way. Happy holidays and happy holidays to you. We're gonna get a brief overview of the very important roles and responsibilities of Health and Human Services and as one of our largest departments it's difficult to really drill down too far because there is so much going on so let's let's jump right in here. Please begin Tom by sharing a little bit about the core services of the Health and Human Services Department. Sure. All counties in Wisconsin Adam are required to provide safety net services for persons who are vulnerable as well as assure health and well-being overall for county populations. We do that over the course of four operating divisions so we have a division of economic support which operates at our Job Center on Wilgus Avenue. We have an Aging and Disability Resource Center in Sheboygan Falls. In our main building downtown we have our division of public health, division of social services and division of community programs and we also provide services to the Sheboygan area school district as part of our programming under the division of social services. We have three staff stationed at Tower Academy School. So four divisions and approximately how many staff do you have in total and give us a sense of that 31 million and where predominantly those dollars are being allocated. Yeah we have 180 staff and again they're operating across those work locations as I indicated. Our 31 million dollar budget is about 60 percent state and federal and the balance of that gets made up through local levies so that's about 13 million dollar annual contribution to services. And you have developed particularly the last few years an outstanding track record with your budget management and of course as Roger and our county board and the public would expect we expect all departments to work within their budget parameters. The county board approves the budget and department heads are expected to work within those parameters but of course a budget process is not a crystal ball and depending on the department things can happen that may blow that budget out of the water and you may want to give an example of something that can stress your budget but back to my point you have done an excellent job working within your budget parameters. Give us a sense of you know how challenging is it and what are some of those situations that can make it difficult to work with budget parameters. Well first of all when we talk about our budget and we talk about the success that we've had I think a lot of that credit needs to go to our staff and our contracted partners so we've we've taken a couple of approaches in recent years that I think position us better to respond to situations help us achieve a positive budget performance. One of those things is we've shared decision-making and program planning and budget management with all levels of our organization. I think that's still a work in progress. You might be familiar with medical studies where patients who control their own medication tend to need less medication than when it's controlled by others so similar concept when we involve our staff and decisions about spending and about programs and about services it brings it to the front line and it it results in better outcomes many times so that's number one number two and you asked about what are some of those things that would cause our budget to be a little bit out of control or beyond our control and one of those things is use of institutional settings. So as an example for mental health inpatient care that's about a thousand dollars per day for juvenile corrections placement that's about three hundred dollars per day. So insofar as our staff can develop approaches that keep people out of those settings when it's appropriate to do so there's significant savings to be had. We also encourage I guess innovation and contribution on the part of our staff as to what new approaches may produce better outcomes. We focused a lot on evidence-based practices those things that have been proven through research to produce positive results. Many of our program staff are being immersed in those approaches right now. I also when I have a chance to meet with new employees I tell them spend less time assimilating to work the way it's done and spend more time thinking about the way it might be done and feel confident in bringing those suggestions forward. So all of those things are in play we've had great great success I think we've realized about five or six million dollars in savings over budget in the last five years and I think we're on pace to accomplish a similar outcome this year but as you make reference to at the end of the day there's a huge amount of luck that goes with that as well so we are we are extremely fortunate and extremely blessed. Good management and good fortune is how I always put it because you do an excellent job with your budget estimates and your projections and of course you involve your staff you have a very collaborative process and and it's worked well but when I say when you can have a stressor or something that can make it very difficult on the budget or is out of your control I'm sure some of our viewers might be thinking well you always I mean even if something's out of your control you better stay within your budget you can move and reprioritize and that's true but for example I know if Marty Bonk was with us today who after 30 years is going to be retiring from our health and human services department every time we sit down during the budget development process Marty will help develop those projections and estimates and he will gently warn all of us and say however all it takes is one juvenile gang fight or you know a spike in some inappropriate decisions and behavior that can impact that budget and then also as we both know if you have elderly abuse or child abuse or something like that that's reported and those numbers increase or spike one year we can't say oh we don't have the money for that we have to respond and again you and your staff have done just a tremendous job don't thank you last time we talked we spoke a little bit about the building addition and I hope many of our viewers have had an opportunity to drive by the health and human services department and see how close we are to completing that building addition please wind it back a little bit and set the stage what was the need or impetus for adding on what's going to be about a two two point one million dollar building addition yeah so our building was constructed in 1921 I think served many years as the sheboygan clinic medical facility and it was never intended for use as a composite health and human services department and as a byproduct of that it hasn't been set up quite as efficiently as we'd like to have it for our application county acquired that building I think in the late 80s maybe 1989 or so and what I can give you by way of example is the lobby in that building is is so small it will accommodate seven or eight people at a time comfortably so visitors are cleared to interior spaces in our building and typically wait in hallways while they're trying to connect with program staff so privacy and information security are compromised we get about 250 visitors per day we have one accessible restroom in the entire building that's located in far corner of the third floor and our meeting rooms are are inadequate to serve our workforce of 180 employees so all of those factors together have suggested that if we could improve our entrance to the building and add a few enhancements to that entrance we would have much improved efficiencies and when you say one accessible bathroom you don't mean there's only one bathroom in the entire building no i'm sorry one handicap one handicapped accessible that's exactly right so again at the period in time that building was constructed it's interesting to see today the doorways on most of those restrooms are 24 inches wide and when you throw molding on the side of those doorways they're 23 inches wide you'd never get a wheelchair through there so when i talk about accessible restroom thanks for that clarification it's the only one in the building that would allow a person in a wheelchair to be able to get through for those of you who have ever flown in an airplane or taken a bus tour somewhere that has a bus bathroom in the back which is in the case with most buses but for those of you have experienced that and squeezed into that little airport bathroom or airplane bathroom or bus bathroom many many of our restrooms at the health and human services department are like that so when tom made the case for it is time to improve upon this it wasn't a difficult challenge from a bathroom situation because those are just tiny bathrooms i i i've joked around with tom in the past and i don't know how many of our viewers have ever seen the movie with chris farley and his bathroom seen in an airplane i don't recall the name of the air the movie anymore do you or not uh was that trains planes and automobiles i don't think i think different movie different movie i don't know in an airplane any of you have seen it you know what i'm talking about it is it's a hilarious scene and it's one that can play out in our department and more seriously you've shared with me tom that if someone's had an infant and needs to go to that bathroom and change the child or anything like that they're just literally isn't room you almost have to hold the door open or closed with your foot well yeah i think what you're referring to there is um our public health division is located on the third floor of our building and um there's a restroom directly across from our reception desk there and as you allude to there there's no changing tables in those restrooms they can accommodate one person at a time and there's no locks on the door so as a byproduct of that we have had mothers you know changing babies diapers on the floor in that restroom and and our staff you know thank goodness for our staff keep an eye out so that no one inadvertently opens the door on a baby in that situation it's not it's not a tenable circumstance it's amazing we got by this number of years the way we did but it's time to improve that it was time and it was time and thankfully because of your budget surpluses because you had a track record for a few years of coming and under budget we're able to support or the county board ultimately approve this addition and not have to tap into any additional revenue or bond bond or borrow for it we're able to use those surplus funds right in addition to restrooms what are other practical improvements associated with this building addition well as i mentioned it all starts with our lobby space that has been woefully inadequate we've had to clear people to the interior of the building when they're waiting to be seen first of all we'll have a large waiting room we'll increase from six or seven persons who can wait at a time to 30 persons who can wait at a time we'll have centralized reception now so rather than having separate reception staff in five spots in our building we're going to have three receptionists working in that main lobby on the upper level we're going to have a large meeting room currently our largest conference room in the building will accommodate 40 persons at a time workforce of 180 again there's a terrible mismatch between those numbers so the new conference room on the second floor of this addition will accommodate 128 persons comfortably perhaps a bit more if needed we'll have a nice break room in there for staff to use and we're also adding a nurse on call office right off the lobby an immunization office right off the lobby and among budget initiatives for the new year we're adding central information and assistance staff who will also be have an office in that lobby area to help visitors navigate not only through our system but community systems of care as well excellent excellent thank you tom turn it over to you roger thank you adam it's great to see the improvements going on there it's much needed and we'll be appreciated by the staff and the visitors that are needed there we also have a facility in shabuigan falls the disability let's see the name aging and disability resource center officially and we've got a building project going on there would you explain a little bit about that sure very similar to to our main office is downtown the site that's occupied by our aging and disability resource center was not intended for its current application so as a byproduct of that entrance into that building is through the back of the building off the parking lot through a service door there's no protection from the elements for visitors the north wind blowing off that lot goes directly into the offices there's no no means of breaking that that the force of that wind and then also the reception area inside that building is tucked away it's not too far from the entrance but it is tucked away in in an office area adjacent to the entrance so it's not immediately visible so those shortcomings are also going to be corrected there will be a canopy added over that entrance that door is going to be replaced a vestibule is going to be added inside to provide better protection from the wind and then also a new reception area is being created immediately inside that building so as a visitor you immediately know where reception is and the receptionist will have you know line of sight opportunity to see who's coming and going so many many improvements and going to be very much appreciated there as well and when do we expect that project to be complete that should be done by the end of this year we got a little bit of a late start but i spoke with jim to beast of our building services department this morning he indicated that we're on schedule to be wrapped up by year-round so we look forward to that and i know our staff and many community partners are also helping with a patio area you want to explain a little bit about that sure that's also at the aging and disability resource center so that particular site in addition to providing eligibility determination for long-term care programs and offering other information also provides senior programming and serves as a senior dining site for the shabuagan falls area and one of our staff members a gal named kathy mani came to me back in january and said you know what it'd be really nice if in this site we could develop some outdoor programming space she had a vision for a patio installation out there she drew it on a piece of paper very crudely and she said it would be great and she believed that we could get community participation and support to get that thing done and she partnered with jill spielvogel of our staff who's one of our program aides out there and jill is just so amazing in terms of her connections and her motivation and she did go out and enlist the support of many community partners who donated good service and labor to get that thing done and i'm confident i'm not going to remember all of them but haymeister architects donated the drawing for that project jill's husband who has an excavating business helped with some of the land preparation we had steker construction involved vandervaart concrete involved restoration gardens designed a landscaping plan if you will otter creek landscaping was involved mustard seed was involved superior lawn and garden was involved and it all came together with the assistance of the volunteer center who was signed a work crew and got all of that work done got all of that work done in one day back in july so it really really was a nice effort it started as a simple concept on the part of a singular staff member and it took shape and they can be very very proud of that and i know too that the seniors who use that site did immediately take to that space and it's a big big improvement for them great great to see an improvement like that and and the staff sees a need and they follow through on it absolutely absolutely with some of these building projects that obviously gets in effort and money's from donated from others but the big project that the health and human services building and it falls where did the bulk of that money come from we touched on sure yeah so as adam referenced our our positive budget performance in recent years positioned us well to utilize some of our fund balance for that building project downtown and in terms of the aging and disability resource center we operate that program through a state contract that's basically a self-sufficient funding source if you will that does not require levy contribution there again we had some positive variants from last year that was carried into this year and permission from the state to apply that carryover for this particular purpose so in both cases we are able to get those projects done within the limits of operating budgets we've otherwise had and not had to rely upon additional bonding or other sources so again very very fortunate and these big projects take some help from other departments within the county too why don't you explain the ones that helped with it yeah in particular big shout out goes to jim to beast our building services director jim has been there every step of the way we had to replace the the east facade of our main building a couple of years ago back in 2012 it had a stucco surface that was beginning to deteriorate it was absorbing water so on and so forth so when jim came to me it said we needed to replace that that facade with what is now some tile paneling i guess you could call it my request of jim was let's do this in a way that does not prevent the consideration of future addition or let's not do it in a way that causes waste through that process so jim did involve an architect at that stage as far back as 2012 to conceptualize what that would look like and jim has been there every step of the way i know that he takes a lot of questions at times a lot of grief from us as a workforce in terms of this work certain this uh walking surface is too rough or there's too much dust or there's too much noise and jim has been great great to work with and so i've so much appreciated his help but then also bernie romer and bernie works as a purchasing agent for the county and city both and uh bernie is is he is just a can-do guy and if you ever have a chance to to say hello to bernie i would encourage viewers to do so because he's a tremendous guy can-do guy and uh he's helped us acquire all of the furnishings he says what what you need this thing to do when he goes out and he gets it and he just makes it so so easy so those guys have both been a pleasure to work with well thanks for all the work that you and your your division managers and all the people at health and humans services do for our county thanks roger as we have this discussion it's kind of ironic to me that we're talking about building and infrastructure improvements for health and human services because of the 19 departments if there is a department that has probably been the most frugal when it comes to asking for any structural enhancements or new furniture or new computers or whatever it might be it has been the health and human services department why because their focus has always been on the clients and the services we provide to the clients and making sure that we do the best we can with the money we have for the clients and so let's let's return to some of the important programming and services that your staff provide uh recently you and i both had a chance to participate in a community conversation to improve mental health services access some people who might be falling between the cracks or there wasn't necessarily the the chain of information and people being sure that they're getting in the right hands so tell us a little bit about your 2016 i'm sorry 2015 i'm already thinking 2016 2015 budget and some of the new initiatives programs that the county board supported that are going to help people in this community sure happy to adam yeah you made reference to this community conversation on mental health that was an event that took place back in march at blue harbor um really uh it was an opportunity for people who had interest or concern about provision of mental health services in shabuagon county to come together and identify gaps and um one of those things that was a recurring theme that we heard on that particular day was that it's difficult for people to navigate through the system and even for people who are working within the system to know what others are doing to know what their you know sister agencies might be doing is extremely difficult we all get busy doing what we do we don't spend enough time understanding what others do so as a consumer you keep hitting closed doors and it's kind of a hit or miss proposition as to where you go for assistance so i mentioned earlier that one of the things we'll be adding within our system of care is information and assistance staff will have two staff stationed right in that lobby to provide information and referral assistance program enrollment assistance functional screening assistance not only for the services we provide but to help people navigate through community systems as well secondly we'll be adding case management staff in our area of behavioral health we've heard about this for a long period of time again it's difficult for people to navigate through systems so we'll be adding one additional case management position in our social services area so many of the kids and and families that enter that program area whether through child protective services or juvenile justice services have early indications of mental health or substance use issues and we're going to be expanding our provision of mental health supports if you will for that population we want to embed that resource right in the work side by side that's being done in our social services division we're looking to develop some detox services in response to the heroin epidemic so we've heard a lot over the past year about the the rise in the use of heroin the impact it's having in the community right now there's not a good detox opportunity in Sheboygan County so we want to get started on that and hope to come up with some resources there and then lastly I also want to mention that youth aging out of foster care if you think about a young person 18 years of age who's been separated from family who's been in foster care and is now emancipated from foster care and how equipped that young person might be to deal with life and the challenges that come along with life it's it's a troubling picture at best so we're going to be partnering with Manitowoc, Kiwani and Door Counties we're actually partnering already we've received a grant from the state that will be carried into the new year to provide supportive assistance daily living skills instruction job placement assistance and I guess assuring that those kids land in good comfortable spots and understand what it takes to maintain a household so on and so forth so very excited about that that's also a long overdue great summary great overview a lot going on at the health and human services department and all these new initiatives actually weren't done with new money they were done by reprioritizing within the budget that tom worked with last year and the year before because not only health and human services but every department is being asked to do more with less and reprioritize and focus on the needs and my compliments tom do you and your team and listening to the community and making some improvements look forward to that thank you for joining us today we're believe it or not that 30 minutes went by quickly a lot of information if you want to learn more about health and human services have some questions about some programs know someone in need who needs to get connected with the right person don't hesitate to contact Tom Eggebrecht or any member of our team and we'll be sure we refer you to the right person our county clerk's office is always a real good resource to refer people the county administrator your county board supervisor or check out our website but tom thank you so much for joining us today and thank you for your good work thanks adam appreciate it next month rebecca per sick our family court commissioner is going to be here to talk about the very important roles and responsibilities of the court commissioner's office and until then have a wonderful thanksgiving a wonderful christmas and best wishes