 Welcome to Sheboygan County government working for you. My name is Adam Payne Sheboygan County administrator and co-host of this program with chairman Roger Distruty and as you know every month we strive to bring a different department department head or a key employee here to talk a little about their role and responsibilities and today we have a director of the largest department of our 19 in Sheboygan County our health and human services director Tom welcome. Thanks Adam. Good to have you here the health and human services department not only is the largest with the number of employees but also has the most significant budget close to about 31 billion dollars so a lot going on and this should be a real good program to get a feel for what is all happening in health and human services and why is it so important to our community. Tom let's start there share a little bit about the core services that the health and human services department provides. Sure all counties Adam in the state as well as other local units of government are charged with certain responsibilities that includes protection that includes health promotion that includes financial assistance for people in need many counties might organize those services in different ways many counties might have separate departments that provide that assistance you might have department of social services department of community programs department of public health office on aging in Sheboygan County decision was made in 1989 to combine those then separate departments into a unified department delivery. So our health and human services department in Sheboygan is covering the waterfront in terms of those services so that includes child protection juvenile justice health services and that includes mental health and AODA treatment we provided out protective services aging services and financial services and we do that in three separate locations our main office is on 8th Street across from Fountain Park we have an aging and disability resource center located at 654st Avenue in Sheboygan Falls and economic support is offered through the Sheboygan Job Center which is at 3620 Wilgus Avenue. So we've got a pretty broad array of services and that comprises about 181 employees currently our high watermark with employees was 204 we have 204 authorized on our table of organization but we'll be entering the new year with 181 and like most units of government we've tried to do more with less than recent years and got a great staff I'm very proud of them. You have a wonderful staff and every now and then I get pulled into some of the areas that you and your staff work on and it's always sobering to learn more about some of the the needs in this community and people hurting in this community and whether it's dealing with children or child abuse or elderly abuse or or you name it there's so much going on so I appreciate the work that you and your staff do. Thanks. There are four primary divisions are there not and they are. So our divisions include our division of economic support and that's what's located at the job center we have a division of public health we have a division of community programs which provides mental health and AODA treatment as I mentioned and then we have a division of social services so those division titles are kind of reminiscent of the former departments that used to exist that have now come together to create our unified department and of course a number of different programs and services associated with each this year or this past year where I know we're we're nearing the end of 2013 but this has been a very remarkable year a lot going on and I know you and and some of your staff in particular were challenged perhaps like never before please share with our viewers what was unique about 2013 yeah I would say you know every year is challenging this year was exceptional one of the things that government is is adjusting to right now is an aging baby boom population growth of entitlement programs and some concerns about how that's all going to be afforded so in the last year or so our economic support division had to partner with nine other counties in the region to start delivering services in a new way we knew that coming into the year as the state budget was developed and as the affordable care act was played out in the state of Wisconsin we also became aware of the fact that specific changes were going to occur in terms of how people might gain access to health insurance who would have access to Medicaid who would go to the private marketplace so the state budget called upon us to add staff to expand our services and so we could assist people through that process so we ended up expanding our hours of work for our employees we ended up adding limited term as well as regular employees to respond to that so that was a challenge in and of itself in the middle of all of that we also had a TB outbreak that threw us into emergency response mode and that we never saw coming that started in April we had a suspected case of TB that was identified and through our contact investigation that infection was confirmed and not only did we have a an active case of TB we also learned that it was resistant to multiple drugs which is a very very difficult circumstance and with that status there was potential for transmission to many many others throughout the community so as I said we were adjusting to changes that some of which we knew were coming some of which we adapted to and then we got thrown into emergency response mode which ultimately involved our working with the state department of health services the Centers for Disease Control we went through many many contact investigations with community partners and businesses we arranged isolation for the active TB where it was found and worked diligently to try to contain that and again at the end of the day it was a very very challenging circumstance we came through it in a good way but required a lot of exemplary efforts I would say on the part of our staff to maintain and to contain tremendous collaboration it was it was just outstanding and of course we the county received nice accolades from the state and federal level about how it was handled here so kudos to you and your team it was it was excellent collaboration let's take a step back a little bit you know I think most people probably read in the paper heard on the radio that there was a TB outbreak here but we may have some viewers who are wondering well what exactly is TB and how do you get TB and why was it here what's a layperson explanation of what TB is well tuberculosis is a respiratory infection it occurs through airborne transmission and when you say many people are not familiar with TB I think that that speaks to our health care system our health care practices there was a time in history where TB was a lot more prevalent than it is now Rocky know our county facility Rocky know is a perfect example of that Rocky knows early history involved serving as a sanatorium for persons with TB infection so again left untreated it compromises immune systems it creates lesions within the lungs and ultimately can lead to death and so while it has been largely eradicated in this country it's still out there it's quite prevalent in other parts of the world and so we unfortunately ended up with some cases of TB this past year that were unexpected and how large of an outbreak was it we started out in April with notification of a singular case this is actually an individual who had sought treatment from a number of health care providers for respiratory concerns and ultimately she was seeking assistance for depression and one can step back and if you have a health condition that isn't resolving you can understand how that becomes emotionally draining at that point and that contact actually occurred through our new Lakeshore Community Health Center contact was made with our staff our department and with suspicion raised about possible TB our nursing staff initiated their own investigation worked with health care partners and as I said that case was determined to be multi-drug resistant and what happens in those circumstances is contact investigations are initiated who did that person have contact with for what period of time and what context and there were additional members of that family that were found to have TB infection so that singular case in April grew to as high as 11 suspected cases over the course of the summer if I recall correctly the 11th case ended up being ruled out eventually but 10 solid cases involving TB we were working with the Centers for Disease Control and the State Department of Health as I mentioned and the modeling around those active cases particularly with the multi-drug resistant strain suggested that for every active case you might expect 15 latent infections and so what that means is persons who might be carrying the disease but not in an active state but still requiring treatment so if you take that modeling as was suggested the 15 cases that we were anticipating could be seen through our investigation and again it was capped off at 11 at one point but those 15 cases could have led to another 225 persons requiring treatment so in the early days of our investigation as those numbers were growing and growing rapidly we had feared the worst and had expected that we could have as many as 200 plus individuals with TB infections needing treatment. Right right and before I turn it over to Roger you know just a point and a shout out to our clinic our Lakeshore Community Clinic which really just got ramped up about a year ago maybe a little more now tremendous need in the community I think for dental alone they have a waiting list of around a thousand people and if you can imagine children who have never seen a dentist or struggling with dental needs and have no place to go so they're really providing a valuable resource in the community and this individual who went there had she not gone there had she not received that care and that diagnosis and had someone step up and then refer her to the Health and Human Services Department we may have seen a far more significant outbreak and you know for those who aren't real familiar with TB and I certainly wasn't I learned a lot in the last year if you are multi drug resistant or if you're really in dire straits with TB literally it can be months and months and months before you can return return to a normal you know lifestyle whether you're no longer going to be able to go to school go to work what have you which if you're someone who already is struggling a little bit financially that's just going to make things that much worse so a real credit to our new community clinic a credit to the Health and Human Services Department your staff and and as I pass it on to Roger of course there was a lot of collaboration and other good people that stepped up and help us address this thank you Adam as Adam mentioned there were a lot of a lot of agencies and people that helped us out would you explain to the audience who always involved and who helped us sure be happy to Roger I hope I can remember them all because the the response and the assistance was was tremendous I already mentioned that we had great support from the State Department of Health Services the Centers for Disease Control we also put a call out to other regional health departments on the front end big shout out goes to Manitowoc County Manitowoc County Health Department took on our other disease investigations so that our staff could concentrate on TB response we also had other health departments across the region contacting retired nurses who came on board with us in in order to help with administration of treatment and containment of the disease our HR department here in Sheboygan County was tremendous in clearing the hurdles that allowed us to hire those people very very rapidly the county's emergency management director Steve Steinhardt played a key role we actually activated an emergency operations structure much the way any unit of government might do in a disaster circumstance whether that be flood or or fire tornado things of that nature that structure was activated in this circumstance because of the magnitude of what we were dealing with because of the risks that were involved and Steve played a key role in helping activate that and coordinate that Sheboygan fire department was involved and sat at the table with us they did fit testing for those staff that had to go into homes where therapy was being monitored so that proper masks could be worn to protect those workers from contracting the disease they developed protocols for their staff in the event that any infected individuals would require ambulance transport during a period of infection and how to protect their workers during that circumstance Sheboygan police department assisted us with isolation set up and containment when we discover active cases of TB that could transmit to others those individuals are isolated in those circumstances and the police department was tremendously assisted in helping with that we had Wisconsin emergency management personnel who were there and helping us coordinate response effort our local health care partners Aurora and St. Nick's Hospital were tremendous big shout out again to dr. Porcina of the Aurora system who who worked side by side with our staff to arrange treatment and monitor status and even within our department as well collaboration ended up being required in ways that was previously untested so it started out as a nursing issue but when you throw in the full magnitude of challenges that were emerging and trying to manage that situation very very close collaboration between nurses social workers and accountants needed to happen in order for that effort to be successful and when they were working separate you can't accomplish the same amount as you can together so again I'm probably forgetting some important people I can think of Bernie Romer our city county purchasing agent Bernie was there to help acquire equipment to arrange housing when we needed to promote isolation to contain the disease so many many people Roger played a big big role and big shout out to all of them it's great to hear the cooperation and I know health and human services for Sheboygan County has done so well in the past few years in meeting their budget but there was a financial impact could you explain to us how our our local legislators helped us with that yeah that too is an important point and I neglected to mention them to mention them just a moment ago so in the early days of our discovery process where we were fearing that we could have as many as 15 active cases and those could transmit to another 15 individuals each the fear was that we could have 200 plus individuals infected when we're talking about the multi-drug resistant strain as Adam alluded to a few minutes ago the costs of treatment and the length of treatment suggests that that could cost between two and three hundred thousand dollars per person absent any other resources available to assist so we were concerned about how to manage that how to respond to that and quite honestly if people who are infected don't have resources through which they they can seek treatment there was an obligation on us to protect the community to make that happen so the state budget was close to being finalized I think it was in May we met with Adam I think you were involved early on as well Roger and call was placed to our legislators and senator Lybom and representative Lemme who in particular in their role with joint finance worked with the governor the department secretary and their legislative colleagues to seek an emergency allocation within the current state budget to assist Sheboygan County with that effort there's a TB dispensary allocation that exists within the state budget that we can gain access to they were able to accomplish an emergency appropriation in that dispensary I think the final total was about four point six million dollars available for our access on an as-needed basis and so tremendous assistance on that front great relief for us and would otherwise have fallen to our levy obligations if everything else had failed and we all have have heard about the problems of the startup with the Obamacare situation how do you think if possible that would help with such as a TB outbreak or would that not have affected that yeah so when we talk about the Affordable Care Act it's a difficult topic to talk about given the way it has started out and so I can't make any great predictions about what that program will be but when you step back and you look at this situation it does start with health care access and if you're a person and you don't have the means to pay for health care we know that there's a tendency for people not to seek treatment and in this example if you're not seeking treatment you're now posing risk for the rest of the community and the costs of that treatment as I indicated can be quite extensive so if you step back again you just simply understand that there's people out there who have health related conditions who oftentimes don't have the means of addressing those conditions or oftentimes might wait for them to rise to a crisis level then they show up in emergency rooms at higher cost for the rest of us and that translates into insurance premium increases for the rest of the population as a concept access to affordable health care makes sense it's something we should embrace now how that gets delivered is a whole separate matter so we'll leave it at that and as we all know we're entering the flu season how can what can people do to protect themselves from from the flu sure that this flu season is no different than any other it's now standard annual advisory populations at risk should plan to get a flu shot so what does that mean who's at risk and that that includes young children I think generally between six months and five years of age that includes pregnant women that includes other folks with chronic health conditions or immune system deficiencies that includes persons over age 50 that includes persons who live in long-term care facilities if you're in any one of those target groups you are strongly advised to get a flu shot they're readily available Roger every primary care physician will give you a flu shot every walk-in clinic will give you a flu shot many pharmacies now offer flu shots and retail outlets that have pharmacies offer flu shots so there's very few reasons that people can't or shouldn't get a flu shot sometimes people say well I didn't get one last year and I didn't get the flu therefore I don't need one but there's different strains of the flu that emerge each year and the immunizations are intended to respond to those specific strains thank you Tom and for up for your staff for all great work you do thanks Roger switching gears just a little bit Roger and the county board recently adopted a 2014 budget and as you know it's a lengthy process and every department has a role in putting together a department budget and it's all rolled into the final document as a component of that 2014 budget we have a five-year capital plan and we bond and we every year the board selects projects to invest in whether it's road construction or putting your roofs on or what have you and for 2014 as you know there was a decision by the board to make a extensive investment in our health and human services building yay yeah it's it's fantastic news not only for our employees there but but certainly our clients and guests and share with our viewers a little bit well what's in store for the health and human services department yeah thanks Adam yeah I'm very very excited about that project we will be adding a new addition to our building by way of a lobby that has certain office capacities built into it that building we're in was constructed in 1921 as many people know it has served as the Sheboygan Clinic and it's they and as the clinic operated I think the the setup was probably fine you had a different area that you would go to for dental work a different area you would go to to see your doctor different area you would go to for immunizations and within that kind of setup different reception points made sense now with our unified department configuration one of the main drawbacks of that setup is that we don't have centralized reception we still have to staff five different spots in that building with receptionists we don't have a waiting room large enough to accommodate the visitors that we see on a daily basis there's actually about 250 people that we see on any given day that come to us for various services in a lobby that can accommodate about six or eight folks any point in time and oftentimes people entering the building have to trip over those who are otherwise waiting in the lobby in order to get into the interior space so we'll have a new addition that will offer seating for 25 to 30 folks will have central reception staffed with two receptionist and surge capacity for up to three we're gonna have a couple of exam rooms in that new addition so that when folks present with communicable disease such as TB one of those rooms is going to be equipped with negative air pressure handling so that we don't risk contamination of others we're going to have an accessible restroom in that lobby like why is that a big deal we have one accessible restroom in the entire building so to have one available for the public is going to be great otherwise they go to the third floor in the far end of the third floor we'll have an elevator going up to an upper level with a large meeting room and a break room that staff can gather in and share new ideas and work more closely with each other and a couple of additional restrooms up above so we're excited about it I think it will be tremendous for the people who need services from us I hope that we can open it up for the community use in general and it's very very great to see appreciate the support we received from you as well as Roger in moving that project forward as you said 1921 it's a it's a grand old building but it was time for some improvements so my compliments to you and your leadership on raising awareness to the needs and solidifying support from the county board you did a wonderful job with that so looking forward to seeing that those improvements made we only have about two minutes remaining but tis the season we are going to be entering the holidays here soon and cold weather and with cold weather for some people in this community that can make things pretty difficult especially if you're struggling financially with paying those utility bills or or need to rely on food stamps what have you so economic support one of our four divisions certainly provides some services in that area if someone's in need or you know someone's in need during the holidays or during the cold winter months where do they go to get some help or where do they go to get information you can get information online for those folks who have access to a computer simply do a search for Wisconsin Wisconsin home energy assistance program information on eligibility etc to apply people can call our main switchboard number which is 459-3207 459-3207 correct very good well thank you I hope you got a feel for some of the very very important work that the health and human services department does the programs of services I think countywide we have about 126 million dollar budget and as I mentioned at the onset 31 million to support key programs and services and health and human services when I when I think about county government and the the role that Roger and I have and having kind of our our hands on all 19 departments and having some oversight and leadership roles but there are some key departments they're all important but there are some key departments that really are providing critical services life-saving services to people in this community and without question it's health and human services that certainly are our sheriff's department and again there are many other important ones but health and human services tends to pull at many of us because of just how important it is to give that helping hand and get people back on their feet or in the case of a TB outbreak make sure that the rest of this community is safe so thank you again for joining us today Tom and the important work that your staff do and on behalf of the County Board chair Roger just Rudy and myself thank you for joining us next month our highway commissioner or now transportation director new title will be joining us to talk about the important roles and responsibilities of the highway department and our airport until then thanks for joining us