 Everybody back to the Board of Supervisors budget hearings. This is just the continuance of our budget hearings, so we're going to get Straight into it. We're going to lead off with the introduction of the item from Ms. Mary Riggs if you wouldn't mind Introducing the health and human services budget item. I'd be happy to do that. Good morning chair friend members of the board Christina Mallory the county budget manager. I'm going to give you a brief overview of the health and services health and human services budget category So just to let you know these departments agencies and budgets make up the health and human services budget category child support Core investments human services health services and homeless services The health and human services category expenditures are approximately $313 million for the upcoming fiscal year This represents about 40% of the total county budgeted expenditures for fiscal year 2018-19 and this represents a 7.6% increase over the prior year And this is primarily increased costs 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 and you can see health services is approximately 54% And human services is 42% and that makes up the majority of the funding the largest expenditure in This category is salaries and benefits which comprises about 147 million of the total and supports over 1,153 positions It's an increase of about 18 positions from the previous year which was primarily added mid-year Due to the whole person care program Additional expenditures include services and supplies of 93 million other charges of 80 million and other Financing and fixed assets which make up the remainder of the expenditures at about eight and a half million the Revenues include about 285 million dollars Which represents about 91% of the financing with the general fund and other funds making up the difference are about 9% To meet the expenditure needs these revenues represent 49% of the total budgeted revenues and are comprised of about 205 million dollars in our governmental revenues from state and federal sources 47 almost 48 million in charges for services Almost 24 million and other financing and 5 million the use of money and taxes and 2.9 million in licenses and permits Additional financing includes 27 and a half million dollars in general fund contribution and Less than a million dollars in other funds This chart shows the share of financing by department and agency and note that core investments are not represented as they are totally supported by the general fund and here you can see the general fund contribution by department It's approximately 27 million dollars represents about 19 percent of the total general fund net cost and Further details will be provided in each of the department budget proposals So we like to in a high note and give you some highlights and successes As noted yesterday, there are still some critical unmet needs in the health and human services arena Including services for the homeless population including the navigation center year-round emergency shelter behavioral health and substance use disorder treatment and Permanent supportive housing needs However, we'd like to leave you with just a few of the accomplishments in health and human services this year Serving our most vulnerable population emergency shelter capacity increased by 30 percent and New on-site health care and benefits enrollment services were offered at these shelters a Dressed over 22,000 communicable disease incidences and provided over 400 home visits through the nurse family partnership and Supported veterans through increased outreach and reduction in wait times for benefits appointments The majority of the health and human services budgets will provide more information on the regular agenda Child support is listed on the consent agenda as a status quo budget proposal in Jamie Murray The department head is here today if you have any questions and that includes my presentation Thank you for that introduction. Are there any brief questions before we move on to the consent agenda Okay, see none just we have one item on the consent agenda Which is to approve the 2018-19 proposed budget for the Department of Child Support Services, are there any questions or comments on this item? Is there anybody from the community that'd like to address us on the Department of Child Support Services before we go into our regular agenda? Okay, see none will bring back to the board for action. I would Move to adopt the consent agenda and thank child support services for the good work that they do We have a motion from Supervisor Leopold and a second from Supervisor Coonerty all those in favor I Opposed it passes unanimously. We will now move on to the first item of our regular agenda Which is to consider the 2018-19 proposed budget for homeless services coordination? Including any supplemental budget materials is provided in the referenced budget documents. We have the FY 17 18 goals and accomplishments the homeless services coordination FY 18 19 proposed budget and the 2018-19 supplemental pages Good morning and welcome morning Good morning chair friend and members of the board. I'm rainy Marr the homeless services coordinator and Today I'm bringing before you the proposed budget for homeless services coordination With me this morning is assistant CAO Alyssa Benson who has recently joined our team and is providing a tremendous amount of support around this issue Before I begin my presentation I would like to extend my immense appreciation to our many nonprofit providers the faith community and our local Jurisdictions for their excellent work Partnership and support in our collective efforts towards addressing homelessness in our community. I Would also like to extend a special. Thank you to our county administrative office Human services department health services agency Planning department probation and sheriff's office for their support and partnership as we have been working towards recalibrating our internal efforts Their talented leadership and staff have provided invaluable guidance at the policy level and their staff is providing services with both professionalism and Compassion This morning. I'm going to provide you with an overview of the various elements of coordination Our office is leading 2017-18 goals and accomplishments the proposed budget 2018-19 goals and unmet needs My role has been very systems level engaging with all of the necessary people and Organizations that are working on this issue to collaborate on implementing system improvements and Expansion to bring new resources to bear and to drive systems change all with the ultimate goal of reducing homelessness and Assisting our unsheltered residents into permanent housing the 2017 point-in-time count tells us that we have 2249 homeless people in our community at this time 80% of those or 1800 are unsheltered of Those 36% are living on the street 30% are in a vehicle and the rest are in abandoned buildings or encampments Most profoundly underserved is our youth population 98% of them are unsheltered On the youth advisory board. I've met a number of young people One of them is a full-time student at Cabrillo and and working full-time at the same time And he can't afford housing so he lives either in a tent behind the college or sometimes sleeps in his car Another one wanders the street at night trying to stay awake because he doesn't have a safe place to sleep Within our county family I get calls from folks in various departments They're calling to ask how can they help the mother that they know who's sleeping in a car with her children or the senior Citizen who is about to lose their housing and is on the brink of homelessness The need for emergency shelter and affordable housing in our community cannot be overstated Homeless services coordination staff consists of one full-time homeless services coordinator. That would be me Additionally since January Alisa has been dedicating about 50% of her time to this issue Our county does not have a formal office of homeless services and historically We've had a very decentralized way of addressing this issue There's been no collective county voice on the issue nor an internal forum to strategize execute and operationalize This has been our first year to do things differently Over the past year internal efforts have focused on recalibrating in order to organize and leverage our existing resources for a more collective impact Bringing together the key department heads and their top staff to create in essence a virtual office of homeless services The result of that effort is a new county homeless coordinating committee These 18 key county leaders are now working together tackling tough policy issues Planning for the future and figuring out how to recalibrate our efforts to maximize our effectiveness Our goals include advising your board on policy issues planning and evaluation Coordinating operations across departments and giving a new focus to equity and access to services across the county Three working groups have been formed and are actively engaged with implementing smart path coordinated entry within the county departments developing a robust communications plan to articulate the county's response to homelessness and Pivoting towards outcomes focused contracting for homeless services. I Would like to thank the directors and their staff for their leadership Guidance and support and ask that those members of the committee that are here today Please all stand and be recognized at this time earlier I talked about engaging with all the necessary people and organizations to implement service improvements and expansion This happened. We are missing one slide missing one slide. She will just speak to it This happened yesterday when we were doing a run-through. I don't know why To bring new resources to bear and to drive systems change What you're missing is a visual representation showing various spheres in which our work is going on that includes South County Youth homelessness Leading the homeless coordinating committee internally working closely with various homeless services providers Working in South County and so forth Over the past year Extensive collaboration has taken place with a wide range of these partners on implementing coordinated entry establishing shelter programs integrating mainstream resources with shelters expanding services and funding for South County and Providing leadership and support related to the youth homelessness demonstration project and the youth advisory board Our non-profit partners and the faith community are the boots on the ground They're the ones that are actually changing lives every day and the work that we do is in service to theirs And if there are members of these initiatives or others engaged in homeless services here in the audience today Would you please stand and be recognized? They're doing important work in the 2017 18 proposed budget. We set these goals for ourselves consistent with the all-in plan 2017 18 saw introduction of new programs services and funding for South County Approval of projects for the 2.2 million dollar HUD grant and the launch of smart path coordinated entry Significant progress has been made and good work continues with both supporting the HAP and improving our governance structure Over three million dollars in new funding was secured through a variety of grants The budget cover letter provides an overview of these goals and accomplishments and the supplemental budget provides an in-depth discussion of each As the year progressed new goals emerged and so I would like to take a moment to highlight some additional key accomplishments We worked on system-wide improvements that included developing new models of delivering services and expanding capacity We integrated county services into existing shelter programs Our health services agency introduced the new hopes model which you'll hear more about in their budget presentation in Supportive shared systems the supplemental budget includes a recommendation to transition the smart path Coordinated entry lead agency from the homeless services Center who launched it to our human services department Where it will be stabilized and supported for ongoing operations Planning for this transition has been a vital part of ensuring the stability and sustainability of smart path In addition to internally recalibrating how we are coordinating and delivering services here at the county We also launched an internal review of how we are organized around homeless services functions and operations We successfully secured numerous grants for homeless services and also secured critical one-year funding for ongoing operations and sustainability of smart path the proposed budget provides for one full-time staff position The county's share of cost for the emergency winter shelter program and the new homeward bound program that will launch this summer While this budget includes Staffing costs for my time It does not reflect the staffing cost of our assistant CAO Elisa Benson nor of the members of our Homeless coordinating committee It also does not reflect the county's substantial investment in homeless services Which includes shelter housing and a wide range of supportive services The county's significant investment in homeless services funding can be broadly categorized in three areas Administration in addition to what I've already described happening out of our office Includes planning department staff providing oversight for HUD continuum of care operations Shelter and housing includes emergency shelter sober living environments Transitional housing and permanent supportive housing Supportive and stabilizing services includes a wide range of things including homelessness prevention housing navigation case management rapid rehousing employment training and other key supports What's not included here are substantial expenditures on mental health and substance use services or Entitlement benefits such as general assistance Cal works and Cal fresh Those are very difficult to estimate as to which portion of those benefits are being provided to homeless people 2018-19 goals are grouped in three categories, but all of them map to the all-in plan We will continue to build off of the planning work that has already been underway and completed to date We will open new navigation centers in north and south county and develop project plans for emergency bridge housing We know we need to continue to expand services for this population Including substance use treatment mental health services, and we plan to test new models to reach those who are hardest to serve As we transition smart path lead agency to the county We must support and sustain it and we will implement smart path intake and assessment processes in all county departments and divisions Where substantial numbers of homeless people are being served We will analyze the effectiveness of our current investments and evaluate if we have the right mix of programs and services We will complete our internal analysis of organizational effectiveness And we will develop aligned outcomes across housing and homeless services contracts and continue to improve data quality and Consistency across programs. We will also continue to seek new sources of funds Despite progress, we have significant needs. There are few sustainable sources of funding for homelessness an Estimated 1.5 million in emergency sheltering costs for fiscal 18-19 will only address about 10 percent of our total shelter need We will still have substantial unmet needs for year-round shelter throughout the county Including population specific services for seniors women and youth that are as yet unaddressed We still need a substantial supply of supportive housing to move homeless people into Shelter is only an interim measure On a one-time only basis we anticipate emergency block grants from the state This will solve some of our short-term funding needs to address homelessness But it doesn't resolve the issue or the need for long-term sustainable funding With a crisis level of homelessness in our community state and nation we have a lot of work to do And we are challenged every day to reevaluate what we are willing and able to do to address it The partnerships we have forged the systems changes that we are making And the innovations we are testing Demonstrate our community's commitment to solving this complex problem I would like to thank your board for your commitment to this issue and your support for the work of this office With that I would ask that your board adopt the proposed homeless services coordination budget as recommended Including the associated items in the supplemental budget for the human services department and planning department to Transition the lead agency for smart path from homeless services to the county and this concludes my remarks And I would be happy to take your questions. Thank you miss Mar. Are there any questions from supervisors supervisor Leopold Thank you chair. Thank you for the presentation and thank you for the ongoing work Just had a couple questions with the smart path assessment the the Supplemental showed that there were about 119 assessments completed But we know we have lots of folks accessing services. What's the expectation of how? when we will have The the over 2,000 people who are homeless At part of this system We don't have a set date by which we think we can have everyone assessed But as of yesterday we had 160 trained assessors in the community and we're still training more people and You know our goal is to have what's called a by-name list so that for you know We we have a sort of takedown list if you will of all the people that we can identify who are homeless We're able to prioritize them for the you know services that we do have available And we're working very aggressively kind of like when we rolled out You know the new affordable care act and we did a very intensive enrollment We're attempting right now to do very intensive assessment. So As soon as we can but you know, we're working on building it out Yeah, well, it seems very important to To get people into the the system so they can access all those services the the other question I had was The winter shelter and the capacity at 87 percent, you know, given that we know that we have so many people unsheltered Are is there discussion about strategies in order to increase the the number of people who use this the Shelter services when we have them available Yeah, I mean, I think this year we're looking at a Change of the model from a winter shelter model to a year-round model and our focus is on a low barrier system You know, we we want to be able to accommodate, you know couples people with dogs and you know, those are some of the reasons why people don't go You know having population specific shelters could also help in the long run because for example many women Especially women who've suffered trauma and abuse won't go to a shelter youth won't go to a shelter. That's designed for adults So, you know, we have some some very specific needs and until we can address those I think we'll still see some underutilization, you know, the only times we see full utilization of the winter shelter is on the coldest Wettest nights Thank you Supervisor McPherson Thank you, chair. I Just want to first of all thank those who in the audience that stood up and the coordinated effort I've never seen anything like this and this is our most pressing and complex problem We have in this county probably overall along with housing in general and I think the same holds true for the state of California This new problem relatively it seems like it just exploded five years ago or maybe a little more But it's throughout the state of California and everywhere. I Just want to thank the in particular the the faith community and the nonprofits who have come to the table We're very well aware of that this very very pressing problem But you're right there with us and we can't do this without you So I just want to say how much I appreciate what you're doing for us I don't think there's an example of a more Coordinated effort trying to solve a huge problem that we've tried to address in Santa Cruz County Since I've been here for five plus years now I Just with the state It has also been it's evident from the state budget that was just passed to be signed by the governor They have really put a lot of Effort a lot of attention to the homeless problem in the state of California. What in general how much in general does that? mean for us and I think with the program that we've outlined It seems like we're in good good position to get any kind of a matching grant that might be available I don't know if there's something out there that you say we're in good position to get more funding for some of these programs Is in general? I know that budget just passed. So Do you have any kind of a calculation or is there more out there that you're hopeful that we may be getting? Aside from what's being presented here There's there's no specific other grant that we're seeking at this time Except for the no place like home grant which is going to be going on the ballot in November And I don't think that we would be able to use this as a source of match for that But having a source of match is extremely important It is often the case that you know there are grants out there that require match and if we have a ready source of that that'll make it much easier and You know, we're always looking for every possible source of grant funding that we can get and we will continue to do that And aside from thanking the the faith community and the nonprofits who have helped us so much I wanted to thank The city particular in the city of Santa Cruz who we've worked with in this year-round shelter is absolutely necessary It's really troubling to see how many children are our minors or are facing homelessness as they are but I want to thank you and spent me some for getting a Focus on what we need to do in the direction we need to go This is going to be a long process But we're well on track and I really appreciate what you have done with Cooperation from others in our community. Thank you Thank you. Surveys McPherson supervisor Coonerty. Thank you, and it's amazing to see both the Coordination within the county and then externally it's been missing for a long time And I think we're starting to see real benefits from that and I appreciate that when we look at the staffing of one That that while everyone else is putting in a lot of time and effort Trying to coordinate and all these programs is great in terms of the goals I mean a supervisor Leopold just asked about the coordinated entry system when we did the ACA rollout We knew exactly how many uninsured there were there were annual goals. We had to meet those goals Systems were changed. Can we do the same thing? I mean I didn't what a lot of these goals are missing is the number that it's going to be provided at the end of of When we come back here next year, how many coordinated entry how many people will be through the coordinated entry system? How many people will be left when what's them? What's the mandate? And so it's What can we do to get better numbers around some of these goals? We can do a better job of getting the numbers We can you know It's one of the things that we really want to do this next year is focus on data and evaluation and setting those targets I don't believe there are any set metrics yet, but that's a very good suggestion that we should do that There are reports being developed right now that will allow us to pull the information We want out of the new coordinated entry system there being worked on as we speak so Being able to get those metrics of how many people are being assessed What's their outcome and so for that's data that we don't have now or haven't been able to get up until now so we will we will be doing that and I think having very measurable goals and Having data that we can measure that from is is a key part of what we want to do going forward I like to add to that a little bit. I think one of the key benefits of the transition The lead agency role to the human services department is their strong Capacity in using data and creating systems as we were looking at options recognizing we need that Organizational backbone to really support this kind of program that definitely fed into the recommendation That's before you today. Thank you, and I yeah, I trust HSD. I've seen their dashboards. They're great and I think And just just for all the departments, but specifically for on this is you know as we put numbers these goals My expectation is not that you're gonna hit every number every time And I don't I don't and I actually my colleagues don't plan on, you know, waiting till next year and then berating you for not I expect that some of the goals will not be met because Federal funding starts to shift or there's a new new need or we just set a really ambitious goal and couldn't quite get there But I think having those numbers would be helpful because then we know What's working and what's not and that's the second part which is I think the overall goal still has to be to reduce the number of homeless in our community And have that be the goal and that be tracked and then understanding as Supervisor McPherson says that this is not Just our This is not a phenomenon that's happening locally. It's happening statewide It's happening nationally is even if we have comparable counties Even if our rise is slower than their rise, then we know we're on the right track But I think Having that goal and then having some comparable counties so we can see well, what are they doing that may work or what are we doing? That's that's working better than them I think that has to be out that has to be the goal that then drives all the other goals going forward So I'd be interested in that Going forward. Thank you Supervisor Caput Thank you for your report This is a very Grave problem that we're facing and it's not just us. That's everywhere And it does say Homeless services coordination This could come under the core or it cannot come under this subject right now but in South County, we have the Salvation Army working right now and I'd like to ask is there any coordination between The Salvation Army and Teen Challenge that is trying to open up a women's shelter In that area. I don't know if we should wait or are you able to answer that? I am not aware of any coordination efforts between Salvation Army and Teen Challenge But captain Harold from the Salvation Army is here and me I want to thank you Salvation Army for everything you're doing right now our pleasure So the Salvation Army and Teen Challenge began working together four or five years ago with providing emergency shelters And recently we we traded and shared some buildings and things like that and those things have transitioned now Into some of the same buildings that they were recently using we have We have redesignated into the South County winter shelter in the South County Day Center and things like that So those services are still being provided even to men women and children that said the Teen Challenge has Has left those buildings and they have been working on the Brennan Street building where that that they plan on a Larger women's shelter, but the issues there are complex and they've been working on on remodeling that building for a couple of years now And so I don't think that the remodel has gone quite as planned That said our our plans to do the winter shelter and the day center and ultimately the South County Navigation Center are all on track and And the only reason that we were able to make those transitions is because we realized Teen Challenge also runs a women's shelter up in freedom And they run their regular shelter down in Pajaro now while the while the shelter in Pajaro is not technically in Santa Cruz County It does serve many Santa Cruz County people because they just crossed the river that said the the coordination between the two agencies now We do daily referrals back and forth Help each other with resources things like that. It's just not not as strong and sharing buildings as it was a year ago Or two years ago Can I just ask one other question? We've gone through a recession and that kind of started it seems the homeless population spike But now we've recovered for a couple of years Have you in that period of recovery? Is there still an increased surge in the number of people you're serving? Yes I think I personally I believe that's more because of our area that we live in then Then economic conditions or anything like that Obviously with a growing economy and things like that people are attracted to our area and once those people Arrived and they did not realize that housing costs are what they are here or or joblessness or whatever so they arrive without any money to go home to whatever state they came from and and then of course that tends to lead into addiction issues and and Maybe mental health issues and things like that. So yes, the the need is increasing But I believe that is because the population is increasing as well Not just the general population by the population of those that are that are moving to our area and bringing many of their issues with them I think I think that's a sign of being unfortunate that we're probably the northernmost county in California where you can Some can get along with a few blankets comparatively to hum-hum bolt or Mendocino Correct. Yeah, yes, we've received many in our winter both winter shelters that we operated last year We received many people that have transitioned from Minnesota and Washington and many much colder states And and one of the reasons one of the reasons that they come is is just that is worst-case scenario They have no blanket no sleeping bag and you have to sleep outside here You don't necessarily die from exposure when that happens because of the you know the ambient temperature So you're right They are they are attracted here for just that reason is the same as San Diego and LA and everyone else has a huge And growing homeless issues for the same exact reason. It's a it's a climate issue Thank you. Thank you We'll now open it up to the community that anybody like to address us specifically on the proposed budget for the homeless Services coordination item. Please feel free to step forward Morning, this is victorious Alexander civil society activists before I put pivot into my public comment I want to be able to thank district for For sending back great cap it he's a great man And I want to be able to say congratulations on your win and coming on back I was able to sit down and hear your presentation. I want to be able to tell the staff Thank you for your diligent and illuminating report I was just concerned because I deal with a lot of the emissary population. I was in the scott's valley library yesterday There's a lot of homeless people out there. I would say is that we need to appropriate funds for outreach There's a lot of people in the library that you can just smell them. They smell really bad, but Reaching them letting them know about the pathway. I did see your brochure in the library there But actually having outreach where they'll go in there and talk to the people, right? And a lot of the librarians the the managers and the staff will know which people are struggling reaching out to them also one thing I notice also. There's a lot of people living in their RVs Having the vehicle codenforcer or whatever they call it. I don't I don't know the exact exact political agency When they're out there doing their work designating RVs Or people living in their cars And letting them know about the services that are available that outreach appropriating some money to them because there's a lot of men That are very prideful. They don't want the nanny state taking care of them You know, they rather deal with it themselves You know in the in the woods and in their RVs and stuff like that But reaching out to the men as well because their humanity is important too and I see a lot of men that are very prideful Don't want to look for the handout But to be degraded is to be dependent and they don't want to be dependent on the nanny state So I would say is we need appropriate outreach money and reach out to the people that are that are wallowing in the at the library And in their RVs in their cars So it's something to consider. Thank you. Thank you, Mr. Alexander Anybody else like to address us on the homeless services coordination budget item? Good morning. Welcome. Good morning. Good morning board of supervisors. I'm Angie Moreno, I'm the South County Collaborative Collaborative coordinator from from the community action board First of all, I want to thank you all I want to thank rainy for your great support and leadership for services for homeless and a risk South County families So I just want to start with saying a little bit of a collaborative So our collaborators started after the Pajaro Valley Unified School District PV USD Identify an average of 3,000 students living under the McKinney event to homeless definition a Collaborate consists of the community action board as the lead agency The Pajaro Valley shelter services Families and transition California rural legal assistance and the Pajaro Unified School District also knows of the PV USD So in this first year of core funding our goal was to serve 44 families. We served 90 families Which of which are 190 students We have conducted vulnerability assessments and work closely with smart path Provided housing navigation to 70% of the families referred provided 10 families with rental assistance 79 families received legal and advocacy consultations are remarkably education outcomes of 38% of the students have improved on educational performance, meaning they're missed schools less 20% have improved their grades and 80% have improved in less or non-disciplinary actions and Wonderfully, we were able to attract and leverage the case Kaiser Foundation grant to support our work with families for the 2018 and then I so want to close it by saying that as I'm working with this I also found out that my family was one was homeless and we were part of the power however power valley shelter services So I'm really proud of being the coordinator of this grant and I want to thank you all for your support Thank you. Thank you for your work So everybody else I'd like to address this on this item Okay, so you know we'll bring it back to the board for action on this item. Oh I'll move the recommended action with additional direction to set as a goal the reduction of the overall number of homelessness benchmarked against similarity similar California counties And return in the second meeting in August I think at August 28th with Metrics on the on the appropriate goals For board consideration Motion from Supervisor Coonerty a second from Supervisor McPherson any additional discussion all those in favor I Opposed it passes unanimously. Thank you both for your work We'll move on to item 3 which is to consider approval of the 2018-19 proposed budget for core investments including any supplemental budget Materials as provided in the reference budget documents. We have the core investments 2018-19 proposed budget the revised supplemental The investments supplemental for 2018-19 and the line item detail for 2018-19 Good morning Ms. Timberlake. Good morning chair friend members of the board I'm illan Timberlake the director of the human services department and this morning Emily Bali our deputy director will be presenting with Sheriff Clinton our director of planning and evaluation our proposed Supplemental budget report on core investments. So with that I will turn it over Emily, thank you. Good morning chair friend members of the board As you know core investments is the new funding model that supports local nonprofit and public agencies providing safety net services The model identifies collective results and promotes the use of evidence-based practices and measuring outcomes Fiscal year 18-19 will be the second year of the three-year core investment contracts as Directed by the board HSD will be turning in the fall to provide a report back on the progress of the core investments collective impact model The total budget request for core including the hundred and fifty thousand dollar set-aside funds and Supplemental requests is slightly over is over four point three million dollars Next I will review the recommendations for the core set-aside funds on March 13th of this year the board approved the release of a solicitation for letters of interest for fiscal year 18-19 core investment set-aside funds in the total amount of a hundred and fifty thousand dollars The solicitation for these funds was broadly distributed and outlined a brief and simple application process as requested by local nonprofits and directed by the board HSD received 39 applications representing 43 programs Requesting a total of seven hundred and eighty one thousand seven hundred and sixty eight dollars More than five times the hundred and fifty thousand dollars allocated The award recommendations 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 Over 50% of the recommended funding will go to services supporting seniors and the disabled as well as children and youth Given the vast need outlined in the applications the Recommendations for funding awards were developed with the knowledge that all needs presented could not be sufficiently met by this fund Staff recommends awarding funding for 16 agencies as shown on this slide in the amounts ranging from two thousand to twenty three thousand dollars If approved by the board the board staff will negotiate purchase orders or order agreements with the recommended awardees At this time I would like to thank all of the agencies for the work They do for our community and I would also like to thank HSD staff as well as staff from health services agency Probation and parks for their assistance with this process At this time I asked that the board approve the recommended fiscal year 18 19 core investments budget and supplemental items This concludes my presentation and I'm happy to answer any questions at this time Are there any questions from board members before we open it up to the community? Supervisor Caput Thank you very much. I I guess you could explain We do have an item here for twenty three thousand for the immigration services correct and Is there any other money they can get from human services We are we have in the past and continue to work closely with the immigration project And based on and actually I'll be addressing this a little bit later in my presentation Based on some data that we're seeing within our department with the decrease in in Applications and enrollments and some of our benefit services programs we are going to be working closely and Providing some additional resources to the community action board in an attempt to try and increase The number of immigrants who are accessing benefits because we've seen Alarming declines in that so we will be partnering with them, but that's separate from the set aside That's basically our department moving forward to try and ensure that we don't see any Any regression in our Cal fresh participation in Medi-Cal enrollments The only thing I'm worried about is they're getting a little bit less than they got last year, right? But they're under more pressure right now probably than any time in the last few years so Verbally They're gonna are they gonna get more money? We are we are in discussions with the community action board around ways that our our department can partner with them To do outreach to immigrant populations so that we ensure that we don't see any Decreases or at least we try to mitigate the impact of some of the due cases we've seen in Individuals with varying immigrant statuses applying to our benefit programs So we are already in discussion That that will be Increased help from the human services department right separate from separate from the core investment right set aside Okay, but how does that translate into the money that they might need to operate their ongoing Service in Watsonville well that'll be part of I mean Setting aside the set-aside request the discussions that we have with the community action board on the desired outcomes that our department has to try to increase The enrollments on our benefit programs that will be a discussion that will result in probably a purchase order where we're able to Actually, we did this several years ago when the raids and not I think it was last spring or the spring before We've already had this relationship with the community action board before so we will be sort of reengaging and we're in that particular set of scope of work in order to ensure that we increase enrollments Okay, so we haven't I mean we're still in the process of discussion. So we aren't we don't have any number to report to you But we will be working with them in fiscal year 1819 To provide additional resource. I know you have the same concern I do and a lot of people do and especially what's happening right now with separation of families So I don't want to see anything that's going to actually reduce the service that we're offering in South County and all Throughout the whole county when it comes to immigration services When pressure like this comes from the outside that's where a lot of Undocumented immigrants will they somebody An uncle and aunt or a friend will say go and talk to this lawyer over here pretty soon They're in two three four thousand dollars and they never had a chance in the beginning The great thing about the immigration service in Watsonville is the county overlooks it They get money and the cab is overlooking it When somebody goes in there The only thing that's ever asked of them while they're working through paperwork and anything is a donation if they feel like giving it I mean so Sometimes the answer is no, but they're not out for five thousand dollars And they're also talking to a lawyer That is not going to turn them in for being undocumented So that's what I'm getting at is here. I want to have some insurance. I think I believe last year they got 30,000 and then What I see is 23,000 Actually in written in writing on the page So what I what I would recommend is that we give the 30,000 the same as last year I think they requested 33, but I would like to see them Get 30,000 the same as last year because of the increased pressure going on with separation of children and families Going on at the border right now Supervisor Leopold. Thank you chair First of all, thank you for the work on the core investment strategy This was a huge undertaking And now in year two of this. I appreciate all the work that's going in To thinking about how we measure that collective impact. I'm looking forward to those Continued discussions about that. I think that the department is approaching in the right way by including our community partners in that discussion to help Ensure that we have metrics that really make a difference that we could see how this 4.4 million dollars is is doing. I I just had one or two questions First of all as I look at the set-aside Recommendations you would be hard-pressed to look at this and say these folks don't need money They're all incredibly worthwhile. They could probably all use additional resources And they're they cover a wide range of issues. So you did not you did not focus on one But you met a lot of needs in the community and the families in transition Grant recommendation. How does this fit into the South County Collaborative that we've funded also as part of it? It is to support services being provided through families and transition for the South County Collaborative case management and Assistance for Families with housing subsidies or the other services that fit provides through that collaborative great I'm not asking the question because I think it's it shouldn't be given I'm just were they not part of their South County Collaborative or is this an additional money on top of What was in the South County? This would be additional funding to what was okay provided The the other question I had is in addition to these set-asides. It seems like there's also this supplemental one-time funding For a handful of organizations and so group like the community action board is getting $23,000 In the set-aside, but then another $10,000 As part of the supplemental one-time right so the cab will be getting the $23,000 is for the thriving immigrants program the social innovation fund dollars that are going towards cab are for another existing Core contract That's different. There are different services being provided by cab But it is the around $33,000 that we're providing the cab for a variety of services because the thriving immigrant initiative is is also Multifaceted it's not just the immigration project is the other pieces of it as well Well, I just want to thank you for the for the work This isn't easy. I'm glad that we're not Stepping down. I know some one of our other partners is is is looking at possibly reducing their core investment Funding but with this set-aside the supplemental Innovation fund. I'm glad that we're investing and reinvesting in the in these Programs that are making a difference in the community. So thank you for your work Supervisor Coonerty. Yeah First of all, thank you and I'm confident that you're gonna be able to work out a way to support the immigrant families in our community who are like immigrant families across country under Amazing stress. And so having this kind of project Is a is vital and thank you to all the partners in the room who've really spearheaded this and then I think I think we're gonna figure out a way to make it go and I'm also happy Yeah, unlike adjacent jurisdictions who are cutting back on the community programs. We've been able to continue our investment That we increased last year In order to in order to support the needs I guess my my question is as we head into the we're at the midway point and as we head into a new The future of core funding What if you don't mind briefly what lessons were have been learned and and what are you looking forward to? for the next as we head into this Analytical phase and then the next round. Oh boy What lessons? I Like to say when you know folks talk about the Efforts that we've been able to put forth with core that we are so much in the infancy stage of our Understanding and our partnerships on collective impact. So I think you may recall that we submitted to your board and evaluation It was an incredibly and important evaluation for us as a department I think for us as a community with our with our nonprofit partners to look at where did we where do we do pretty well in our efforts to Transition a long-standing, you know, wonderful program of community programs into something that looks a little different So I think we saw some things that we did well, but we also within that report There are a lot of lessons learned that we fully intend to in the next cycle Integrate into all aspects of what we do before we put out an RFP what we do with that RFP and and afterwards so We welcome that and I feel like we will see improvements as we move forward What I'm really excited about is the community dialogue that's happening and has been happening, you know Since the spring on sort of the broader question of collective impact in this community And what do we need to do to double down on the indicators to revisit some of the initial assumptions around our strategic planning? To look at the type of and hear from the nonprofits and and in all of our partners What are some of the technical assistance pieces that notwithstanding the absence of makes it very difficult to? Move the needle and some of the ways that we're expecting and then hold ourselves accountable as Public agency partners and we we are very committed to doing that some of the discussions We've been having in the homeless coordinating committee are around Ensuring that we bring the same principles of collective impact and and measurement and evidence-based practice Into our coordinated efforts as a homeless coordinating committee. So I think I'm very excited I'm very excited about the steering committee and the advisory committee and we had our first Community event. I guess it was back in May And there believe it or not there were tickets for this event a little worried about tickets But they sold out and and it was an incredible event. There were over a hundred and hundred twenty people attending So we'll be returning to your board I believe in October with a report back on the broader sort of status of where we are with that community dialogue and You can bet that we will be incorporating those lessons learned from our evaluation report into our next cycle, right? I mean, I think one of the things it's sort of because it's just now the standard practice But one of the things that we should all be remembering is it freed by having the three-year cycle Freed up all the non-profit partners to stop filling out paperwork and do the services that they That are so desperately needed and it freed us up To do the analysis and and outreach in order to figure out how to make these investments in a start smart and strategic way And so we shouldn't forget what our reality was only a couple years ago for everyone in the room And hopefully the benefit that we've created Yeah, just one I'd like to make one point well first of all Thank you for the implementation of core it was a long time and coming to the county I think we're seeing the benefits of it and we will in the future as well But one thing I wanted to point out is the approval a general fund expenditure Contribution to core investment contract with community bridges for the provision of meals on wheels program services I know that members of this board and throughout the community Go out and give the meals to these folks. I'll tell you this makes not their day It makes their week in our month. It is really so essential. So I'm glad we have that provision in here, too It's a little bit separate, but it's absolutely necessary and Hundreds thousands of people Not hundreds of thousands, but hundreds maybe thousands of of our county residents depend on this and it's a big deal for them Just a follow-up question to that. I appreciate my colleagues remarks and we strongly support The meals on wheels program that there's there seems to be a slight discrepancy in the document where it says that in The supplemental budget request that says 84,000 by the narrative it says 85,000. What's the number? It's 85,000 It's been corrected So We would like to get it open. Is it okay if we open it up to the community comment here So I'd like to open up to a community comment on the core investment budget item, which is item 3 Anybody like to address this on the side and please feel free to step forward now Thank you for waiting Morning, welcome Hi chairman friend and the board of supervisors. Thank you for letting me speak I'm Deanna Zachary with the diversity center. We support LGBTQ folks in Santa Cruz County I'm thrilled that you have the set-aside funding because it's made a world of difference for us We support Latinx youth in Watsonville LGBT youth Ages 12 to 18 and what we heard a few months ago from these youth You know these youth as you know have a lot of challenges They have higher depression higher anxiety higher levels of assault and being bullied higher levels of homelessness It's so important that we've been talking about homelessness because when you look at our homeless data You see that there's a Increasing number of homeless youth and their LGBT so for us we really try to support the kids What we find is if these kids get support they have less anxiety less depression less suicidal ideation They just really thrive but if their families don't provide support Then the diversity center steps in and we have support groups and leadership training and community events that support these kids So these kids came to us their ages 12 to 18 But once they're 18 they have nothing else to support them and they said we need help You know at 18 we don't have enough support. So We decided to focus this connexiones program on the transition age youth Ages 18 to 25 to give them support to give them kind of a chance to thrive to give them a safe place So this set-aside funding was crucial for us because we had no funding and so we applied for this and got funding Proposed funding that we would love for you to support for these LGBTQ youth ages 18 to 25 in Watsonville They're Latinx many of them are Spanish speaking. So it's a community that otherwise wouldn't get support We do have program evaluation data from looking at our youth ages 12 to 18 we did a survey with them last year we talked to 49 kids and We had let's see 40 48 kids felt better about themselves by being in the program 47 felt more comfortable expressing themselves and 45 knew where to go if they felt unsafe and finally 44 of them felt more comfortable coming out as LGBT So really want to thank you for this set-aside funding thing at the department And ask for your support for LGBTQ Latinx kids in Watsonville. Thank you. Thank you. Thank you for your work Yeah, it's really critical. Thank you. Thank you Good morning. Welcome. Thank you for waiting Thank you for having me and thank you chairman friend and the entire board of supervisors for this moment You allow me time right now to tell a story that will personalize the struggles of LGBTQ youth as my Colleague just described. I'm Stella Moreno, and I'm a member of the board of directors Santa Cruz Diversity Center Santa Cruz, but I'm also Stella Moreno former principal of middle school and associate principal of high school in Watsonville for for decades And by the way a special hello to a supervisor cap it with a cap cap it with whom I've shared the stage at numerous graduations and good to see you and congratulations My story is simple as a but it's important As a school principal in Watsonville and anywhere your charge is the education and well-being of students And to do that well you obviously have to enlist the support and trust of your Youths and children's first teachers their parents We had a student that came to our school in middle school Her name was Liliana changed the name for obvious reasons Liliana was a very good student entering middle school good grades ever felt ever-vescent Vital and confident and I was her principal at Pajaro Middle School and She was in a leadership Club and and well-known on campus and her parents came in to meet with me one day because they were just really really Upset about their child and I'm thinking what could be wrong with this perfect child But for them it was a real real situation where they felt she was a tomboy identifying with boys all her friends were boys and they were really concerned about that so Um Talked to Liliana got her into counseling and talked with the parents more and she just said I feel like a boy That's that's what I like. That's what I feel like So there was more conflict at home things got worse parents We had more meetings and I had the opportunity to become associate principal at Watsonville So I followed that eighth grade class to Watsonville and stayed there Um parent pressure increased they knew I was an out lesbian Administrator they would come to me at high school and talk with me and we had them get involved in counseling with PVPS and whatnot In Watsonville and Liliana got involved in the Gay Straight Alliance at the high school But the parent pressure for this child to identify gender identify with her Her her with females was really really stressing and creating problems. So Can you just very briefly finish? Okay long story short She eventually the pressure got too much she eventually tried to kill so as commutes suicide with aspirin she lived she But but she just became the student the no grades missing class missing school The Diversity Center Connexionist Program is the reason Is part the reason we've created this program and we're asking for your funding for kids like this So at the end of the day, I just want to say that not only are you helping Latinx children? But you're helping families who are going to support those kids. Thank you. Thank you for sharing the story Morning welcome Good morning board of supervisors. Thank you so much for having me My name is Jonathan Salinas. I am the Connexionist Program Coordinator through the Diversity Center as the two previous folks also were So in my position, my duty is to create events programs resources and spaces in which People of the LGBTQ Latinx community in South County can get together. We can talk we can share stories and support each other overall Each time I go to these youth meetings. I I see the importance of programs like this. I I see that these programs are more than just a place for these kids to hang out and just come together after school It's a place where these kids can get together so that they can survive in this world That continues to push them down so that we can continue to give the resources that are denied From them by so many other channels and systems within our society And so for me the importance of this program is to make sure that these kids can live past the age of 18 They can go to 25 35 80 years old Superceding their life expectancy Due to the hate crimes that they have to endure every single day because of the color of their skin or because of their gender Identity or the person that they love This funding not only will support these youth But it will continue to help this program grow as it is one of you in this state I can I can probably count on one hand how many programs there are like this within the state of California And I think that highlights the intense need of the reasons why we need to continue to support queer Latinx youth Thank you so much for putting forward this recommendation of Budget so that we can continue to support these youth and young adults in South County. Thank you so much. Thank you Morning welcome back. Hi there I'm here to thank you for not cutting the community programs line the core budget line It's been a tough couple of weeks for those of us that are advocating for children for obvious reasons on the larger level but also as you Mentioned with our your jurisdictional partners that actually did make decisions to cut our funding And I also want to thank you for thinking of us when it came to the set-aside supplemental funding Your help will help us to continue to provide quality care for a diverse population of children in our county and what we hope to be able to continue to do in order to sustain this work is to Support our teachers who are the low-income workers of our county I just wanted to read a quick line from an article in yesterday sentinel about the start gaps between the haves and have knots in the Bay Area They said the region is the worst in the nation for service employees and security workers according to a new analysis by real estate website rent cafe and Childcare maintenance and food service workers have so little money left after paying living expenses that many are forced into debt Or sacrifice health care and other needs. I hear this from my teachers every day. They're not able to go to the doctor Their kids aren't able to go to summer camp when they're out of school. They're home with a disabled grandma My teachers are the low-income families that we struggle to provide for so your help with the Set-aside funds will help us to Hopefully provide a bit more of a sustainable wage for these people. Thank you very much I'm not sharing your name and I'm sorry Norah Caruso from the Santa Cruz toddler care center. Thank you so much We know you miss Caruso. Thank you. Yeah Good morning, welcome. Good morning. Thank you supervisors and staff I'm Kate hidden camp from the community action board Santa Cruz County immigration project and I want to thank all of you that spoke up this morning and voiced your support of immigrant families as we all know this is a I Think unprecedented time for immigrant families certainly in my lifetime and I think in generations So it's really really vital and I want to thank the county For your ongoing support of of immigrant families that are part of our community Programs like cabs immigration project provide our immigrant neighbors a degree of stability and hope where it's in short supply As you know, and I wanted to clarify about the funding skip is has been receiving $63,000 in core funding this past year and That's projected for the next two years We also got 30,000 in set-aside funds to to support emerging needs like We've been working with a coalition doing child care safety planning for families trying to Prepare for the possibility of someone in their family being detained and as well as Stepping in with crisis support. We've worked with 11 local families that have been impacted by ice detentions and as well as we've been working with the HSD to on this purchase order to increase or Decrease the drop in enrollments in public benefits like CalFresh and MediCal so we have county staff coming in every month to our office to Do outreach with people who are who may be eligible for those benefits We've also been working really closely with second harvest harvest food bank there in our office a weekly actually Doing outreach and one of the things we found really effective is Working with because people who have public benefits are eligible for an immigration form fee waiver for many services We actually encourage them to to apply for CalFresh or MediCal if they don't have it They can save hundreds of dollars on their immigration forms So we really want to thank you for your support and we look forward to continuing our partnership in the future Thank you and thank you for your work. Good morning. Welcome Morning. Good morning members of the board and staff. My name is Isaia Ambrosio I'm the director of the Davenport Resource Service Center and I'm here on behalf on behalf of the North Coast community To thank you for supporting our program through the core grant in the last year. We have worked with about 45 families 12 youth and 12 seniors What we have done with them is mainly through case management monitoring their needs. We started last year Just asking them what what sort of needs they have it's mainly food shelter And I want to share an example We started working with about 20 youth last year and we asked them what what goal do you have for the year? That's one of the Aspects we asked them for this grant and many of them said I want to improve my grades I want to get a driver's license at the end of the year. They wanted to get a job for the summer so fortunately we were able to partner with the county office of education and so now about seven youth are going through the process of Getting all their paperwork All their documents to apply for a job through the county to get a job. So and we are supporting them You know through the process with mock interviews and getting ready for them for most of them except one It's gonna be their first time actually working. So we believe that that's a great opportunity for them to improve their Leadership skills, but they're gonna be our role models and they're gonna be a great example for the community So that's just one example of the impact that we can work that we can have working together So I wanted to thank you today for your support Thank you. Thank you Morning welcome Good morning. Thank you board and staff I am Joanne Gadoy and I'm the part-time executive director at Pajaro Valley Loaves and Fishes in Watsonville Thank you for continuing the core funding for our program Just to let you know every day we provide more than a hundred and twenty five sometimes up to hundred and fifty hot complete lunches and Then the equivalent of about a thousand meals To about sixty families that come into our pantry program. They leave with boxes of food But that's the equivalent of about a thousand meals So if you times that by two hundred and sixty days that were open a year you can see that we're providing close to three hundred thousand meals both hot in in our lunch program and then in produce and can goods through our pantry program Something new that we've done this year is to recognize the special needs of those people who don't have kitchens and we've created these no kitchen boxes that has high quality protein canned fruits and vegetables beans and Recognizing the fact that many of our People that have no kitchens are seniors or children and they have problems chewing We take that into account so that the foods are safe sanitary Easy to chew easy to prepare So that that's where we're focusing there and I do have to give a shout-out to Supervisor Caput and that he's made a significant personal investment to the to that would Consist of about a 10% match on the $10,000 that we're getting Three core funding so I do have to give a shout-out. I I didn't get permission to recognize you but He puts his money where his mouth is and where and since we're we feeding People we appreciate that Thank you for your comments. Good morning Hi, good morning members of the board. My name is Jorge Reese I'm with central coast Center for independent living and for the last 35 years We have been providing services to people with disabilities in Santa Cruz County and also Monterey County and Seminole County We have for CSOL or consumers or staff or board and volunteers We thank you for reporting on CSOL and recommending us for future funding. Thank you Thank you Good morning. Welcome. Good morning. Thank you. Good morning to everyone here. My name is Celia Gackerman I'm both the executive and clinical director of the parent center And I just want to say that our mission at the parent center is to prevent and treat child abuse improve parenting skills and Help the everyone in the family heal as someone who has been trying to reunify families for over 40 years I just want to say that I'm sure that I'm in particular pain right now with what is going on That your families are being split apart and I appreciate your acknowledgment of that as a community and as a board We are very grateful at the parent center to the county for the $5,000. You are giving us as part of core investments This money will be used for match funding to use Medi-Cal to provide $25,000 worth of professional bilingual counseling services to meet the ongoing needs For therapeutic wraparound treatment for the most at-need children at need children in our community who have diagnosable mental health issues All of our therapists at the parent center in this contract our licensed practitioners use evidence-based practice and rigorous evaluation tools and I look forward to sharing our results with you as they occur I Look forward also to continue serving children with open child welfare cases as well as children in our general community Thank you again for this honor Thank you Morning welcome. Thank you all for waiting My name is Freda oral and I work with meals on wheels with Robbie and Carol behind me And I would just like to say thank you very much for the additional money that you gave our program the majority of our clients are homeless and We asked them one day if they could please jot down their feelings about why they like this program and why they come to this program and We've put that together In pamphlets so that each of you can read them and maybe you could exchange them with yourselves so that you can get a Full idea of why these people come to the program again. We appreciate very much your support for the program That was meals on wheels. Yes. Thank you. Hi. Good morning everybody Carol Childers with meals on wheels First of all, I want to start my first. Thank you. Thank you for the eighty-five thousand dollar Supplemental funds. Thank you. Thank you Also, you know, we did a lot of talk about the homeless population In our Loudon Nelson Center our recent demographic show that 47% of the clients we're serving lunch to Monday through Friday are homeless So our center down there is unique from the other ones, you know all over the county in that It's a safe haven our folks that come there. They know that they're going to get a good hot meal They're safe and they can relax and it's so important to those folks. So thank you I also want to thank you on behalf of the home-delivered folks I know Bruce speaks highly of our adventures when we go out in the boondocks. I have a new boondock for you We are now serving a woman. We pull off highway 17. She waits on the side She lives up a trail in a trailer and It's because of funding from folks the county that we are able to provide services to this really really sweet woman And thank you Bruce for making Penny's birthday special Thank you Thank you for your work Good morning. Welcome. Good morning. My name is Kimberly and I am the YW teens coordinator with the YWCA of Watsonville and First of all, I want to thank everybody for their past support to the YWCA through funding Today, I want to talk about the YW team program in the past. We were funded by the state to address Tied teen pregnancy rates in about five middle schools. Unfortunately. That was eliminated in 2011 From then we only continued in one middle school with a small grant from the Green Mountain coffee from Green Mountain coffee Last year we were able to add one other middle school with a 17,000 grant from the community foundation of Santa Cruz to focus on social and emotional development of middle school girls Next year. We will continue with this school only Commonly known now as girls paving the way With core when core emphasize the need to provide evidence-based curriculum, which we have been doing since 2011 Along with our high score on the application. We were surprised when we received no funding However, we understand that there are many community needs through core To continue to provide services we applied for the emerging needs Mainly for our summer program to cover the cost of providing that safe space to community members for partner meetings for trainings And then including serving our lunches over the summer who we partner with community bridges We do receive the lunches for free However funding is needed to hire people to be able to provide those lunches to be able to provide the activities And to end the cost of supplies We know it's a quality program because even though there are 12 sites in total participating We have been consistently in the top three and in Watsonville. We are the top site serving lunches We serve around averaging 1500 lunches every summer This year we did not receive any funding from the county It is difficult for us to get funding from other sources when our own local government is not providing any financial support Which indicates that perhaps this is no longer in need So I'd like to thank you for your consideration and I hope that today we learned something new about our summer program. Thank you Thank you. Good morning. Thank you all for waiting Hi, good morning Paulina moreno thriving immigrants initiative project director with community action board Dear supervisors and staff. Thank you for your leadership and vision to support programs that are tangibly Improving the lives of immigrants in our county as you heard last night Thriving immigrants collaborative is cabs newest initiative that was brought together as a response to the political landscape and the federal administration's anti-immigrant actions that have definitely impacted our community This is an extension of What cab currently provides as a me for immigration services and we are focused to work with families that are most vulnerable Are undocumented families that have limited pathways to immigration remedies Your support will ensure we can expand our current case management work Which helps families navigate the process of finding legal representation Accessing needed services and exercising their rights Our case manager is currently working with families where at least one member of their family is in detention Fine and that work consist of fine to legal representation To help family understand and navigate the complexity of detention work with the family to gather important documents of the detainee and Assess need and work with the family to provide referrals and obtain services such as rental assistance food Transportation and the like it will also help ensure we are able to continue the important Education and outreach that we conduct to provide the latest information on immigration Now more than ever we need your commitment to ensure we can support families in our county We respectfully request your support in the full amount amount of funding we requested in our set-aside proposal and Would like for you to direct County staff to work with us to create a countywide Immigration strategy that mirrors your three by three plan and homeless strategy that will ensure immigrants in our county feel safe We'll take advantage of resources. They are eligible and protect family unity. Thank you. Thank you Morning Good morning Chairman friend Board of Supervisors and staff my name is Andrea to Leo I'm with the Boys and Girls Club of Santa Cruz County And I just want to say thank you so much for your core funding support which has enabled us to Provide new services at live oak or increase our service live oak and also for your supplemental funding For the Joe and Linda alibarity clubhouse, which we've just added 150 members and we're serving over 75 kids a day Right now Your core funding is providing after-school programs a safe place to come for over 2,500 kids ages 6 to 18 and you know without the funding from the county and city and our other Supporters these kids really would not really have a really safe place to come. That's affordable with support services around academics staying healthy teen programs and Being able to be supported by mentors. So thank you very much Moving forward. I really want to compliment you Ellen because The conversations around collective impact are significant in terms of being able to share resources for thousands of kids and Just being able to open up those dialogues has been incredibly important And I just want to thank you for moving those conversations forward. So, thank you very much. Thank you Thank you for your important work Morning good morning, and thank you very much for allowing me to speak I'm a Lisa VR from families in transition, and I just wanted to thank you for Not only the core support Which is helping us address the housing supply aspect of homelessness and the expansion in Santa Cruz But also the set-aside safety amount, which will help us and continue to provide services to Undocumented documented immigrants in South County. So thank you. Thank you. I appreciate it Laura Jacobs of the MLM preschool center, and I just wanted to say thank you for your support and for the county for the Acknowledgement of the additional funds this year, and that's it. Thank you. Good morning. Welcome back Good morning Craig and Mendeville senior citizens legal services, and I'd like to thank you all for being in suits So I don't feel overdressed up here talking to you I wanted to tell you a little bit about the stuff that we do that doesn't show up in the reports. So Senior legal helps 600 senior clients a year, but we do that through Mainly advocates from UCSC. We have them from the legal studies department psychology sociology and we help but we Train about six to ten of those every year and we also have law students who come through and do summer Internship programs with us and we train them on senior issues and these to me are the leaders of tomorrow These are the people who are going to be supporting senior issues moving forward In the past six years that I've been with them with senior citizens legal services We have 11 new attorneys that have come through our program who are now practicing law Three of which practice law here in Santa Cruz We have seven of our Advocates who are currently in law school and three who are starting law school in the fall of this year So these are the changes that we are making that doesn't show up in the reports But we're also trying to affect the youth and the future through senior legal and the grant money that you've given us Is going to help us in our outreach for that. Thank you. Thank you for your work Morning. Thank you for waiting I'm Marina Racine. I'm one of the youth of tomorrow. I'm a law student at Santa Clara and I'm working with senior citizens legal services I just want to thank you for the support that you give to that organization. It's helped me See the need for more compassionate lawyers and more compassionate legal services in the community And I just want to thank you for the support. Thank you Morning. Welcome back Buenos dias First of all, you know, I want to thank you for you know, the core funding for everybody that is doing work I'm not gonna go through what all the stuff that we do, you know, we've been around for over 40 years, you know, and And I want to thank for the funding that we've gotten but I'm here more to speak about for Those that don't come here and those that are doing work out there without no funding and Don't have the capacity to write Proposals, but they're still out there every day. So I want to I want to say my deeply respects for those folks And lastly, I just want to point out That we need to do something about the violence in our streets and to create Some kind of street outreach that is willing and wanting to hit the streets People don't do that no more and we've had an increase in violence So maybe in the future you can start looking at how do we reach those? individuals that are out there in the shock callers and and after 26 years doing work in prisons I've learned a few things But we're still not reaching that community and I would really you know advice you To start looking at that because if we don't We're gonna see a bigger increase and we have to do something Street outreach is not tied to law enforcement So we don't lose the credibility that we have in the streets and in the prisons and in the jails So I hope you take that into heart. Thank you for your support. Oh Nani your name and organization for the record Nani Alejandro's Paris Unidos Santa Cruz. Thank you So anybody else would like to address this on the core investments Morning morning morning. These critical services are really Imperative as we go forward and I do appreciate the meals on wheels and also money being allocated for the diversity center They have a lot of wonderful people that do need that I know a lot of people within my community American born Mexican that are struggling with you know coming out And this is a real issue So being money allocated to the diversity center really helps so the deal with people just coming out and also dealing with the suicidal rate Thank you. Thank you anybody else like to address this during the core investments, please Is there anybody else after this speaker? Good morning. Welcome. Morning. My name is Carly memory I'm the program director for suicide prevention service and I work with Family Service Agency and Survivors Healing Center We just want to thank you for your continued support for our agency for our programs We're working really diligently to help people in our community be safe to continue to expand our services to implement new evidence-based Programming even in the face of flat funding or funding cuts So your support means a lot it goes a really long way and specifically for the core funding here for survivors healing center Providing services to adult survivors of childhood sexual abuse is hard work. It's rewarding work It's necessary in our community and your willingness to fund this Also helps us to continue to bring it more into the public light so that we can talk about this have conversations about it make Advocacy for protecting children more effective in our community So well it's the needs are very great And we will continue to ask for more in the future years so we can do more good work as we're doing now Your support really means a lot to us and helps us to do the work that we're doing that the community greatly needs So thank you. Thank you All right, we'll bring it back to the board supervisor Coonerty sure just to kick it off I want to move the recommended action Thank our staff and thank the community members who are doing great work and also recognize that there is far more need Then then we have the budget for But that hopefully through collaboration and collective impact will be able to impact more people in more ways In a in a more effective ways So thank you everybody We have a motion from Supervisor Coonerty second from Supervisor Leopold Supervisor Caput well I would I would have What I'm offering is this I See the compassion of how you put this all together. So we're all on the same page there We're trying to help people that really need help I see that foster grandparents is in there when we had a discussion last year and The importance of that and of course meals on wheels. We're taking care of that which was Humbling discussion about a year ago also What I'd like to do is offer to the motion if it's accepted We with immigration work right now the timing and a Actually showing that we're supporting people and what they're going through right now Is very important. We have people that are being separated like never before We have tremendous stress stress on families that are having a hard time getting along and We do have People that are seeking help and trying to get help Legally in in the system that we have and I Would like to just add that we we raised the Community Action Board thriving immigrant initiative for support case management and services with immigrants who have been impacted by the current ice practices from 23 to $30,000 I know we all care about this Yeah, so I wonder if you'd be willing so Absolutely, we absolutely we increased our funding last year for exactly this reason with the idea of These funds are limited, but our HSD has made a commitment to work with The cab work cab to identify other resources I'm wondering if we can change it to a direction to staff to work with cab to identify Other resources to support the immigration project Maybe yes, maybe the only thing what I'm getting at is I've seen them in action There it's in a wonderful old Historic building in Watsonville It's probably about close to a hundred years old There's really no there's no way to heat the offices and there's you know Their their bare-bones Work what they're doing and when you go down the dark hallway At their office on the second floor in the Lennich building in Watsonville you see people lined up many of them only speak Spanish and Many of them are seeking advice and they're coming there and they're in a very safe trusted environment and They're not going to be taken advantage of so Right now there is an increased number of people that are Going to that office and I think I'd like to see the continued support of human services But also making sure that they do have enough money that they don't have to require people to pay for the services They're giving they're only asking for donations. I think that's a wonderful thing by the way Especially when people are working in the field trying to feed their families. I think it's also related to homelessness In a sense of if you have somebody that's undocumented and if they don't have support They're very well can end up in you know in a homeless situation So I would like to add the seven thousand but also with the direction that they Human services continues to show their compassionate support So as I mentioned, I can't add the seven thousand because I mean as we've seen there's a huge need And a limited budget and we want to respect the process that we've been through I am happy to add the direction that HSD work with cab to identify resources to continue to provide these really important services To our community Okay, and let me actually just maybe be a little bit more direct I think in the presentation because this question was asked a couple different times It seemed pretty clear that human services would find additional funding outside of this funding stream to do exactly what you're asking to do So it's just a procedural thing supervisor Coonerty is saying that we should be clean with the funding that we've got The ask that you're making will happen. It just will happen in a different funding stream Through a different a different method. So we're just trying to get through this item So everybody can get funded right now exactly what you're asking for will happen, but in a different way I haven't heard the word funding or they're going to get additional funding from human services money They are going to get additional funding from human services money that that's about as direct as you can get so No obfuscation here in government. So we do have a motion in a second and that was not a friendly amendment You're confident now with what it is Supervisor Caput We can argue about how much the figure is and I think it'll be over the seven or eight thousand that I was asking I Think it would be premature and I wouldn't want to you know negatively Impact the community action agency because we need to sit down and talk with them about what their needs are so that We can fully be responsive in a way that's going to work for them. So I'm not prepared to Suggest a number at this point until we sit down and I've learned more about what we share what our needs are because we're seeing Dramatic and decreases in the number of immigrants who are applying for benefits and we work with the community action board to hear what I anticipate will be Many many unmet demands and because I know you and trust you I'm going to go along with this Well, I appreciate that and what I think you will hear in my presentation Is that our department is one hundred and fifty percent committed to doing everything possible that we can To mitigate the impacts that we're seeing in our community with regard to immigrants and their access to benefits and their fears All right, all those in favor I Opposed it passes unanimously. Thank you for that. We're going to take a ten minute break right now before we come back For the human services Departments so we will come back a little after ten fifty I'd like to call back to order the board of supervisors after our short break And we're going to move on to item four, which is to consider the 2018 19 proposed budgets for the human services department Including any supplemental budget materials is provided in the budget documents. We have the 1718 goals and accomplishments of HSD We've got the HSD 2018 19 proposed budget the line-at-em detail the supplemental the continuing agreements Within the supplemental the fixed assets and the Rada and we have a presentation from Ms. Timberlake Okay, again Ellen Timberlake the human services department. Good morning chair friend members of the board I'd like to start by thanking the CAO and his staff for their assistance in developing our proposed 1819 budget as Noted yesterday Under the fiscal stewardship of your board and the CAO's office the county has made significant progress Strengthening our financial position since the Great Recession Please know that our department is Committed to continuing to support your leadership in this area through our strong fiscal management practices and our commitment to Leverage general fund and aggressively pursue grants whenever possible I'd also like to take a moment to acknowledge members of our leadership team who are present today for their hard work and dedication Throughout the year working with this team motivates and inspires me their talented and committed to the work and Care deeply about helping all of our programs succeed the care for the greater good is a trait You'll see with all human services staff So turning down to our budget presentation before I take your questions I'd like to give you a short overview of our department and our 1718 accomplishments Followed by a review of our financing and a brief summary of several state and federal issues that we're tracking closely Additionally, I'll highlight three emerging issues that we see across all of our programs and share examples of how we're working in partnership to address them Everything we do is informed by our mission statement our North Star 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 our mission we offer a variety of mandated programs and services All of which are designed to help us achieve these four overarching goals Over the course of a year One in three members of our community are served by programs administered by the human services department Our annual report which will be posted to our website in July provides more detailed information on all of these services Last year during budget hearings I emphasize to your board that we view the budget as a tool for ensuring that we do everything we can To accomplish our goals and meet the needs of our customers and clients as you can see by a sample list of our Accomplishments strategies to achieve our goals are informed by data and achieved through partnership What matters most is the experience of our customers and clients and the impact our programs and services are making in their lives As you know, we invest heavily in not just valuing these principles, but tracking outcomes We look at our data through a variety of lens gender race citizenship Geography to ensure our services are benefiting everyone. We pride ourselves on rigorous inquiry and data-driven decision-making I have highlighted for you in the past our key indicator system and our real-time data capabilities Today, I want to raise up the voices of our customers These are just a sample of the phone calls emails and personal notes. I get on a regular basis about our staff Across the board wherever they go and whoever they meet HSD staff are dedicated to making a difference These quotes are very representative of the experience. We aspire to provide for all our clients and customers as Well as the experience we want to see reflected in our workforce and our community partner relationships Now I'll move on to our budget HSD's total proposed budget for fiscal year 1819 is approximately 132 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 programs The general fund contribution is a required share of costs that differs by program, but taken together represents 10% of our overall budget Over the last five years our financing sources have remained fairly constant The spike in federal and state financing that you see occurring in fiscal year 1516 is primarily associated with the expansion of the Medi-Cal program for single adults Which was which resulted in over 20,000 additional county residents receiving health care coverage As to pick that on this slide our largest expenditures are for staffing costs followed by other charges Which include direct payments to recipients of entitlement cash aid programs like cow works and general assistance foster care and adoptions assistance as well as provider wages for the in-home supportive services program The majority of the general fund increases included in our proposed fiscal year 1819 budget are associated with the county's required share of cost for these entitlement programs At the federal level we continue to monitor proposed changes to key safety net programs Congress has until September to reauthorize the farm bill which includes funding for the supplemental nutrition assistance program snap Otherwise known as CalFresh in California as you probably know this bill was recently voted down by Congress We're monitoring this very closely as the house version includes both eligibility and work requirement provisions that punish low-income individuals and families in Contrast the Senate version which we expect to vote on before July 4th is quite different It received bipartisan support and looks to strengthen the SNAP program Also of concern or proposed regulatory changes to the public charge policies That govern how use of public benefits may affect individuals immigration status under current policy Individuals may be determined a public charge if they rely on or are likely to rely on public cash assistance or Medi-Cal for long-term care Not only does the new draft proposed policy include the use of non-cash benefits such as health and nutrition programs in public charge Determinations it is also allows the federal government to take into account the use of programs by citizen children and other family members public charge and other unresolved immigration policies like DACA and the recent heart-wrenching practice of mass separation of parents and children at the border and sporadic ice raids at the local level are taking a serious toll on our immigrant community Leading to fear and uncertainty as evidenced by decreased enrollments for many of these families in Cal Fresh and Medi-Cal We will continue to monitor all of these federal issues moving forward and through our state association Advocate to retain critical safety net services for all people At the state level our proposed budget includes a reduction of over one million dollars in allocations Supporting the administration of the Cal Works and IHSS programs Additionally, we've been concerned about whether the final budget would include sufficient funding to fully cover the cost of Implementing the continuum of care reform and child welfare Although some of the areas of concern have been addressed in the final budget agreement Much of the anticipated restoration is in the form of one-time funding We're also very encouraged by the Cal Works grant increases which prevent provide long-needed supports to the safety net These increases would raise the maximum aid payments over a four-year period Beginning with a 10% increase in April 2019 The goal is to get all children and families in Cal Works to 50% of the federal poverty level by fiscal year 2021-22 Other new investments in home-based visiting for Cal Works families and Housing subsidies for at-risk seniors offer new tools to support those we serve Today I'd also like to focus your attention on three cross-cutting issues that we're seeing in all of our programs The issues themselves are by no means new What is new however is the growing number of individuals in our communities impacted by them To address these emerging issues we rely on some of the following promising partnerships tools and resources Let's start with homelessness That's reflected in Rainey's presentation It is clear that more of our local residents find themselves either homeless or at risk of homelessness in the most recent point-in-time Data count our youth followed by seniors represented the fastest growing age groups of those experiencing homelessness Within our department. We see this showing up in an increased numbers of adult protective services referrals for homeless At-risk seniors and disabled individuals with our youth We know that kids in the foster care system are four times more likely to experience homeless homelessness And as depicted in this picture painted by one of our youth homeless advisory members We see a powerful expression of feeling ignored and invisible This picture is on the cover of the community plan to end homelessness in youth homelessness and Offers the inspiration for a redoubling of our efforts to in their words be ignored no more Our department in collaboration with a network of partners is committed to addressing homelessness and housing insecurity For example through rapid rehousing funding from the California Department of Social Services Approximately 80 homeless families receiving CalWorks have received housing support this fiscal year And I'd like to note that over the past three years for this program. We've housed over a hundred and forty CalWorks families who are still 98% of whom are still in housing After support from this program We're also working with the community to increase capacity for employment and training programs for the homeless By drawing down federal funding to help successful programs like the downtown streets team Increase their capacity to provide work experience and in partnership with the housing authority We're applying for 100 new family unification and youth housing choice vouchers And as Rainey mentioned HSD is excited to build on the successful implementation of our coordinated entry or smart path program We're very grateful to the homeless services center and Robin McKean for her leadership in Launching this critical component of our system and we look forward to working with our community partners to take it to the next level And to develop outcome measures One of our most important jobs is to ensure that all members of our community who are in need of and entitled to benefits and Services get them for this to happen. We must analyze data to identify underserved populations Understand the barriers they face in accessing our services Employees strategies to mitigate the barriers and ensure that the strategies are evidence-based and responsive to the diversity We see in our community For example as I noted earlier we believe current immigration policies are having a negative impact on the number of immigrant families Accessing CalFRS many do not feel safe reaching out to government. Some parents feel Are experiencing fear being separated from children based on their immigration status? We also know that the recent gender matters report and our participation in the justice and gender task force That women who are incarcerated and their families face unique challenges and getting the support they need So what are some of the ways we're responding to underserved populations? First know that HSD is committed to doing whatever it takes including traveling to the four counties of corners of the county Enrolling customers into benefits at college campuses homeless shelters correctional facilities and it targeted neighborhood events to name a few Working closely with our community partners such as second harvest food bank and the Santa Cruz immigration project To get accurate information to those who may be concerned about receiving benefits due to their immigration status Employee technology to make it easy and possible to apply for and maintain benefits and Working to improve services to incarcerated parents and their children who are involved in child welfare through increased coordination with the sheriff's department Targeted behavioral health support is another area where we see a growing demand for services across all programs We see this in the children youth in our child welfare system who are impacted by trauma and in our seniors who are increasingly reporting feelings of isolation and depression To address these needs we again rely on opportunities for collaboration and partnership For example, I am very very excited to announce that our department is working closely with the Museum of Art and History On an upcoming exhibit that will focus on senior isolation and loneliness Our hope is that through a community-wide effort We will increase awareness and spark community actions similar to what we experienced with lost childhood exhibit I'd also like to take this opportunity to thank and recognize Mimi Hall the interim director of the health services agency and Fernando Gerardo the chief probation officer and their respective staff As you know our three departments have a long-standing history of strong partnership Partnership based on shared values and a commitment to developing integrated system of care These initiatives represent just several of the recent examples of our joint efforts to improve behavioral outcomes for those in need I'd like to end my presentation with a word cloud. I grew fond of word clouds as a member of the county strategic planning steering committee This one caught my eye because it captures so many of the values that your board RCAO and all employees of Santa Cruz County aspire to uphold and with that This concludes my presentation and at this time. I'd be happy to Answer any of your questions and ask that you adopt the recommended budget and supplemental items Thank You miss Timberlake and thank you for your departments for markable work, especially during this time right now Are there other board members that would like to ask any questions or make any comments to start off? Supervisor Leopold, thank you chair. Thank you miss Timberlake for the presentation. It's We could spend all day talking about the Human Services Department because the the reach of your staff is is incredibly broad It goes very deep into the community and provides incredibly important services So thank you and thank you to all the staff who helped make that happen, you know when I when When I think about the the work that I see ongoing all the time with human services I'm incredibly impressed by the commitment to evidence-based practices to really looking at data to drive To drive where programming was would go and the deep commitment to partnership Within the county family and in the community is a real hallmark of the department And I just want to that starts at the top, but it's but it's pervasive throughout the entire department And I'm very appreciative. I have the pleasure of serving with Miss Bali on the justice and gender task force and I've just seen how Issue comes across the the transom where Human Services Department can make a difference and Miss Bali immediately jumped on it work with staff work to To create a create a response didn't wait for some decision by the task force worked very Quickly to start addressing and I just want to appreciate that You know when when we think about the external factors that affect the work we do here in Santa Cruz you mentioned a couple of them the the the The the deeply inhumane way in which they're looking in Washington at things like the Cal fresh program Which is you know food is basic sustenance, right? We cannot survive and The the fact that they keep on throwing impediments to people accessing these services and through their Incredibly divisive rhetoric and actions. We see people who can benefit from these services Stepping away from accessing these services. So I appreciate the commitment that the department has to keep on finding new ways You know recently there was a pro-publica story that featured Santa Cruz about the raids that happened here in February of 2017 and a year later there are people still greatly impacted by those raids and I've seen it in live oak schools. I am in my conversation with parents involved with the cradle to career program I Hear these stories and the article really highlighted that It might be over a year old, but it the impact is and the crater it left is is it's still being felt by a lot of people so Regardless of what happens in November or whether there's going to be any change in in Congress we're going to be dealing with the ripples of of the Of the callous acts of this administration for a long time and and you're going to be on the on on On the front lines of dealing with that Mention the cradle to career Program I just want to acknowledge your staff member Leslie good friend serves as co-chair of the of the initiative This past year has been a great year of success for the cradle to career initiative And this collective impact project has been able to attract resources So we're able to expand to schools in the live oak school district and that wouldn't have happened without Leslie's leadership and deep commitment And the department's commitment to help make that happen I also want to acknowledge the work of the veteran services group we Deal with requests from veterans all the time that they've been very Helpful and addressing needs are out there when we look about the kind of work that they're doing They are helping making the difference in the lives of people who've served our country So I'm very appreciative of that the workforce Development board and the work that mr. Stone is doing The kind of expansion that's going on this year with the Cal works program is very impressive And it's actually so much what we need in order to Help people get into the workforce stay in the workforce be Competitive in their jobs, and I just want to thank the work of Of that group as well The the sort of unsung Members of your staff, I don't work with them directly, but I just appreciate both the child welfare services Adult protective services we we have to call them at times to help with constituents concerns the staff is always there to to help respond and to Go into action to help people out and I'm very grateful for that of my constituents And I think the whole community is grateful for the work that you're doing there So I'm in regular all of the work of the human services department, and I would just want to express my appreciation to you and all the staff Thank you so much. Thank you so far as McPherson. Yes, I You know 132 million dollar budget is big money But it's even bigger of what you do with that and you're in the whole staff Or to be commended It's really impressive of how many people we reach with some basic so basic but necessary services I really want to thank you for the The huge outreach efforts that you've made to some newly heightened concerns Homelessness and immigration probably the most pronounced and Also to say thank you for working with the Museum of Art and History to get to the general public to Come in and understand Comfortably so to speak what are some of these really issue? Pressing issues that you are addressing and we are addressing as a county the lost childhood Foster care we had a board meeting there the seniors in isolation These are community issues that are all around us But I don't think people really understand the severity of them and the the need for us to address them So I want to thank you for the cooperative effort that you've had with others public agencies to and non-profit agencies to Just to let people know what is out there and what we're trying to do to address and improve those situations The the most pressing issue that I see Nor one of homelessness and immigration certainly are there but the in-home support services and I think we're going to be hearing some some comments, but the action that was taken by the State Department of Social Services to Shift the non-federal costs in 1718 they were going to do it this year and with the work of CISAC and some local governments In county governments throughout the state we were able to put that off that They were going to shift that responsibility They are going to shift that responsibility down to the counties We held it off this fiscal year and next fiscal year But this is going to be a huge problem a multimillion dollar problem that we have to fill and I can tell you that the County governments throughout the state are working on how to correct that. I mean, it's over three maybe four million dollar Problem that hit that you put on counties that would be fully responsible for so so I appreciate your input and The the folks in Sacramento that we've been able to to discuss this with But this is going to be something that's going to really hit hard in a couple of years, but I appreciate Your efforts and everybody throughout the county here and throughout the state for that matter for At least giving us some breathing room to see how we can adjust to this huge multi-million dollar Problem we're going to have to provide this essential service to our county residents If I might I would also like to acknowledge your leadership in this area And we really appreciate the strong voice that you've had in Sacramento not just currently but last year as well And we will do everything in our power to try to mitigate as much as we can Thank you survivors on first and supervisor Caput Thank you and Yeah, I'm glad to see the The help you're doing and working with Cal fresh and second food harvest I did notice like there's a 12 12% decrease in applications by immigrants and That's related to what we were talking to talking about earlier were with the Santa Cruz County immigration project giving them legal advice and helping them fill out forms and all that it's quite Reasonable to To consider the fact that a lot of the decrease in immigrant supplying is the fact that they have to put down their name address Phone number and in order to fill out an application and they're more worried now than they were before So that's why what you're doing is very important And that way they can at least get food on their table and they can also fill out of you know a simple form without living in fear that maybe somehow they're impacting their family because we we do have a lot of Blended families in South County where some of them when one family are here with Documentation they're born here. They're citizens Others have a green card and then others are they have no card whatsoever So we we have to be very careful. We don't fracture families while we're doing this work Now compliments, I guess you're willing to take a lot of compliments on the next issue the veterans Services in Santa Cruz County In my opinion is going as well as I've seen it in a long long time About five six years ago. There were unfunded positions There was no real outreach and the coordination that you have to do. I think is very commendable We're talking about federal positions that are funded. We're talking about state positions that are funded We're talking about county funding. That's also going into these different Services that we're offering We're dealing with the Watsonville's Veteran services now that has gone from one and one and a half days a week to four days a week of Actually being open and having a door there where veterans can drop in and say This is my problem and they also make reservation they reserve a A Time time to go in and before they would end up going to Amaline Street or they would end up going to Santa Cruz And now they could just if they live in the South County or Watsonville. They can go to the Watsonville office That's very commendable because Lorena Vasquez the work she's doing and all the positions being filled One example is the outreach part-time Funding that we provide We're an outreach worker is going out there and Talking to in many cases homeless veterans or veterans that have fallen through the cracks and Are not getting the services or benefits that they deserve one example is I was knocking on doors about a couple of two years ago and One veteran in a poorer part of the town Had broke his leg and it he broke it like a week before he called up the Palo Alto Veterans Hospital and they actually said well you can come we have a reservation for you to come up here 30 days from now well anyway We called the veterans outreach worker to go and visit with them and Within two days they took him up to they actually transported him up got him Transportation to go to the Palo Alto Hospital to set that leg 30 days later. I don't think they could have said it right they would have to re-break it probably Anyway, that's that's a good work that we actually see happening and We have also the Veterans Center and Santa Cruz going really well and staffed and also 41st Avenue and And also offering transportation to Palo Alto or the new Veterans Clinic in Monterey So that takes a lot of coordination. I think what's really commendable when I when I'm talking to different components of this Federal state and county that they all know who to talk to and they all know which is the right referral and That was not happening Five or six years ago, so I want to commend you on that Anyway, and then we're also we already talked about it before where human services is going to step forward and help out the Immigration project in Watsonville. So thank you very much So advisor Kennedy Thank you for your work This is when you look at the clients that you serve these are folks who need a specific intervention at a specific time often This intervention is critical and if it's right We can get people get their lives back on track and and Stabilized and save us money and them pain in the future So and I want to appreciate Your commitment to data and then continues improvement and also employee training It's it's really a Leader in our county and I think a leader in the state for the work you do For your accomplishments, you have very clear Numbers and goals that you met and then but your goals are a little more broad I'd be interested in and we don't have to do this now But in the future having a little more clarity on what specifically you're looking to do over the year and how Hopefully if aren't derailed by really harsh and ineffective federal policy changes what we'll be able to accomplish in terms of Serving these particular populations one of the things I might want to add about that I think your observation about that is absolutely accurate and what we could do better And I actually look forward to talking about this as we move into the performance data discussions county-wide is How do we give space to both process outcomes and Initiatives that we see coming forward in the in the new year that haven't yet received all the input that we need to Actually clarify those so I can see some ways that we could possibly address your issues that are accurate and find a way to Maybe separate those and in a fashion that could be a little bit more or you know fine-tuned on those numbers that you're looking for So thank you for that input. Thank you when I open it up to the community There's an opportunity for members of the community to address this on the human services department We may from the community like to address us specifically on item four Please feel free to step forward. Thank you Good morning. I know that I got to the community action board of Santa Cruz County I just want to start off this morning by saying thank you thank you for the leadership of the department I feel a full-force commitment to help create a response plan to what's happening in the community We know that that our families what they're going through We're seeing it in the data and we have to do something different And I want to say that Ellen and I have had wonderful conversations about what are strategies that we that we need to Look at how do we do business in a different way? We have to do it in a different way people aren't coming out and I don't blame them I wouldn't be out either and so I think I feel the commitment I feel the support in the direction from the board. I feel the advocacy from Supervisor Caput. Thank you so much We will we will come together and the vision is to have seamless services The community doesn't need to know who's providing the service. It has to be seamless It's about being able to find a strategy that works in the most difficult of times And I believe that we can make that happen. So I want to thank you and thank the leadership of the department Thank you. Thanks those comments Good morning. Welcome. Hi. I'm Stacy Garcia and I'm the director of community engagement at the Santa Cruz Museum of Art and History And I'm just here on behalf of the mod to support the proposed budget and I'm just speak to the incredible partnership We've had over the past couple of years that is just growing with the human services department Last year you all were invited to have conversations with foster youth at the museum for our last childhoods exhibition That was done in partnership with the human services department and through that exhibition We were able to really meaningful change her foster youth here in our community People not only stepped up to donate items and to volunteer, but people became causes people donated cars We employed foster youth and one family even stepped up to become foster parents as a result of that exhibition And so these kinds of creative partnerships and really highlighting the work that the human services department is doing and Creative and innovative ways really broadens the reach of what we can do and how we can invite our community to step up and take action On these issues that are so important And I'm really excited to share that we're going to be launching a new initiative focused on the social isolation of seniors in Our community starting in September. We will host meetings with seniors Advocates artists and leaders across our community to really think about how can we share the stories of seniors who are Experiencing social isolation and invite our community to take action so that we have stronger social connections across our community And particularly with seniors seniors who are affected by this So just speaking in support of that and thank you for coming to meet foster youth And I hope you'll come to meet seniors once we work on this exhibition coming up this fall. Thanks. Thank you morning Morning, my name is victorious Alexander civil society activists I want to be able to share our members of the public that the American public is struggling living from paycheck to paycheck Wallowing in a capricious existence and we all understand this this is trying times But I find it very shameful that you know, I'm hearing your presentation, right? And I love the catchy words, you know fiscal stewardship redoubling community partnership work experience at the HSD Community white actions strong partnership or word cloud Evidence-based practice and I want to remind the the not the last speaker, but the previous speaker Where she talked about the community doesn't need to know Where the money's going and how it's being spent now the meaning of the community does need to know where it's going And how it's being spent because civil society activists that do fall on hard times like myself You know, I'm being politically prosecuted in Santa Clara County. I'm an exile over here my bank accounts frozen My offshore accounts because I was successful I have no shame for my humanity when I fall on hard times and I'm relying on the general assistance Right and I go in there trying to shape the policies that affect the American public What they want to do is they want to vulgarize and criminalize my activism my activism doesn't stop at the door I'm able to engage in lawful activity and participate. I find it very shameful and I would ask Ellen Timberlake You're a good woman. You have given me many Audience with you the last time you ran away because I have my GoPro. I don't want my my activism being criminalized. I would say that Emily Bali your leadership is is obsolete I would ask for your resignation because the work experience that you're doing Right is enslaving the American public with purposeless work hiding behind work experience We don't want to turn good lot buying citizens into public slaves. We're not here to gravel over the system We're not here for political servitude. We're here to be liberated. Thank you. Okay, and mr. Alexander We're focusing on the budget here. Is there anybody else I'd like to address us on the budget for human services My name is Serge Cagno. I work a lot of different homeless stuff some of the coordinating committees with Rainey on the YHDP and the smart path I work to the winter shelter over the winter And I just really wanted to thank Emily and thank the human services team for all of the Flexibility to access services that we had a bunch of meetings about getting different Assessors for CalFresh and GA and all the different programs to the winter shelter to make it more of a navigation center model and it was It was just that flexibility and that definite Goal of trying to help people that was something that they were always willing to try to figure out a way to make things happen Just wanted to shout out to the team. Thank you. I Thank you. Is anybody else who'd like to address us Okay, we'll bring it back to the board. Just like to note that those comments only reflect one individual and nobody else in the entire world Ms. Volley So but he's welcome to express them that is why we live in a democracy But I think every single day you do work and Ms. Timberlake does work and the entire staff does work for people That don't have a voice and they're not here to say it, but trust me. They would thank you if they could Is there an action from the board on the side of the recommended actions on the human services department budget second We have a motion from Supervisor Leopold a second from Supervisor Coonerty all those in favor aye opposed passes unanimously We'll move on to item 5 which is to consider the thrive by three early childhood funds 2017-18 implementation progress support and nurse family partnership annual report 2018 Approve the proposed child care development fee increase and direct the Human Services Department to return honor before October 30 2018 with an updated CCDF ordinance and approve the proposed thrive by three funding allocation for fiscal year 1819 direct HSD in the health services agency to return on or before August 28th of 18 with recommendations on various thrive by three allocations and Take related actions as outlined in the memo of the director of Human services and interim director of health services We have the thrive by three early childhood fund 17-18 implementation progress support and attachments and the nurse family partnership annual report Will begin with miss Timberlake. Thank you chair friend. I am very pleased to be joined Today with Mimi Hall the interim director of the health services agency and as directed by the board We're here this morning to provide an update on thrive by three activities expenditures and funding recommendations for fiscal year 1819 and today the presentation will be led by Emily Bali the deputy director of the Human Services Department and Jennifer Herrera director of nursing for health services agency with that I'll turn it over to you. Great. Thank you, Ellen Our presentation this morning will begin with a brief overview of the thrive by three initiative Then a review of the goal areas Sorry, I'm clicking to And progress and then within this review Jennifer will provide a deeper dive into one of the home visiting programs supported by thrive by three The nurse family partnership We will also discuss future system initiatives and investments to support thrive by three and then review funding recommendations for fiscal year 1819 on January 24th of last year your board voted to dedicate $350,000 to implement the thrive by three initiative with the goal of improving outcomes for Santa Cruz County's youngest and most vulnerable children prenatal through age three and their families The following June the board adopted the thrive by three system of care model that outlined outcomes in the following areas Babies are born healthy Families have the resources they need to support children's optimal development Young children live in safe nurturing families and children are happy healthy and thriving by age three HSD and HSA through partnerships with first five in compass early childhood education providers and safety net clinics Were able to identify ways to more than double the initial investment to $723,000 After the adoption of the initial implementation plan and approval of service agreements Implementation of thrive by three began in February of this year Next we will review the thrive by three implementation goal areas and progress Strategies and funding for thrive by three fall into these three goal areas Enhanced system capacity strategies focus on home visiting programs and high quality infant and toddler care Enhanced system coordination targeted towards increasing coordination among the thrive by three partners and services and Strengthened system of care foundation which focus on critical system building efforts for development funding Implementation and evaluation of the thrive by three system of care First we'll review strategies to enhance system capacity The first strategy to address system capacity is geared towards increasing capacity to home visiting for high-risk families Through the investment of CalWorks funding CalWorks recipients who are pregnant and or have children under the age of three are being Referred screened and routed to the home visiting program that best fits their needs From February through April of this year 26 CalWorks families have been enrolled in one of the four existing home visiting programs that serve families children Children prenatal through it three years old The four home visiting programs that serve thrive by three families are Families together and early head start home visiting through encompassed community services Public health field nursing and nurse family partnership through the health services agency I'm now going to turn the presentation over to Jennifer who'll provide additional information about one of these programs the nurse family partnership As you are aware nurse family partnership is an evidence-based home visiting program That serves first-time mothers and their families from pregnancy until their child turns two years old Here's a quote from the program's founder dr. David Olds There is a magic window during pregnancy It's a time when the desire to be a good mother and raise a healthy happy child Creates motivation to overcome incredible obstacles including poverty Instability or abuse with the help of a well-trained nurse NFP leverages this magic window to improve pregnancy outcomes child health and development and the family's economic self-sufficiency 2017 was a very busy year for santa cruz county nurse family partnership In february our local program received initial approval from NFP's national office to implement the program Although the health services agency had spent prior years garnering support To bring this program to the county In march we hired four public health nurse home visitors pictured here In april we accepted referrals while the ph n's completed their training in may we enrolled our first client Last july we implemented an electronic charting system Which has allowed us to analyze data more efficiently In last august our first nfp baby was born We expect our first nfp graduation in this county in may of next year From april 2017 through april 2018 we received 159 referrals for nfp Of the 159 total referrals 116 were eligible for nfp services 95 or 82 of the total eligible referrals enrolled into the program This shows that our program has been successful at converting eligible referrals into enrollments This graph represents the frequency of completed home visits and clients served in a 12 month period The dark blue represents clients served and the light blue represents home visits as an intensive as an intensive home visitation program Most clients have a one-on-one weekly or Visit or every two-week visit you can see the steady rise of clients and home visits since the program started By april 2018 the nfp program had completed over 730 home visits with over a thousand hours of face-to-face contact time These are the most common demographics of our enrolled mothers Most notable 60 percent are under the age of 25 and 22 percent are age 30 or older The most common primary language spoken by the mother's english followed by spanish and 70 percent of our nfp mothers identifies hispanic or latina 12 months into the program we have collected data to indicate we are meeting our goals As of april 2018 80 percent of our mothers have had their first prenatal visit in the first trimester By april we had 35 infants born into the program 92 percent of which were born full term All of the mother's initiated breastfeeding and the mothers we have so far with the baby six months or older have continued to breastfeed All children who have turned six months old are up to date with their immunizations 97 percent of children age zero to six months had no visits to the emergency room or urgent care And there have been no visits to the emergency room or urgent care for our toddlers and no Hospitalizations of any of the nfp children so far Thanks, jennifer As I mentioned earlier the second strategy to address system capacity is related to infant and toddler child care As part of the approved 1718 plan and funding for thrive by three your board allocated $70,000 to implement an early learning scholarship pilot program to be administered through first five The purpose of the scholarship is to provide quality To provide funding to close the gap between the cost of providing high quality care and available state and federal subsidies Approximately 25 families participating in home visiting will be served through this pilot Now we move on to enhancing system coordination The strategy in this goal area is to create a centralized eligibility and coordinated entry system into the thrive by three system of care To match families with services that best fit their needs Phase one was to develop a system for home visiting programs Encompass families together working with first five develop key elements for the system such as procedures for assessing eligibility for home visiting Criteria for matching family needs and program availability Mechanisms for referral and documentation of services and a simple tracking system Other activities to support this strategy include the development of learning collaborative meetings For the home visiting programs and discussions with the safety net clinics about their critical role in the thrive by three system of care And how best to align services A lot of work has also gone into strengthening thrive by three system of care foundation The essential pillars that create the foundation for thrive by three system of care are high quality programming funding and financing data and evaluation governance and administration accountability and technology Activities that support this goal area include evaluation of thrive the thrive by three implementation process and short term outcomes establishment of the thrive by three advisory committee Development of the Santa Cruz individualized cares child care subsidy pilot plan Completion of the child care developer fee study and the identification of workforce development needs Next i'll provide additional information on one of these activities the child care developer fee study The child care developer fee provides revenue for the child care developer fee loan program The purpose of the program is to increase and or maintain the supply Of licensed child care in santa Cruz county The loan is a forgivable loan for licensed child care centers and family child care homes for capital expenses to increase or maintain capacity The child care developer fee has not been reviewed or increased since 1991 HSD contracted with consultants keiser marston associates to complete a child care developer development fee nexus analysis Based on the results of the analysis staff recommend a graduated increase in the fees over the next three years The this recommendation also also modifies the fee categories to line with other development impact fees The proposed fee increase will provide much needed resources to support the critical role child care providers play in supporting families with young children I'll now discuss some upcoming Initiatives invest in investments that will support the thrive by three system of care In the state budget for fiscal year 18 19 funding was allocated to implement the cow works home based visiting initiative effective january 2019 Santa Cruz was one of six counties involved in helping develop the state develop this program This funding will allow us to expand services to families where only the children are eligible for assistance For example parents and eligible due to their immigration status The health services agency human services department and safety net clinics Are also submitting an application for a substance abuse and mental health services administration grant to improve outcomes for infants and children Who are at risk for show early signs of or have been diagnosed with a mental illness Additionally on May 22nd of this year the city of Santa Cruz took a proactive step in the support of children The council approved an allocation process for the city's cannabis business tax children's fund And designated half of the revenue in the fund to focus on early childhood development And the other half for vulnerable youth populations and prevention Council members further further specified the children's fund should support Santa Cruz city children And suggested that the early childhood development allocation Could potentially be administered through a partnership with the thrive by three initiative and or complementary programs Next i'll review funding recommendations for thrive by three for fiscal year 18 19 For 18 19 the thrive by three advisory committee has recommended continuing the same allocation distribution of the thrive by three funds as in 17 18 hsd and hsa will return to the board in august with an expenditure proposal Following the advisory committee's recommendations for unexpended 17 18 funding and one time 18 19 allocations As you can see from this slide just as we did in 17 18 We have augmented the initial investment by leveraging other funding for a total of 844 thousand dollars to support the thrive by three system of care We recommend that your board take the recommended actions as outlined in the agenda item And as ellen mentioned in her presentation The experience of our customers matters to us and we use their feedback as one of the tools to evaluate our effectiveness We'd like to conclude our presentation with some quotes from our cow works customers Regarding their experience with home-based visiting provided through thrive by three At this time on behalf of the human services department and the health services agency We want to thank our thrive by three partners First five the early childhood education community Santa Cruz health improvement partnership safety net clinics encompass home visiting programs kma and associates Members of the advisory committee and others who have been involved in improving outcomes for young children and their families Thank you that concludes the presentation and we'll be happy to answer any questions Thank you. I'll open up for questions from the board supervisor Coonerty I don't have as many questions as I do want to just say This is really exciting when we allocated the three and three thousand dollars I don't think any of us had the expectations that it would turn into what it is which is More than doubling the amount of money in the system, but more importantly really intervening and serving Babies and their moms right when they need it most and the numbers these early numbers where you show That these kids are not ending up in the emergency room that they're being visited and supported and And breastfeeding and doing all the things that that kids need to do Um is going to pay long-term dividends for those lives and for our entire community And so I really want to thank you and then the fact that we've been able to grow the system With great partners. David Brody of first five and others Has been and the and this and now bringing the safety net clinics We can really Really serve this the kids and this community Supervisor Leopold. Thank you chair. Thank you for the presentation um This is a very interesting and exciting work That the human services department is is working on as with our other partners It's great to see the number of home visits that are taking place The with the benefits that that we've already seen Although the the the sample size is small that we're we're starting in a great place So I thank you for your coordination of that It's also nice to see the utilization of the The els allocation Uh and in awarding scholarships to 25 families. I think that that's that's really helpful And it's part of the leveraging that's going on with this work And it's nice to know that a bill that the that the board supported ab 300 is seeing so many Good benefits in terms of increasing eligibility for people for child care I also support the the The long sought after much delayed Change to our child care development fee. We've heard at this board many times about the the the The dearth of quality affordable Child care and the resources that this will help provide Won't close the gap completely, but it will help us And help the those child care agencies. So thank you for that Supervisor McPherson Thank you, mr. Chair This is one of the most exciting programs that I've seen the county start up In recent years, and I want to thank Supervisor Coonerty for bringing it to us last year At at first blush, and I have received some Calls about the concern about the increase in the development fees in our at in the aftermath of our discussion on housing and how we want to play our part In making Builders more receptive to providing affordable housing in our community But I think this is is reasonable. This fee has not been increased since 1991 I do and I appreciate that in those housing discussions that we had We talked about going from to square footage from Um Just not per bedroom and so forth, which this follows and I think it's appropriate I do think a caveat needs to be said that I don't think it's would be a wise thing for some other Purpose or cause to come and try to increase building fees to pay for their way But in this is it's very appropriate. It's uh in historic and uh for This historic thrive by three program. I think it's appropriate To the advisor cap it Yeah, thank you mind is kind of one question and Uh slight a small comment Father's day was just a couple days ago and uh I know that I I have a responsibility and the mom and the mom does and everybody does for this child Uh How many of the women the mothers that are actually single moms that are Being helped by this program I know in our cow works program 87 of our cow works households are headed by women so Coming in for help for all the services single mothers. Um You know, I don't have that those numbers with us right now of nfp mothers But that is data that we do track if uh, they declare themselves as a single mom You bet because uh, you would be a tremendous asset for uh, it could it would be very frightening. I think for uh, a mother a woman If the father walks out and just leaves them or whatever So I maybe if we could look at that in the future and make sure we're helping out women Thank you Thank you. I would also like to compliment supervisor Coonerty on bringing forward Both of these programs quite frankly and uh, the human services department for taking what really was a small investment And leveraging it into what had a significant impact on people in the community and although there weren't necessarily comparative Stats of uh that were provided the the the pure numbers that you showed on the nurse family partnership were quite remarkable on the positive outcomes That are occurring especially with this disadvantaged population. So there's a lot To be said and and although it looks as though it's just an impact on a young child's life The reality is is that uh, this will Decrease a number of other issues that could arise within these children as they grow up Not just reducing costs but having significant impacts for the positive on on the lives of those children It is true as supervisor McPherson noted. We haven't raised the child care fee in in over 25 years Which is unfortunate. I mean it would be useful if we indexed it. I know that's a moving forward where we'll be going But you know child care is a significant barrier for Quality affordable child care is a significant barrier for many working families within our community and and What the board is trying to do is balance That need as well as building affordable housing It serves the same population and we want to ensure that that people aren't forced Either out of the labor force or out of the community because we don't have quality child care We want to ensure that people aren't forced out of the labor force or out of the community because we don't have affordable housing And and I think that a number of the changes that you've made Which really? To square footage a number of other issues actually do reduce the impact on smaller type homes and or rental housing specifically I do think that there's probably a couple other modifications We could make as you come back to us in october to ensure that this has Little to no impact on on especially rental housing and affordable housing to the degree possible And I know that that's your goal as well. And so When the board comes back for a motion we'll try and craft something that does exactly that But I appreciate the fact that you've already taken significant input in from people in the community on this issue We will open this up now to the community if there's any members I'd like to address us specifically on this item now would be your opportunity Item five It's roti welcome. Thank you very much Still morning time right just barely good morning members of the board Uh Chair friend I just want to I just want to make a comment first overall As much as a citizen of this county As the executive director of first five that having watched their morning's proceedings and the work that this board and the staff Do and have done I mean this from the bottom of my heart. I feel tremendously grateful To be a member of a community whose county government is truly So enlightened whose staff are so dedicated and thorough Whose work is characterized by intelligence by competence And by compassion and you can hear it in my voice. I really mean that Given the nature of the challenges that we face collectively it is it is truly I'm truly grateful And with respect to thrive by three I want to again recognize and thank this board for Really an enlightened position to invest in our youngest children and families As you know proposition 10 and first five the funding that supports us is declining and continues to do so Just this coming fiscal year will face a reduction of approximately 11 percent In the neighborhood of just under four hundred thousand dollars. That's you know, something that's been known for some time and so investments like these Investments at the federal at the state and the local level are all the more critical To ensure the success of our families of our young kids in our communities Straight just straightforward With respect to the child care developer fee study. I want to also thank you for your leadership in this regard Kathy Lathrop who's the director of our early childhood education child development program at bahara valley unified school district our largest provider of child care in this county um Once said to me when we were talking about the difficulties of you know, providing high quality child care for our kids the greatest difficulty Wasn't just money which is hard, but there really there actually are contracts available at the state level now it wasn't workforce Attracting and retaining the workers that we need though that is a critical challenge across the state in our county But her first answer was facilities That she simply cannot access the facilities facilities that her program needs to expand Programming that she may otherwise be able to expand So again, this is a team effort at the state and the local level But it it certainly is time to modernize this policy So I just want to again express on behalf of my commission and myself personally my appreciation Appreciation for the work of this board and your staff. Thank you Thank you for your work yet the Mr. Brody, I would say that the very words that you used to describe this department We could use the same to describe the work that you do at first five. So it's a mutual admiration society Thank you for waiting. Good morning. No problem. Uh, good morning. I'm larry drury. I'm the executive director of go kids uh, we're a child development agency that provides uh, subsidized child care for Uh, young families and so forth with young children across four counties santa cruz monoray San Marito and santa clara I have been the executive director of go kids for 18 years When I got here in 2000. I was dumbfounded by the developer fund Uh, child care ventures was involved in that back then with a lady by the name of marsham miers Who worked for the county office education who kind of spearheaded some of this stuff very innovative Um, as I go from county to county Uh, and some other areas of what I do in my I'm blessed to be able to do in my job I constantly get Oh, I might add also. I'm a resident at 18 years of aptos So, um, very familiar with what's goes on, but I get the questions. What are what santa cruz doing? You the reputation. I don't think you really understand sometimes of what santa cruz does How it spreads across from county to county across the state. I continue to to also Uh, foster that as well and make sure the messages get out there the whole thing with a thrive by three Again, I'm getting questions every time I go someplace. What santa cruz doing? And I'm just delighted to be able to share with them what is happening It is a very very unique initiative that is so long overdue When david talks about facilities Three years ago my agency applied for and received about $850,000 in new subsidies With a commitment from a couple places for facilities Those once we were awarded it those facilities fell through I have spent two years for almost three years Trying to find other facilities I decided I was not going to you know Limit it to one county or two counties or three counties. You just go after anything Finally last year coming clearly that we weren't going to find the facilities I had to give back that $850,000 to the state So it is it's a crying shame of those types of things happen Facilities are a huge huge issue Thank you Thank you. Thank you for that story Morning, mr. Or afternoon, mr. Simon. Hi, I'm civilly simon I uh This is such an incredible program and I want to echo that I really thrilled the county is taking it on Um, but I'm struggling with my own story When my daughter was born I stayed home for a year. Uh, so nina could continue work at the ma And uh, when I was then ready to put a lot more effort into working on homelessness and trying to find ways to build more affordable And workforce housing in our community I saw daycare for my our daughter and we found a wonderful licensed in-home daycare That we were thrilled with But after about four months It had to close and it was because the longtime residents Of that family that were running it who had raised their kids here lost their housing The owner wanted the housing back for themselves and they could not find anywhere else to rent Where they could continue running daycare and they moved to the central valley We found a new licensed in-home daycare that we were equally thrilled about Almost a year later the same thing happened The owner wanted their rental housing of at least a decade back to sell And they lost their housing They were able to find housing in our community community, but not housing would support them continuing to run daycare I'm just so deeply saddened that the way we find to fund this incredible program Is increasing fees on housing production. I think we can do better I would love to work if we do have time as you suggested zack I would love to work. I think there's a lot of stakeholders who would come together To find ways to have fees whether on properties whether on development That don't add. I know it sounds modest the amount of fee I know we haven't increased this particular fee unlike a lot of other fees Over many years, but we build almost no new rental housing in this county We build We're not building inclusionary housing that we could build And it just I I'm just It's hard for me not to be really emotional The fact that we're pitting these two objectives against each other when I think there's absolutely win-win solutions And I I want nothing more than to be a part of creating that I think this fee Should not be increased at all for Bonus density eligible housing. It means it's building more affordable housing Then is required by our inclusionary ordinance or for affordable housing itself And one of the challenges if we don't look carefully is, you know The opportunity to build a lot more less expensive or smaller rental housing is often in our mixed use zones Which means that housing has to build money losing commercial space Which means we're now paying more fees out of that as well. So I think also commercial Uses that are building a lot of housing, you know, it should not have this fee increase So I hope we can work a lot more On this so that we can provide even more funding for this program But doing a way that doesn't hurt creating low-income housing. Thank you Thank you, mr. Simon. Is there anybody else that'd like to address us Okay, seeing then we'll bring it back to the board. I mean, I'll just briefly say I'll turn it over to Supervisor Coonerty in a second. We agree. Mr. Simon exactly with that. We consider these complementary items As I said earlier, they both serve a purpose for working families. I don't consider The direction is to come back in October late October. So it's a long time to work On meeting these can on meeting both of these goals, which I consider to be complementary since it's the same Set of people that we're trying to work with Supervisor Coonerty. Yeah, so first Let me thank you again, and I'm excited I'm already excited for next year's budget report on the on the outcomes that we're hitting and What what we'll be doing then I'm going to move the recommended action with the additional direction that we look at Reducing or eliminating these fees for affordable housing and or and based on the testimony today and or developments to provide space for child care Facilities for child care in their in their development For the October and by the October meeting Motion from Supervisor Coonerty a second from Supervisor McPherson Ms. Timberlake that's it's broad direction to give you an opportunity to come back and understanding that the board's desires Do not have impacts on affordable housing. We appreciate that. Okay. Are there any other discussion before we vote on this item? All those in favor I Opposed it passes unanimously. Thank you for your work on that We'll move on to item six, which is to consider the 2018 19 proposed budgets of the health services agency including any supplemental budget materials as provided in the reference budget documents of the HSA 2017 18 goals and accomplishments the hsa Proposed budget line item detail supplemental unified fee schedule continuing agreement wished an errata All are you going to give the Presentation ma'am. Good morning. Good morning and welcome to your first budget presentation. Thank you It's my pleasure to be here and make sure that the microphone is on is it on at the base is a green There is a green light on how's that? You might want to get close to it so we can hear you Good morning chair friend honorable board of supervisors. My name is Mimi Hall. I'm As chair friend said I'm the interim director of the health services agency for county of santa cruz And it is my pleasure to be here for my first budget hearing with the county of santa cruz I'd actually like to invite our interim Administrative services director joe ferris to join me So I'll have a little company here They're gonna make you fly solo uh, that's right Good morning. So what I'd like to do today Is present the board in the public with An overview of the health services agency how we're organized I'd also like to go over our night 2017 18 goals and the accompanying highlights of our accomplishments related to those goals Provide a brief update regarding the hopes project Review our budget requests with the board Also go over some future issues and challenges that Will be presented to both the agency our partners in the county And finally end with some unmet needs Although we're doing lots of good work. There are there's still more work to be done so The health services agency is divided into five divisions administration public health environmental health clinic services and behavioral health Santa Cruz county is one of 61 local health jurisdictions in california We're one of 58 county health jurisdictions And the way that we fulfill the responsibility for providing some very specific publicly funded health services to all of the residents are through our five divisions of services So the kinds of programs and services that we deliver are really a broad range They can be from environmental and systems types preventive services or policy work All the way that are aimed at population health all the way to Very direct and specific services for individuals living in our community It's really important to note that the way we differ from the rest of the health care system Is that we are a safety net provider? And that means that we play a very critical role in providing care and services to low income medically underserved Immigrant and vulnerable communities As a safety net provider by definition We have a substantial share of the people that we serve who are uninsured who are on medicaid Or who are otherwise medically indigent So it's interesting for me as this being my first time budget presentation to go over the goals and the accomplishments of the health services agency I wasn't here for 17 18. So I do want to give a huge amount of kudos to the staff of the agency And in each of the divisions for their leadership and their dedication in reaching the goals for 17 18 The clinics division first I'd like to talk a little bit about what it does It oversees the county run federally qualified health care centers And those are the clinics that qualify for federal funding under section 330 of the public health services act We receive grant funding from HRSA, which is a health resources services administration To provide comprehensive services for our underserved populations This division is entirely focused on increasing access to high quality care for our community's Most vulnerable residents So in pursuit of that mission one of the things that the clinics division has done over not only 17 18 But the last several years is expanded its lines of service as much as possible And it has included things in its efforts over the last year such as integrated behavioral health Which is coordinating primary care with mental health services and alcohol and drug services increasing access to dental care And providing medication assisted treatment And for those of you who don't know what medication assisted treatment is it is It is one of the best ways to combat opioid addiction And in order to be able to provide this providers need something called an x waiver so that they can prescribe the appropriate types of drugs for this kind of treatment and In the past year the clinic has really focused on expanding the number of providers who are able to provide this as well as increase the number of Individuals that reach out we reach out to to engage in medication assisted treatment In terms of increasing access to primary care In 17 18 we provided I think by the time we end the year I just got the may reports this morning The estimates for ending the year will probably be closer to providing 91 000 visits this year Which I think is a staggering amount of service to provide To about 16 000 unduplicated patients so a little bit more than at the time that we developed this report In terms of enhancing patient care and quality The dollar amount that you see here is not important It is important to us because it helps us provide more services But we applied for a number of quality based awards meaning we receive incentives based on measures of the quality of care that we provide And through those efforts the clinics received 873 000 in quality awards In terms of expanding clinic space It's really hard to provide more services without having the physical capacity to do so similar to the discussion with child care services So one of the things that the agency is highly focused on is adding 17 patient rooms And this includes three rooms at our watsonville clinic In 14 rooms at the emeline campus Integrated behavioral health has been quite a journey Anytime you start something new that also involves additional staff as well as Leveraging new funding streams. It's always quite an administrative oversight and staffing effort And i'm proud to say that our integrated behavioral health visits Increased by 10 to 11 000 visits in 2017-18 Next i'd like to move on to public health A lot of people have a hard time quantifying or defining what public health is Our public health division like the 60 other health jurisdictions in california We have a role and an obligation to protect the public prevent disease and promote Good health by providing services such as prevention early intervention education treatment and policy change so a lot of our public health programs are They exist due to federal and state mandates and Fortunately on top of that we also have a lot of flexibility as a local government to decide how to best Identify our priorities and and move our funding to be responsive to those There were many Many goals in the public health department of which the division is proud of but i would say A few things that highlight The work of public health and the way they strategize and collaborate with many partners in the community One of them would be the hepatitis a outbreak that we had during 17-18 During the hepatitis a outbreak one of the things that the public health division did Was number one collaborate extensively with many many community partners from Our hospitals community clinics planned parenthood the ceo's office office of emergency services the Medical reserve corps and there are many more that i'm sure i'm going to forget But i think the point of it is that we had a potential epidemic Um that was successfully stopped due to the expertise of our epidemiologists our disease communicable disease experts And the ability of this entire county to join together with our chief public health strategists The other thing that i would like to highlight is um something that is often um Something very difficult to uh to address So one of the things that the public health department implements is our syringe exchange program or ssp syringe services program And over the last year, uh, we have Undertaken a lot of planning to ensure that folks who come in just for syringe exchange Also have um we use that program as a point of contact to engage people into further services So starting the first week of april we implemented a new pilot program to identify folks who um seemed amenable to primary care services and other services and we would do a warm handoff to take them from a confidential program of syringe exchange And transition them into primary care patients getting them into health care coverage other supportive services And most importantly integrated behavioral health and primary care Our behavioral health division Our behavioral health division in in a few more slides. I'll be talking a little bit more about one of its programs, uh, the hopes program Uh, but one of the things that we did want to highlight about behavioral health is that it is a very complicated Patchwork of different kinds of funding from federal to state to local to billable revenue And um, it is the largest portion of our health services agency budget at about 80 plus million dollars for 1819 And I would say that despite being a huge portion of our 169 million dollar budget The funds that we receive to provide these important services at many different levels to the community Are still not enough So to properly manage what we do in the behavioral health division is we continually reinvent ourselves to be in a state of transition so that we can Um, constantly take a look at the methodologies for implementing our services reprioritizing the populations who are most in need of our services And again, just like our clinics division expand our services as much as we can Environmental health so the environmental health division is one of those divisions that does look at protecting the health of the public And is uh, widely population focused Environmental health division provides all of our health related approvals and permits relating to land development We have a consumer protection unit that uh, inspects food facilities and public pools small water systems water resources and hazardous materials and um It is a really important part of a system of public health And I'm proud to say that santa cruz county has a really strong environmental health division And a really proactive and effective water resources management department as well Um, I think that the county is really lucky to have such great staff in that division um Some of the things that they've done this year are streamland land land use and permit processes by using technology for plan review And field and office operations They were a key partner in the hepe outbreak and the county's response One of the things that's really important to the department is um, its service to its customers This is an outward facing department and it does a lot of service both in its own At its county site and also out in the field and um, the environmental health division provided um implemented a customer satisfaction survey that uh Had very positive responses and let us know Where we were doing well where we could have room for improvement and um And I think that it's through this continuous seeking of feedback from those that we serve that we improve So kudos to them for that effort The the one slide that we don't have here is um a slide for our administrative division. I'm going to go back one And um, I just wanted to take a moment to say even though there weren't goals in um In last year 17 18 budget for the administrative division It plays an extremely important role in the health services agency When you have such a complex, uh, county department that provides Many a wide range of health services that are many of them are mandated It also comes with a high level of regulation a lot of reporting requirements and um fiscal accountability And without a really strong administrative division We wouldn't be able to meet our not only compliance but properly serve the residents of santa cruse county Which is really the whole reason that we exist So with that I'd like to transition Into an update on the hopes team model of service delivery. We were before the board I believe it was in may on may 22nd providing an update of the hopes team model Hopes is the homeless outreach proactive engagement and services team This team began its operations just about 12 weeks ago on march 12th 2018 And in the 12 weeks that it's been in operation. It has received 113 referrals Out of those 113 referrals that the team has received 70 individuals, which is about 62 Have been connected to community services or continue have continued outreach within the 12 12 weeks of the program start Um, it's interesting. I had a discussion with staff about is this a good number? Is it a bad number? Um, I think this is actually pretty darn impactful Uh, for those of you who aren't familiar with what the hopes team does they do outreach to our community's most difficult to engage citizens Many of them are homeless and actually, um being homeless is one of the things that is an identifying factor in why we might outreach to you But these folks that we're targeting also are dealing with mental health issues substance use disorder issues and many many other factors as well as health factors And engaging this population in care is something that takes a lot of intensive effort and outreach on behalf of our staff and many partners So our staff continues to reach out to the 43 individuals That haven't engaged in services Many of those that haven't engaged in services. It's because they're very difficult to find and their transient population But they remain on our radar and our our staff continually works to engage them The last time we were here before the board to provide a hopes update We talked about 33 performance measures in five domain areas And one of the things that we will be doing in the 1819 fiscal year is Searching for an evaluator to help identify An eval a process evaluation and ensure that as we move forward that we're actually making the kinds of impacts That we desire rather than just counting number of persons served number of persons assessed We really want to be able to measure the difference that we made So the other piece of the hopes team is the specialty courts that this team works with um I think that when we started so one of the things I wanted to kind of Redefine about hopes is that hopes is not something new It's not a new program. It's not a new set of staff people Hopes is a way to take the resources that we already have in place um from our emergency response teams to our most teams to homeless persons health care project And bring them all together in a multi disciplinary team manner to meet regularly and Review how we're going to best wrap our services around those people who are most in need so So given that we continue to work with the specialty courts that already exist There's the bobbly community partnership of accountability connection and treatment Which is our PAC court the behavioral health court um And in the pursuit of continuing to work with the courts our next steps are to Try to work with the courts and other reporting agencies to figure out how we can properly Properly analyze unduplicated counts of clients for reporting categories And the other thing that we're interested to do in doing in 1819 is to continue leveraging All of the resources that we have through our multiple program partners Now we'll move on to the budget discussion So as I mentioned briefly in an earlier slide Our recommended budget for the health services agency for 1819 is 169 million 295 $588 and What this slide shows is And There's an issue of semantics here The pie chart on your left is labeled general fund supported These are not county general funds, but general funds in terms of being county generated funds So about 166 million dollars of our budget is are generated by county funds And those are the core services Provided by the agency Which as I mentioned before behavioral health is the largest part of the of our budget and it's also our largest division We have our clinic services, which is The next largest part of our budget public health services environmental health and administration On the non general fund supported areas we have Fees and fine fees that come in for charges for services damages fines etc that fund our csa 12 and also our zone 4 And fish and game and that budget is about 3.1 million dollars The health services agency thought it would be important to Uh show the tenure trend of our health services agency budget as you can see The tenure trend is upward and our revenues and accompanying expenditures have increased As we have worked over the years to try to figure out how to increase our service delivery capacity And our ability to remain fluid to meet the changing means of our community The total budget for The health services agency Is on a steady curve up and it remains at the same proportion to Nound county revenues and net county cost The net county cost or which would be A general fund contribution to our hsa budget this year is just under six percent of our total budget Of the almost 10 million dollars in support that the county general fund provides to us you can see How uh how these funds are proportioned and distributed across our divisions And I believe this is the the last fiscal fiscal slide that we have which is our Trend of full-time equivalent staff positions So you can see that although we have slightly increased from From 10 11 to about 15 16 there's been a relatively static amount of staff positions And um in 17 18 we had a bump and you will recall that we received Because of a lot of the needs that happened in our community We had many many changes in 17 18 particularly in behavioral health So one of the things that we did was uh the agency Pursued and received the whole person care grant which is 20 million dollars over several years So many positions were associated with that the other thing that we have done is we've implemented drug medical organized delivery system And um implementing that which really expands access to alcohol and drug substance use disorder services also added some positions And the other piece of that is that our clinics division pursued Care coordination grants and they received five new care coordination grants with a total of I believe it was 11 positions So because of all of this new funding and all of these new efforts, we were able to add several FTEs And that's all good news. One of the things that I would like to note is that um despite having the money to Create these positions. We're still having difficulty filling them I'll talk a little bit about that in our future issues and challenges So next I'd like to present to the board and members of the public our supplemental budget request for this year Our supplemental budget request is a total of 352 thousand dollars and you can see the detail of Where this request is uh divvied up We'd like to have some extra help staff to assist with our whole person care In public health those of you who are familiar with prop 56 It was passed this during this fiscal year And it provides additional funds for tobacco prevention and oral health At the time that prop 56 passed we were told that we would not be able to have rollover funds for tobacco Or well actually or oral health. So most of this 200 thousand dollars is Available money to our tobacco program that can roll over into the next fiscal year In behavioral health, we received a no place like home technical assistance grant that we hope will be very helpful to the county Homeless services and all of our partners in securing additional funds for homelessness And in environmental health, there is a request for a vehicle for remote area inspections It's very difficult to get into some of our more remote areas with a regular Compact car So that is our request for the supplemental budget for 1819 So now I'd like to Change course and talk about our future issues and challenges We talked a lot Today well today. We're here for budget This is our budget hearing and um in the world of health and human services. There are many evolving funding issues Over the last several years We have had as counties some major dramatic shifts to how We are our core services are funded by the state In addition our federal our federal funding and some of our other local revenues have also shifted What this has done as you can see from some of the discussion in The earlier slides Is that as a health services agency we've had to increase our reliance on grant funding We've had to be a little bit more creative about how we leverage additional funds And by necessity I think the only way that we can continue to properly serve the public is to Place an increasing importance on partnerships both within the county and outside of the county The other thing that we've done is we've had to respond to these federal and state shifts and funding by reshaping and restructuring how we deliver our services and programs and um It's been something that luckily we have staff with the talent and the drive and the passion to do But it's also something that creates an constant change for our community So changing service demands This morning we had rainy mar talking about homeless services We had a discussion from the human services department ellen timberlake and her staff About some of the really important pressing issues that are under the charge of their department And it's clear to us as a county and as a set of partners that we don't have enough resources to address all of these things That are impacting the health and well-being of our residents We are faced with issues such as poverty unemployment housing substance abuse mental health and crime And they are all inextricably interlinked And what we find as a health services agency is that the services that we provide We have always provided and we will continue to provide whether it's family planning nurse family partnership home visiting Hiv care and counseling case management Whatever it is we're still going to provide those but we are seeing a higher and higher proportion of the people that we serve in those programs Experiencing homelessness Experiencing food insecurity and that is a shift and that that is a a trend that we expect to continue And we expect to continually be fluid and work with our partners to address that So um and that that is why We are the nature of our work and the fact that we're continually searching new funds and reorganizing how we deliver our services changes So what does that mean the issues that arise from this rapid growth and innovation mean that We have a commitment to invest in workforce Infrastructure adequacy and development You know, we can't serve the people in our community properly if we don't have a workforce that is well taken care of well trained able to earn a living wage and feel like they're prepared for some of The stressors of the type of work that they do as public servants in this field We also need to prioritize investments in data Technology and they end the ability to measure what we do Are we making a difference and on top of all of that what we have to do is maintain our focus on that foundational core mandated Health services that we're required to do And I mentioned before you know part of our challenge in health services Is that we are constrained by this very complicated network of funding And restrictions on its use and we're continually trying to be creative on how to blend that to best meet the public's needs So looking to the future, I would like to provide a commitment to this board and to the community That we as health services are committed to being a part of the collaboration that happens in this county most importantly I would like to express the need for the nexus between health health services and human services That is kind of the peak of the pyramid in terms of meeting people's basic core needs So we really look forward in health in the health services agency to continue the foundation Of collaboration and partnership with the health service with the human services department In addition to that we have this Really incredible network of partnerships through um through Community partners through other community clinics that are safety net clinics and partner with the county through many of our community Non-profits law enforcement. There are too many to name But I think that the theme of the future is and I've said this before so excuse me for those who hear me saying this all the time Government alone can't solve all of these very important towering social issues that we're facing today So um today I commit to the board that the health services agency wants to be a part Of that solution along with our community partners along with the rest of the health services system in the community Along with the board along with law enforcement along with h s d um And again because of this time of great change. I think it's important to note That it's important for our own department to invest in our future infrastructure With all of this constant change one of my fears for the future of health services is unless we pay attention to how well we're organized And that um our goals and our priority setting and our planning is well aligned with the rest of the county We'll be an island and so What we want to do is move forward being mindful of the larger efforts of our health care system our city partners And also the county as a broader organization So my second to last side is really to talk about the fact that while we've done great work And a lot of progress has been made and the health services agency in partnership with many of other departments and others in the community has made great strides in Leveraging as much as we can Applying for as many grants as we can we still have some unmet needs I talked a little bit about um the hopes The hopes team model and its efforts to address those most difficult to engage members of our community and um It's great that we outreach to 113 individuals in the first 12 weeks and that we were able to engage 70 in services That means there's still 43 individuals that were In high enough need that um That someone took the time whether it was the police department the sheriff's office a community member to call us But it doesn't mean that we can convince people to engage in services So one of the things that we need is some focused effort on the high need and hard to engage folks As many of you know for health services People still have to consent to our services And we put a lot of intensive effort to get folks um to that point But sometimes our efforts alone are not enough So what we really would like to do is find a way to leverage our partnerships and leverage resources So that we can better engage this high need hard to engage population the other The other area of unmet need that we have is the need to improve public safety With all these important issues that we've talked about the resulting impacts of poverty of lack of access to services has resulted in In a more visible A more visible threat sometimes to public safety especially in some of our more populated areas And um what we'd really like to do is work more closely In in combination with law enforcement the city and other folks so that we can really Intensively target the folks who are most in need of services And um find some new resources to fill the gaps that we just can't get to with our existing programs and staff Some of the strategies that we have been exploring in partnership with our sheriff's office Our um evidence-based focus deterred focused deterrence initiatives. These are initiatives that um wrap a team of clinicians care coordinators case managers and even nurse practitioners with law enforcement um to Again target those individuals who are um least open to services, but also most in need of them And um we believe that in the future if we can do a little bit more work in Figuring out how to develop our own pilot program that there can be a way for us as a county to address this very important unmet need and finally Our recommended budget for this year I would respectfully request that the board approve the proposed budget of the health services agency for fiscal year 1819 Including any of our supplemental materials our supplemental budget as recommended by the county administrative officer And before I close I just wanted to express my immense gratitude to county of santa cruz the ceo's office Especially the human services department for all of their support in my first few weeks here in santa cruz county and the incredible staff of the health services agency who Really have put forth all of the work to um That resulted in the accomplishments of the past year and also resulted in the budget that you see before you Thank you miss all of any brief questions or comments from board members Survisor coonerty and then suffrage leopold. Yeah, just uh two comments. The first is uh use the word staggering Uh one point and when you look down the list Of what you're planning this year of doubling the number of treatment beds Enrolling the thousand highest utilizers of the health care system through the whole person care initiative clinic expansions both at ameline and waspville implementing hopes and the mental other mental health programs environmental health And public health initiatives which will both be the daily business as well as likely um some new emergency that we are we don't know about today The whole child initiative, uh, which is uh kids who are High of high medical needs and are being Shifted to us to make sure we're care approving our ambulance contract Then as you said aligning with the overall county and then with the community That is a um daunting list of to-dos and i think it's really incumbent Upon you and your team to make sure you're reaching out to us and to the ceo's office For the support you need because these are many of the most critical issues Facing both individuals and the community and you have to be successful Uh, and so we need to get you the resources so that you can be successful And see the outcomes and the second part is uh, I was really grateful for you to Outline the unmet need which is these the few high impact individuals who are having a tremendous impact on neighborhoods and our public spaces Who are resistant to services and who we need? Your your workers Can't solve it alone Public safety can't solve it alone. We need a coordinated response A community is banking us for it And it's incumbent upon us to figure out a way to provide those services And so I appreciate you outlining the framework for how we could do that now. It's a matter of Developing the resources and getting them into place. So thank you So far so good. Thank you chair Thank you, miss hall for the presentation For someone who hasn't been here this long to be able to cover the breadth of the health services agency Is is a daunting task in and of itself? You did a very good job and you know, I appreciate the humbleness of not taking credit for something in which you didn't do Um, medical professionals sometimes do that a lot and I'm appreciative of that Uh, you have a very as I look over at the staff that you have here. You have some Incredible staff and staff that will be able to help you around the issues that Are incredibly important. Um, I appreciate that Through the work of the department the drug Medi-Cal waiver the whole person care That we're beginning to see resources to increase our substance use disorder treatment services And we're not 100 percent there a treatment on demand, but it's something that that the staff And our community partners are going to have to work towards achieving To be able to really help the need I i'm glad that you spoke very favorably about medicated assisted treatment because I do believe that that is an incredibly important tool for us As we see the opioid epidemic happen here and as we know that the other Uh, the other issues of of substance use disorder Require that treatment like that is incredibly important. Um, the uh Likewise The changes that are being suggested or in place now with the syringe services program Seems to me to be An a good evolution of that program To to be able to to meet the need that you know that program's been around for over 25 years But to really help it achieve its goals and getting People in that program into primary care connected with doctors Is is uh an important part of that program and I'm glad to see that the staff has worked To help make that happen you know The accreditation process that you Mention only briefly. I think as important. Ms. Randolph has been heading that up For the department has been doing a good job. I think it's very critical to finish out all the pieces of that and And I think it's been a good exercise for us to identify The strength of our program and the gaps that we have in the community Dr. Leff and heading up our public health, you know, he's he's only fought off another epidemic here in Santa Cruz and his uh in his long career. He's had a couple of those And they got thrown a curve last year and he and the public health staff along with everyone else worked very hard To ensure that it didn't get worse here in Santa Cruz And if we look at around the state where there were other outbreaks We can see that the strategies that we used here were very successful Our clinics do an incredible job under uh miss peeler And they become very important. I'm glad we've been able to expand Uh Exam rooms so we can meet the needs of people who come To our clinics Eric riera and the behavioral health program They're really a critical part of the health services agency and sort of the way in which the the community also interacts with the department And the efforts to increase The crisis intervention teams the the mobile teams the partnership with law enforcement's the the partnership with community based organizations to We have to continue deepening that work. I think you've highlighted that in in sort of where we need to go and uh, and I think I would say to our county administrative officer That i'm sure this is an area that we're going to be looking at when we talk to the sheriff On thursday, but this idea of a partnership between Behavioral health and law enforcement We have to deepen and we have to find the resources to be able to to make that happen And i'm glad that your commitment is there to that collaboration because In health care to me collaboration is is Is the secret sauce to getting things done um Lastly the environmental health program is the is the is the poor stepchild of the of the Health services agency both the ongoing work that it does with restaurants and everything But when we when we look at our water resources division and our septic program and all those pieces It's incredibly important and I see John ricker here who plays an incredibly important role Along with sierra ryan and the others and the water resources the division dealing with Just another pressing issue we have here, which is water And though their work there has been incredibly important in terms of shaping the community discussion and bringing people to the table And I appreciate the work and I can tell it's a budget day because mr. Ricker is here in a jacket Usually we don't get that combination We're going to take a picture later Um, the last question I had about the hopes program Um, we talked about coming back in october with an evaluation or evaluation Uh, or picking an evaluator and I think evaluation is critical Um, um in the program and the the the question I have is Um The program will will and this new configuration is kind of new Will we have enough data to be doing an effective evaluation? Um You know starting in 2019 or do we need to have a year or two of the program to know where we're going with that? Well We don't have baseline data. That's what we're collecting right now And part of the reason we're going out to bid for an evaluator is To ensure that You know Eric and his staff put a lot of work into identifying those 33 performance measures across five focus areas But are those really the measures of success? Are those things that we're collecting information on on a regular basis? Really the widgets that show us we're making a difference And so I think part of what we want to do with this evaluator Is look at that widget counting for the first six months three quarters of a year in a year And start seeing if other factors go down Um, if we follow an individual over time, are they being arrested less often? Um, has has someone who was placed in a shelter placed in permanent supportive housing are they still engaging in services? There are all these things that are the true factors on are we making a difference and some of them are part of those 33 measures Um, I think others we may be Working and we don't the goal with hiring that evaluator is not so that they can sit in a room And pick out, you know, how do we make a difference? It really is engaging our partners from the board to law enforcement to others that Teamed together with us to to set those measures of what difference did we make? Well, I think you know the the 33 measures over across five That has been expressed at the board that that um, that number isn't the important part and there are some who've been concerned that that that Amount of measures might actually detract from actually getting the work done So I hope that the evaluator will take a look at that and make sure that we have good measures Um that are can be effective and can tell the story without getting in the way of doing the program If you don't mind one of the things that I'd like to add that will Assist in this effort as well as many other data collection efforts is working with seho on our health information exchange One of the things that will be happening this fiscal year is working with that organization so that we can have exchangeable data Not just among health care providers, but other support services And I think that's one of the biggest barriers that we have in being able to see are we making a difference How where do we need to course correct? The last thing I'll say is uh, uh, I mentioned earlier that collaboration is key and I see we have members of some of our community based partners here today, but Health and public health, you know, it only works to me if there's really um close coordination with the community with our other partners whether it be hsd law enforcement the safety net clinics and In your role if you can be speaking about the importance of health and as we look And through that lens and almost everything we do I think we'll end up at better programs across the board those within the agencies and those without so Thank you for your work. Thank you Supervisor McPherson Yes, it's evident and thank you for your very great presentation presentation. It's obviously it's obvious that you're Doing a lot, but there's lots to do And and some of it's new and the need for coordinated responses was mentioned is is vital There are probably Week in and week out my office gets Calls on three things in particular health and human services as one Water and transportation and you're right in the middle of three of those four um, I um the the spike in the number of employees because of new funding and I Notice that of your budget. It's really about supported by about 20 10 percent of county funds And then we're so reliant on state and federal Um, how many of these grants you can live and dive by the sword so to speak with grants How many of them are One to two years or how do they usually come? Are they categorized in? Time factors, so I'm just trying to think if you've gotten a surge of grants, uh, and we're doing these new programs Whether it be, you know, the homeless issue itself or the hepatitis a outbreak and we have to really put a lot of resources into that immediately How many of them are short term or is it are there any categories that they usually come in? I'm sure in multi years, but are they five years or are they two or it depends on the funding stream So um, and yeah, so for example the prop 56 funds for tobacco prevention and oral health That's a tax on tobacco. So as long as people are buying tobacco, we will have those funds I expect that as we get better at our work as a state that those funds would decrease But I think what you're getting at is how stable is our funding? And the way that I look at the funding for health and human services Is that There are always needs and the funding is always shifting But what you don't see is you if you look at our trend in our budget you haven't seen it really Level out or even dip although Some of our categorical ongoing federal and state funding streams have And I would say that because as a country as a nation When we have huge problems like the opioid epidemic. So in the next couple of years I expect to be we already are seeing them coming through Across our desks. There are numerous opportunities Both for counties and other health system partners to work on prevention intervention treatment Same thing with homelessness. So I think it's not so much what are the current grants that you have and when are they going away and I will say nothing's permanent So many of our grants that were competitive like whole person care and those things they do have time frames Some of them are one year. Some of them are two years. Some are four and five year And so our role as a health services agency is to look further into the future and to continually pursue the funds That are coming down the pike to help those of us in local jurisdictions address What's right in front of us today and you know if you look at how health services was funded 10 years ago Especially the competitive funding is very different from the funds that we have today I would never have guessed that we would have these huge amount of funds for homelessness and opioid addiction But we do because those are the problems of today So as our I think our charge is to remain flexible and continually pursue a new way to reinvent ourselves in terms of funding And because of the size of our budget If one of the worries is staffing and attrition We do know that we're large enough that if we see losses in funding Let's say in the next two years or three years. We're able to manage that with attrition Okay. Well, thank you very much and thank you and the whole health services agency for being adaptive and forward looking at the same time And being really ready to address and Coming to meet the needs of the people of our county. I appreciate it very much. Thank you. Thank you Thank you and Behavioral health is Replacing mental health as far as the terminology, correct Well behavioral health encompasses mental health as well as substance use disorder services, which in the past was called addiction services Yeah, so it's combination not not a replacement. I see the change taking place. Yeah It said something about 11 000 visits at I believe is that at the watsonville Uh, south county facility for I think for counseling or mental health Issues I believe that's our combined Not just watsonville. Are you talking about behavioral health services or clinic services? Yeah Okay, and then with the new facility going in that's being built right now I Suspect that number will go way up. That's our hope. So in watsonville We have Three additional clinic rooms. We are expanding integrated behavioral health there, which means combining behavioral health services with primary care And we're also hoping to have an additional treatment room for therapy right It's going to be a great asset to south county because The way it was set up before people were kind of even tripping over each other trying to visit from one office to the next So it's it's great On pages 128 and 129 of the budget I got a little bit confused because it says Behavioral health In the general fund division Is 81 million 541,000 Then you go over to the next page 129 and it says expenditures It has actually public health is 81 million 541 Then you have behavioral health 41. They switch places Yeah, I think joe ferris is going to address it. That was corrected in our irata joe. Do you want to speak to that? Yeah, so the labeling of the the first column was Transposed in the second page on 129 for The both the general fund and other fund sections and that was corrected in the supplemental irata So that that is a typo Okay, thank you. So a behavioral health is Much larger costs than actual public health physical health or whatever So I would say that the reason for that is because public health is preventive in nature It's population-based. We prevent communicable disease. We look at population-based strategies behavioral health is direct services And so providing services to individuals who need them on a regular basis is expensive It takes psychiatrists nurse practitioners clinicians um medical assistants um So it is the most intensive part of the direct services that we do And and that's why and it's also the most costly. So that's why you see it being such a large portion of our budget You're welcome I'll be uh, I just have a brief question Because my colleagues have covered most of it. It actually deals with zone four and since mr. Ricker got dressed up I figure I might as well bring him up here On television for everybody to be able to see it. Congratulations. Look at that. Mr. Ricker. Yeah, I know It's a very nice. Yeah, mr. Ricker. Very nice. Yeah You can get good things from the goodwill So, uh, we'd received a letter from rcd Requesting continued funds to provide technical assistance for county residents on storm damage repair as well as the resource management programs last year This board allocated Money for it under the zone four budget I I didn't notice it in there And I wasn't sure if this would be an adverse impact on the zone four budget But would be something I think that that we'd like to see happen again They've done a lot of good work if you could just very briefly address that sure Yes, they have done a lot of good work that supports what we're trying to do in terms of both watershed management and in groundwater management, too We do have the funds in zone four already in the budget that would be available some of the Costs that we had projected are going to turn out to be lower. So there is money available and We plan to come back in august to to make that allocation Okay, so do you need specific board recommendation to come back in august for that recommendation or you'll just bring it back We'll just bring it back. Thank you. Thank you very much Well now open it up for the community. I appreciate everybody's been waiting so patiently here if you could Have any questions or concerns regarding the hsa budget now would be your opportunity to speak on this budget. I am Good afternoon and welcome. Good afternoon supervisors. Thank you for the opportunity to address you here today My name is Justin Palmer. I'm an organizer with the national union of health care workers nuhw We represent 14 000 workers across the state including workers here in santa cruz at sutter vna Dominican hospital and janice of santa cruz Janice is the county's leading provider of substance abuse services, which include residential and intensive outpatient programs methadone clinics a dui program perinatal care and a sobering center Um last year the 85 workers at janice Many of whom are here today Petitioned and voted almost unanimously to form a union One of the main issues driving their effort to organize was the obscenely low poverty wages Which lead to high turnover at janice and diminish the agency's ability to provide quality care for its clients um counselors at janice Providing treatment make as low as 16 dollars an hour And 75 of the treatment texts there earn a wage below the county's living wage ordinance Which as you probably know does not apply to the nonprofit sector So some of the folks here today are going to speak directly to the issue I applaud them for being here that many of them, uh, you know took time out of their Scheduled to be here from 9 a.m. And they're going on their way to work In a minute or two But the bottom line is this Workers providing frontline care at the center of the opioid epidemic in santa cruz deserve to earn A living wage a wage that allows them to care from their for themselves and their families If we want to be serious about fighting the opioid epidemic In santa cruz, um, we need to be serious about providing the hardworking people who are leading that fight a livable income Janice received 70 percent of its funding from the county We are here to urge you to increase funding for the subcontractors who make the vital work of substance abuse treatment possible In short poverty wages short changes substance abuse services. Thank you Thank you Good afternoon. Welcome. Thank you all for waiting Good afternoon. Thank you a little sleepy. I walked to work till 11 30 last night and I'm gonna head back to work here in about an hour So I could become coherent in my thoughts You know, I was getting some groceries the other day in midtown In santa cruz and I parked my car across the street and I go across the street There's a youngster. It looks like a baby laying on a heap of trash Trying to find a vein to shoot some heroin just right there in the parking lot And I I kind of bent down to him and I said I I'm not trying to talk you into anything here I said, but there is there is another way. There's drugmedical now and there's a place called janice And when you're ready come by and see us and um, and it's just really sad. You look like a baby And so I work in that field And I've been a janice now for almost nine years And making less than 16 dollars an hour and I've been there for almost nine years I don't know what that means if that means anything Um, I know that there's been a really high turnover in the last 90 percent of our clients I believe I don't know if that's a true number, but a large percentage of our clients Could be 90 percent or drugmedical clients now since the waiver Went through at the beginning of the year And along with that we have we're getting a higher and higher acuity level of clients and that's sort of a A phrase that's thrown around as far as the complexity of the clients a lot a Duel and and multi and poly diagnosed mental health clients along with substance abuse And we had a client just recently that um had a big cudgel in his hand almost like a baseball bat Don't get close to me and so we're getting those kind of clients and we're working with those kind of clients And I had to ask him to for his walking stick and um I sat with a girl That came in a week ago that I took kind of through detox because I've been I've been a med medication Med tech for the last five years and I'm helped her get her through detox Oops, and she's just said thank you for being so kind She goes you seem to be know what you seem to know what's going on around here But not very many of the texts do and and I kind of made me sad because we all have been getting a really high turnover Higher I think in the last two years. We've had gone through More uh more employees than in my first six years working there either Getting let go or resigning and I don't know if that's indirect correlation to wages Um, but I suspect that might be true And so often I find myself not be able to give services But having to go and explain to some man working with what we need to do next Because they've only been there for two or three weeks because that person that was there for four months quit On that sort of thing and I don't know if higher wages would help or not I'm just I'm here to report that um It's a very sad experience and and also a very rewarding experience And I love what I do and I'd like to be able to continue doing what I do and to live in Santa Cruz. Thank you Thank you Good afternoon. Thank you for waiting Hi, my name is Jason Lubin. I'm a certified drug and alcohol counselor at janice Currently working in the dui department Probably I'm one of the Senior employees at janice, even though I you know, I've been working there often on since 1999 I'm also a Former patient of janice. I have a lot of uh What can I say respect and gratitude? That they helped me change my life around and I've been working in this field for quite a while um, and we brought up We're talking about The Low morale that's starting to set in with the Huge turnover of employees that we currently have in the last two or three years. I've just never seen this kind of turnover um I'm also on the Union bargaining team where we're talking about wages. I just want to share with you a little bit about my situation I am a counselor too Right, and I'm currently working with Just about a dollar two over the Santa Cruz living wage limit. So I'm making 17 dollars and 23 cents counselor to I'm working part-time Not the part-time where you get benefits. I'm working under More or less about 18 or 20 hours a week because in my department, they don't seem to be hiring people To work part-time with benefits. So i'm uh On medicow now Because I actually can't afford I can't afford to uh Uh Pay the premiums for medicare. So i'm on medicaid I I live in a 22 foot travel trailer. The rent is increasing Uh, I've been living there for quite a while Uh, it's just a real difficult time Making ends meet and uh, janice we know has gotten a lot of money to increase their infrastructure to expand Their infrastructure. They're doing a great job at that Brand new industrial kitchen. They put in sprinklers throughout the whole facility They just bought a 60 000 brand new 12-seater van They just uh, rebuilt the intensive outpatient House, which is a separate little, you know, small house facility And I you know And I just want to say that That doesn't seem to be money going into Thank you human resource infrastructure, right? People are struggling left and right just to make ends meet. Thank you Thanks for sharing that story Good afternoon. Thank you for waiting. Hi. Um, my name is lia. I work at the uh, perinatal facility for janice And let me start by saying that I absolutely love my job, but that doesn't make it easy I work with babies straight out of the nicu Who are on morphine doses? I work with women who are directly affected by this opioid epidemic women on methadone women working with the methadone clinic and Helping administer those doses and whatnot We have I feel it's just very complicated For us to continue this work. Luckily at this point in time. I am not Relying on this as I mean income. I'm mostly supported In terms of rent and all of those things, but if it weren't for that, I don't think I could continue to work like this But like I said, I love my job And that's kind of what keeps a lot of me and I know a lot of my co-workers What keeps us banded together is seeing the impact that our work has on these women And seeing them come back and say, oh, I'm so grateful that for the time I spent here But it's just not necessarily a conducive work environment for some of us and I would love to Preach to everyone that this job is You know, it's not only rewarding Emotionally, but it's also rewarding financially. Um, I would love to advocate for that But unfortunately at this point of time, there's people that I cannot Convince to get into this line of work because of the pay and I feel that that's why our turnover is so common and I feel that the turnover in employees has a direct correlation to the turnover of Our clients because they see the disconnect between staff and they see the inconsistencies and I think that it directly impacts them because then they're wondering well Why don't people want to stick around for me? And yeah, I feel that it would just be beneficial to Our clients for us to have a lower turnover rate That's all I really have to say and thank you for providing this space for me to Speak to you guys today and I know a lot of people have left But thank you to everyone who has these Who works at these agencies that we tend to see these women working with such as families and transition and you know Homeless health services and all of that. So thank you. Thank you Good afternoon. Good afternoon gentlemen. Thanks for your time. Bear with my nerves here My name is matt matt van eyes. I'm an iot counselor intensive outpatient treatment counselor janice of santa cruz 10 years ago though my partner and I were homeless on the streets of santa cruz for three years We went from sleeping in the bushes of the red church downtown To a tent behind natural bridges to finally getting this horrible looking van That was so menacing looking we called it the 1984 ford kidnapper because it was just a real eyesore And we parked that all around town I shop lifted from safeway daily I ran receipts cams at cbs I stole personal property from cars I was in and out of jail on a regular basis And short I was a drain on the system. I was a drain on your budget and I was a drain on the community at large Um, I wasn't a bad person inside. I was just hopelessly Hooked on crystal meth and I didn't know what to do and I didn't see a way out Eventually my life came to a head and I realized I needed to change. I didn't know how to do that So I began that journey as a client of janice and their residential treatment facility there At this point. I'm coming up on seven years in recovery I'm a contributing member of society I'm grateful to pay it forward through my work Doing a iot counseling I'm doubly grateful to be expecting my first child In october along with that same partner. Um, who got into recovery as well The problem is that I can barely make ends meet without a kid Let alone with one and I don't want to quit my job And my calling because I can't make enough money and you don't want me to quit I make a difference out there. I make a difference in everyone's pocket book as a result Every addict that enters recovery is money and misery saved Continuity of care is crucial in this field relationships are key to our success And turnover is the absolute enemy of recovery and the services that we do And turnover is at an all-time high and I am certain that it's because of wages Um, so, um, I don't want to have to quit but I will if I can't make more money and enough money to be able to raise a family Um, so I'm appealing to you to help us. Uh, who are committed to creating positive change Be able to earn a living wage while we continue to do that And continue to do the good work in the community that we do and to reiterate what Justin said Poverty wages short changes substance abuse services. So thank you very much Thank you for sharing that story. Good afternoon and welcome Good afternoon. My name is Joe commonsense. I'm actually a former employee of janice. I'm one of those people who had to leave for wage reasons um So I worked at the perinatal unit because I do have a master of public health I have a passion for public health and I have a real interest in maternal and child health So I thought this would be the perfect place for me and in many ways janice was the perfect place I'm also a birth worker. So I could Share my birth my birth worker skills and my knowledge of public health and My compassion for women and their children who are struggling in some of the worst worst times of their life But in general my observations about the counselors and the treatment texts We all greatly enjoy our work and As treatment technicians, we deliver the vast majority of services that the agency bills for We handle life-threatening situations We risk our own personal safety yet we use impeccable judgment we cope with verbal abuse and We're also using different evidence-based treatment modalities to the best of our ability We're constantly solving complex problems And trying to make the best improvements that we can And the job duties of the treatment technician have grown immensely But the compensation hasn't remained stagnant Most people are starting around 12 dollars an hour at janice if you're lucky you'll make 13 because I had a master's degree I got to start at 13 McDonald's people McDonald's workers in santa cruz started 11 50 Panda express cashiers. They're starting pay is 13 to 15 dollars an hour in an out burger associate pay $14 an hour 16 50 after three months And I want to echo the statement by me me hall the workforce needs to be taken care of And we need the resources to be successful and I wish I could have stayed at janice But now actually I work somewhere I make almost double what I was making And I have full benefits. So I mean I just it wasn't really a sound decision for me to say I have a son and as you all know rents a little pricey around here and Yeah, it's just really sad the turnover rate and I do Miss working with my clientele And I work with a much easier clientele to work with now But that was just the choice they had to make And I also want to echo just in statement that poverty wages Shortchange behavioral health services. Thank you for your time Thank you Good afternoon and welcome. Good afternoon. Thank you gentlemen for being here Board and staff. My name is Stephen sills The treatment technician of jazz of santa cruz and I work in the detox unit I've been there a little over 13 years And I'm also a lifetime resident of santa cruz county So I have seen The cost of living in santa cruz county just go up and up and up I'm very fortunate that I do have a housemate to share expenses with But if it wasn't for that, I probably would be Hotelling it or something. I don't know even hotels are out of price nowadays Um I don't want to make it all about wages, but As expressed by my other workers The turnover right now is immense Like I've never seen it this bad in my 13 years there We used to have a solid core of counters Treatment technicians and we could just count each other. We knew our moves. We knew what was going on Now it's like you train somebody for a week or two They're moving to a desert department or they're going off to another job More weight better pay and echo other people it's like continuation of care We've had clients come back many many times and uh Justin myself and scott are about the only people that are left from a long long way back when And to come in and see a familiar face Just makes it that much easier for our clients and our patients to Say hey, you know, this is the safe place to be and I'll make a pretty decent wage but In the meantime, it you know the cost of living is going up Expenses every word is just going up and right now it's like What do I do? Do I get another job? I'm a full-time employee I don't know if I can Do another part-time job But anyway, thank you for listening. Thank you for being here and carry on. Thank you Thank you Good afternoon. Thanks for waiting. Hi, my name is branch. I work at the methadone clinic in town And so there's a theme of just hearing a lot of turnover And you know, I've had clients come to me. I get them from another counselor who's left You're the fourth counselor. I've had here, you know Are you gonna leave soon? You know, I say no, I'm probably gonna stick around for a while We'll see, you know, um, so it's basically about investing in the quality of care we're giving. That's all it is Investing in the quality of care Just In the counseling and the detoxes and it can get pretty ugly as far as dealing with some of the mental health and substance abuse Clients there's a lot of strange behavior and you're investing in Counselors who are seeing a lot of that and to have it so people are sticking around Um, and really difficult work situations. It's hard enough working there. And of course you see a lot of There's always something in my colleagues That brings them to this work and you probably just comes across naturally, but To be able to have that higher income to be able to take care of ourselves is Is um, it makes it easier to serve our clients as well. So thanks for listening Thank you Good morning turned afternoon My name is Edgar Fuerte. I work for janice of santa cruz. In fact right across the street at The shares office recovery center, which is not that it's janice soaring center, but there's a sign out there That says shares office recovery center. There's no employee there. That's a deputy. We're all janice employees I'm an integral specialist. We don't get deputy wages. We're not paid by the county We're paid by janice of santa cruz. My checks is janice of santa cruz yet We still have the sign shares office recovery center. It's not rammed by the shares to ram by janice I've been there since day one june 1st of 2015 Only me and two other co-workers remain there from day one the rest Are either within less than a year two years months working there and the turnover rate there is high too Part of the reason we unionize is because of it's another issue But intimidation tactics to get people to leave like maybe you don't belong here. You're not making enough money Why didn't you go somewhere else? I was told that I said I'm not going nowhere else. You're gonna have me here I don't care if I'm not getting a raise right now, but I'm staying for the long run We deal with people off the streets that come in arrested They're coming in handcuffs for duis drugs alcohol Whatever drugs out there, right? That's what we get them for instead of going to jail They come straight out the cop car into our facility. We accept them We do an assessment medical my co-worker myself. We assess them make sure they're fit for the program Sometimes as soon as the officer leaves they begin threatening us There's been times where they've done violent acts punch holes on the wall crack the window And we're told well, you know, that's part of the job and we know it is we know what we're getting into I have to take another job in order to Attempt to support myself and make it here in Santa Cruz. I'm a Santa Cruz native I was born here when my parents immigrated here in the late 60s early 70s And by the early 90s, they were able to purchase a home I'm someone that has the opportunity. I can't get a well-paid job We only ask that somehow you can help out with some grant money toward the sobering center toward janice of santa Cruz we get a high Clientele of du y's that we send to janice main. So there is money coming in but we don't know what's going on with it Thank you Thank you Good afternoon Good afternoon supervisors and miss hall. Thank you for having us. My name is sonia riftgen I'm a researcher with the national union of healthcare workers and you know, the county has already invested considerably In expanding access to treatment for substance use disorders Especially opioid addiction around the county and as you know janice is the focal point For much of that investment and also the largest regional provider of the kinds of evidence based treatment that you were speaking to Earlier and the kind of treatment that's at the heart of the drug medical expansion That's contributing to the 13 million dollar increase in revenues for behavioral health services this year You know janice's recovery center which edgar works at is a key part of the county's substance use disorder strategic plan And efforts to divert county resources from being wasted on necessary bookings and arrests Bringing janice's workers up to a livable wage would cost about 350 thousand dollars in the next year an investment that we're asking the county to To make which would have a significant multiplier effect The supplemental budget for this year shows janice's contract is unchanged from last year Unlike in years past when it's increased and we're urging the county to work with us to get creative And support these critical services and the people providing them As everyone's spoken to much more eloquently and personally than i can You know janice's ability as an institution to meet the demand for services depends on having a consistent and experienced workforce Folks are making 12 dollars 16 dollars an hour the turnover rate that people are talking about Was nearly 40 percent in 2016 and by our math likely cost janice upwards of 250 thousand dollars that year And that's that's equivalent to the entirety of the contract the county has for their detox services for some perspective You know, we know there's a great demand for these services by one estimation There's 1500 people who are ready and willing to receive treatment if they were able to if there was enough providers And untreated substance use disorders cost the county upwards of 200 million dollars a year In in, you know, um criminal justice costs the cost of auto accidents things like that You know investing in these frontline workers is considerably more affordable than all of that You know janice operates financially like many nonprofits with small profit margins By the last count over 60 of the county's nonprofit subcontractors had been able to pay a living wage And we know that janice can do the same with the county's support Folks the 2500 clients who come to janice each year to serve consistent high quality care Most people in this county have been touched by substance use disorder in one way or another And as you've heard over and over again, you know, folks deserve the best care We can give them and again as you've heard these poverty wages are short changing behavioral health services And supporting janice workers is a critical step. Thank you and we have fact sheets for you all. Thank you Is there anybody else? So I'd like to address us Okay, see and then we'll bring it back to the board for action on the health services agency budget Supervisor leopold. Uh, thank you, uh chair, uh, uh, it was a great presentation We also heard powerful testimony from people who are on the front lines of the epidemic. I would move Uh, the recommended actions for the health services agency budget And I'd also like to add one additional direction to get a report back At our at our next board meeting about what the state of the negotiations are between Janice and the nuhw I'll second that and uh, yeah, thank you for both the presentation and thank you for the folks Who are doing the important work, uh to make the difference in our community We have a motion and a second all those in favor Hi opposed It passes unanimously We do have one more item for your recess. It's just oral communications Is there anybody from the community that like to address us on items that are not on today's agenda? They're within the purview of the board of supervisors Okay, uh, seeing none. We will recess until seven o'clock We will be here to take additional, uh, testimony on the proposed budget here in the board of supervisors Again at seven o'clock. We'll recess until then Good evening everybody. We'd like to call back to order the board of supervisors. This is our continued public hearing on the 2018-19 proposed county budget We'd like to reintroduce our ceo carlos palacios who's going to give a brief introduction On our county budget and then we'll see if there's anybody from the community They'd like to provide public testimony on the budget. Good evening. Mr. Palacios welcome Good evening, uh, chair friend and members of the board Over this next week. We are going to be having budget hearings from nine until noon or until they finish until thursday Also, every one of our budget, um documents is online on the county website We will be considering last day items and the adoption of the budget Next tuesday When I started this job, I outlined a three-year, um work plan And it started with a strategic plan that included In the first year developing A multi-year strategic plan and we have been working on that after having many focus groups and community input Through an online survey in which we had over 2,000 people participate And we also went out to the community for example We went out to farmers markets and community groups that were meeting neighborhood groups and sought their input That strategic plan in draft form was presented to your board at our last meeting and will be adopted on the last day Next tuesday of the budget hearings and it will be a six-year strategic plan Next fiscal year. We will be doing an operational plan, which is a two-year document that actually provides specific projects For the board to consider and We'll align with a two-year budget which will be adopted next year as well So the operation plan is the link between the strategic plan and the two-year budget Last night we were in watsonville. You are at the civic plaza building That was an example of actually a operation plan goal as supervisor cap it remembers. He voted on that We actually outlined the need for new court space and new library And new city hall space and that was actually goals in our operation plan that were brought to furition through the budget over a number of years We'll also be doing continuous process improvement During these next years to improve our service to the public And then we will be doing a lot of training with our staff to do performance measurement And that will be Done through a series of pilot projects We've also been very careful to manage our budget very Prudently and conservatively and the board has led the way in that For example, we have tripled our reserves Since the board set the goal in 2014 of reaching 10 of our revenues as a reserve And the goal the board had set a goal of us achieving that 10 rate in 2021 and we actually reached it last year So we were three years ahead of schedule and reaching the 10 goal and over that time period We have tripled the amount of our reserves which now amount to over 50 million dollars We've also improved our credit rating In november of 2017 s and p global ratings Gave us and double a plus for our lease revenue bonds Which is equivalent to a triple a rating on geo on a general obligation bond Which is almost as high as you can get and in their rating Report s and p noted that we have a very strong local economy That we have very strong management with good financial policies and practices We have very strong budgetary performance with a balanced budget In the general fund We have strong budgetary flexibility With available fund balance that is equal to the 10 percent We have strong liquidity And we have very strong debt management in fact our ongoing debt payments Amount to only less than two percent of our general fund Which is very conservative and very good and also two-thirds of our debt Will be retired within 10 years, which is also a very conservative position to be in strong position to be in The board has also reduced our pension obligations and starting in 2007 The board took action to reduce our unfunded liability for retiree health benefits Working with our labor partners. We negotiated This board negotiated a cafeteria plan And a cap on retiree health benefits This action by itself reduced the unfunded liability by over 35 million dollars And then in 2012 The county board working with our with management and our labor partners Implemented a retiree health Longevity schedule that links the level of benefits Two years of county service and age at retirement This act reduced unfunded liability by 54 million dollars So as a result of those two reforms the board reduced our unfunded liability for retiree health benefits By 89 million dollars Regarding our retiree purrs benefits in 2012 The county board Negotiated with our labor partners to implement a second tier for purrs retirement for all of our employee groups This increased the retirement age reduced the benefit formula and increased employee participation As a way to make the retiree system more sustainable This action alone reduced our unfunded liability by 93 million dollars So taken together the board's actions reduced our unfunded liability for retiree health and pension By over 180 million dollars And then in 2013 the state enacted Public employee pension reform which further reduced Unfunded liabilities We've also controlled our employee growth At the Height of our numbers of employees before the great recession in 2007. We had 2705 employees After that recession hit we reduced by our employee numbers by 15 percent We currently have 2400 employees or 230 less than we had 10 years ago So even today with significant growth in health and human services and the human services department In the affordable care act Even with that growth, we're still 235 employees less than we had 10 years ago And so that means that in the general government section of the county we actually have less employees still Doing a lot more work And then we've also made some inroads in our deferred maintenance, but that remains significant problem as it does for many local governments Despite being very prudent and conservative in managing this the county's financial Affairs the board has been able to augment services We've done a number of programs Where we have augmented services these include The nurse family partnership Thrive by three whole person care And Medi-Cal drug expansion which all work to improve public health We've also expanded our commitment to funding homeless programs by expanding shelter Options as well as Eliminating youth homelessness through various programs And we've also invested in public safety with new Or remodeled facilities at roundtree and blaine street and the sobering center All reduced all designed to reduce recidivism and transition offenders back to the community in a positive way Nevertheless, even though with these augmented services we have critical and met needs These are mostly in the areas of behavioral health and substance use disorder When we went out to the public during this past year in Developing our six-year strategic plan We heard from the community loud and clear That there are significant needs That the community would like us to address Especially in the mental health substance use disorder homeless services areas Even though we've done a lot there's still needs out there. We also have a number of critical parks and recreation facilities that are lack funding And we've also Need more parks maintenance workers and parks and recreation services And then finally we have not been able to invest very much over the last decade in deferred maintenance So county facilities and our road and transportation network Need a great deal of investment That we haven't been able to fund so Anyway, those are challenges that the board will have to consider during these budget hearings about how we can meet those And with that i'll conclude my remarks. Thank you Thank you. Mr. Palacio. So are there any comments from board members? Seeing none, we'll just open up the community. Would anybody from the community like to address us? Okay We appreciate the presentation tonight the board of supervisors will Continue our budget hearings tomorrow morning at 9 a.m. Here in the board of supervisors offices and as always we encourage people to Participate thank you