BOARD OF SUPERVISORS

Good morning everyone. We'll bring this second budget meeting of the Santa Barbara County Board of Supervisors to order. It's Wednesday, June 13th 2012. Mr. Allen would you call the roll please?

Mr. Carbajal? Ms. Wolfe? Ms Gray? Mr Mavinino? Ms Barr?

Here. Would you all

Madam Chair, members of the board. I just want to remind the word as well as the public that this meeting is being streamed alive at www.countysb.org and that all of the budget documents are also available on our county homepage There are a couple of links under News and Announcements, there's a banner that says Budget Hearings Fiscal Year 2012-13. And under those, that banner, there are a couple of links that will take you to the budget book and all the budget documents that are being considered today. And I'd also like to remind everybody this is also being broadcast live on County of Santa Barbara TV Channel 20.

Thanks. Thank you. Mr. Alvarez?

Yes, good morning Chair Farr. Just a reminder that we've also made a distribution of updated materials. They are the salmon colored documents. There's a summary log of the board inquiries that we've completed along with the actual ones that were completed beyond that and as a reminder in the log that's handed out to you there's a new column added that's the distribution date so you can see at which date these came out and these would be the new ones that came out today and will probably have another distribution later this afternoon.

There was one additional document, which was the service level impact is a very minor change on that. The dollar amount actually remain the same

Okay, very good. Thank you and now we'll go into general public comment Mr. Allen speaker to

Madam chair members of the board. We have three requests to speak start with Jeff Bard to be followed by Andy Caldwell

Good morning, Madam Chair and members of the board. I just wanted to address the board to thank you for having public comment as open as you do. I think that what distinguishes our democracy is the fact that anybody from any political point of view can come to this microphone and speak their mind And I want to salute the board for tolerating public comment, which sometimes does cross over the line into personal attack.

And I'm astounded at how patient and tolerant the board often is. And public comment which sometimes is not relevant to what's within the scope of the board's jurisdiction. But I think it's good to have a very loose interpretation of that because people shouldn't have to go to law school in order to go to public comment. I'm lucky, I've had some law school but going forward, I'm gonna thank you in advance for avoiding some of the measures that we've seen with the Los Angeles Board of Supervisors which really has been quite reprehensible in its attempt to constrain public comment. Well, granted it's a big mean city and you've got some pretty sketchy characters perhaps to contend with in a city like Los Angeles if it goes with the territory but Santa Barbara County is really You know, not so high density that we have to take such a defensive posture.

So I'm just going to be brief and if I may encourage the other people that may be watching this stream to get your comments in certainly on everything and anything. Thank you very much.

Thank you Mr. Bard. Our next speaker is Mr. Caldwell followed by Robin Barber.

Madam Chair, members of the board, I am Andy Caldwell representing COLAB. One of the things I wish that the board would do when they are in a severe financial straits as you are today is take the time and make the effort to list all of the things that you're doing right now that are purely discretionary and not mandated because I think you have a mandate from the people to protect public health, safety and maintain infrastructure.

And I know that there's a lot of things that could probably fit under those broad categories but for instance one of the biggest threats to the California economy is going to be the implementation of AB 32. AB 32 was signed into law by Schwarzenegger in the goal which is to reduce greenhouse gas emissions from California And the state of California is promulgating rules.

There is no mandate that the county come up with a climate action plan. There's eventually going to be mandates that will be passed down, but between the APCD, the Air Pollution Control District and the various cities what do you have to regulate? that you would be spending a couple hundred thousand dollars on a non-mandated program. Why not let the APCD do it? Why not let SPCAG do it? Why not let the cities do it and or why not just wait for the state to do it?"

You know, this plan is slated to cost the California economy $180 billion. Jerry Brown thinks he's going to skim one billion off in the first year. Where do you think that money comes from? It's going to come from profit and or operating expenses of businesses in the middle of a recession. And the county can't wait to get on that bandwagon and it's not mandated.

So you could hire a couple more cops or a couple more firefighters. You could hire another doctor, or you could pave some streets. There's other things you could be doing right now. You don't need to be ahead of that curve. It's going to catch up with this too fast as it is already and there's a lot of other things I've mentioned the smoking cessation program some of the long-range plans for instance the Gaviota Coast plan Thank you. Robin Barber, who will be our final speaker.

Good morning, ladies and gentlemen. Robyn Barber representing SEIU Local 620. I wanted to first convey my appreciation personally and on behalf of the members about the thoughtfulness that you've gone through as we go through this process. I particularly want to comment on Supervisor Wolf and your taking the lead in talking about not just considering contracting out blanketly and the thought process that you encourage to be put into that. I also want to thank every one of you who encourages your management to go back and convey your appreciation for the hard work that your employees are doing, and the sacrifices they've made to partner with you in trying to close a budget deficit in times that are very difficult and unusual for us all.

I also want to make sure that I convey as well or request of you if you could encourage your management to look at the impact of what's happening with the budget, the impact to the employees in regards to workload and mitigating circumstances when it comes to their IDPs or EPRs or performance evaluations. We tried to make this request during an employee relations meeting to ask that that be a part of it, that it be considered because so many of them are working way beyond their capacity and it's really pushing the limits. But the IDPs and the EPRs those performance standards are still based on as if they were working three years ago four years ago. And there's no real consideration for what that impact is doing with all this additional workload and that could be mitigated when you're seeing some of these performance evaluations come back and its indicating that people are below standards That's because they're overworked.

That's because a lot of times they are doing more with less every day. And then last but not least, just to reiterate that a lot of times when there is pressure put on management, that pressure goes down to your employees. And sometimes people are overzealous, and they actually display bully boss tactics. We are definitely going to be addressing that as we move forward because we think that the time is right for that to fester and we want to eliminate it. There's no need for it. We're a partner in this. We all are serving the public. The people that work for you are the public and the taxpayers. They deserve respect at work, and I appreciate your consideration for these suggestions. Thank you this morning.

Thank you, Ms. Barbara. All right that concludes our opening public comment session and so now we will go ahead and begin our departmental budget presentations starting first with alcohol drug and mental health services. Good morning Dr. Dietrich

So Chair Farr and Supervisors, on behalf of Alcohol, Drug and Mental Health Services thank you for the opportunity to speak with you today. Joining me are Ms. Christy Thoma our Contracts Manager and Mr. Michael Evans our Fiscal Manager. Several of our other senior managers are also here today. To begin the total recommended operating budget for the department for fiscal year 12-13 is $68.4 million dollars The capital budget is $105,000.

The county's general fund contribution is projected to be $3 million which represents 4.39% of our total budget. Total budgeted FTEs for the department are projected to be 295.2. In the next few slides I will summarize the department's most significant accomplishments for the current fiscal year But before reviewing these slides, I would first like to say how proud I am of the work of our ADMH staff and our community providers who do so much every day to help people of all ages with the challenge of mental illness and substance abuse. So to all our ADMH staff and our provider staff, I say thank you.

Now to our key accomplishments. In FY 11-12, the department has continued to enhance our revenue management activities and make real time operations changes As needed, using weekly revenue expense tracking tools. We have also routinely assessed and modified provider rates quarterly for $17 million in mental health contracts to minimize future paybacks to the state.

ADMHS is saving $80,000 annually by the consolidation of our Lone Poke child and adult clinic locations, and I appreciate the excellent teamwork of our Lone Poke staff on this very significant project. We maintain state and federal regulatory compliance at the psychiatric health facility, PUF, through a comprehensive quality assurance program. ADMHS reduced travel costs and increased productivity through video conferencing.

The department has leveraged Mental Health Service Act funds to create 30 housing units for approximately 48 individuals and families. We have increased public awareness and access by redesigning our ADMHS website. The department received a CSAC award for our family and peer training program, The department looks forward to conducting our next two-week family and peer training this August.

The department has improved cultural competence efforts through focus groups with bilingual, bicultural clients. These focus groups were initiated by the guidance of our very active Latino Advisory Committee. We have expanded outreach for individuals at risk through our Assertive Community Treatment, Outreach and Engagement project. The department has done this by using the existing capacity of three Assertive Community Treatment teams which operate across the county.

If a concerned family member is worried that their loved one is at risk due to untreated mental illness, our department can be called and we will make every effort to reach out to the person to engage them voluntarily in services. And I am very pleased that the Mental Health Commission and the Sheriff's Department have been very strong and enthusiastic partners in this project.

The department has increased co-occurring mental health and substance abuse services through federal grant resources from the Substance Abuse and Mental Health Services Administration. We have increased our capacity to promote alcohol abuse prevention through a state grant that the department was recently awarded. Now I will discuss our proposed fiscal year 12-13 service level impacts.

When the department developed its budget a few months ago, we projected a shortfall of $1,096,000 in the core mental health fund. We have described to the board on previous occasions that this shortfall is largely due to the lack of growth and discretionary nonmedical funding to cover the increasing cost of care for persons without insurance. As a result, ADMHS proposed this initial set of reductions which are included in the D pages.

These initial reductions listed on this page includes $217,000 or 32% reduction in core mental health funding to homeless contracts, $496,000 or 38% reduction in out-of-county acute psychiatric inpatient capacity a $181,000 or 19% reduction in out-of-county long term psychiatric inpatient capacity and a $203,000 3% reduction in psychiatric health facility costs.

Recognizing the significance of the service level impacts And our department has been reviewing options for decreasing these reductions in services. An option that we have decided we can execute is to delay a planned move of four FTE information capital technology staff from our MHSA Fund 48 to the Core Fund 44 in the coming fiscal year. Eventually, this will present a funding challenge as the MHSA Capital Information Technology funding stream will end in several years.

But for now, by delaying the staff move from 48 to 44—I'm referring to Fund 48 to Fund 44—we will be able to reduce the expected service level impacts by $475,000 for Fund 44 next fiscal year. So the next slide shows both our original proposed service impacts and our current revised impacts. So on the top row you see that previously ADMHS proposed a reduction of $217,000 in homeless services. Currently we are proposing a reduction of 125,000. In out-of-county acute psychiatric inpatient care under our original plan ADMHS would have reduced the number of acute psychiatric beds we purchase at Vista Del Mar in Ventura from five beds to three beds. Now with the revised impacts we will be able to purchase 4.2 Long-term psychiatric capacity is also a reduction we are proposing.

Initially, we proposed decreasing the number of beds from 16 to 13. Now we are proposing to fund 14 beds. ADMHS will also seek to gain efficiencies at the psychiatric health facility through a reduction of $160,000 in cost. Currently the PUF has a total cost of approximately 6.4 million dollars which represents almost 10% of our total ADMHS budget. We look to the consultant work that is being acquired through the county RFP to help determine if there are ways to safely achieve savings in PUF costs.

One thing that I would like to add, and I talked with CO Waller about it this morning is that as we continue to look for remedies to service impacts. We have been considering the possibility that for the homeless reduction, we could use MHSA funding. We're exploring that with County Council. That's probably not something we could get figured out if you will until we go through our whole plan update with the Mental Health Commission however I have located $84,000 in Fund 44 that I'm prepared to put toward that cut because I am very concerned about the homeless cut. What I would also do then is I would restore the cut to the PUF cost to 203. So in other words, I feel that I do have a remedy for the homeless cut and happy to talk more about that.

Madam Chair can you repeat?

Yes, go ahead. Dr. Dietrich if you would just repeat what you just said about $84,000. So

in our original service level impacts we said that we were going to be looking at the possibility of Mental Health Service Act funds being able to be used for these homeless contracts. I've been talking with County Council about that and there are no supplantation issues But we would want to look more about the actual activities of those contracts programs to make sure they comply with MHSA.

We can go forward and do that, then we do have a process with the Mental Health Commission of every fall they look at an annual plan update that we provide to them and they approve it. So getting MHSA to cover this would take a little more work and approval by the commission. What I'm saying is that I have another option which is to take $84,000 that I've located in the core fund 44 and reduce the increase of psychiatric health cost reduction back to 203,000. So that saves me about 43,000 so between the 84 and 47,000 from the PUF I have a $125,000 solution.

We have been very concerned about that cut and I'm trying very hard to find a way to remedy it.

Okay, so Dr. Dietrich just to kind of sum up if you went ahead and made these changes that you're considering the revised reduction in the psychiatric health facility costs would not happen? Correct. So that would say at the $203,000 the 3% but the reduction in the core mental health funding homeless contracts would be eliminated as a service level reduction?

Okay. Chair Farr, that's absolutely correct. Thank you. Supervisor Lavagnino?

Madam Chair, so these are already reflected in our updated... It looks like.

So a remedy to the $125,000, Chair Farr and Supervisor Lavagnino is not reflected but I thought that I would bring it up today so you're aware that there is a solution and...

Okay. Thank

you. Yes. All right.

So the top line there would go away in effect That's correct. Yeah, the $125,000 cut would be eliminated but the bottom one for the reduction in the PUF would stay the same at $203,000. That's correct. It's on this page I think Supervisor Levin you know that it's probably more up to date than the one that you have there.

Okay.

Supervisor,

thank you Madam Chair. Thank you Dr. Dietrich for looking at ways to mitigate some of these impacts but it would be helpful I think for me because I'm looking at the service level impact chart. That's right. I'm sorry.

Go ahead. Chair Farr and Supervisor Wolf, there is $125,000 cut there for ADMHS in Fund 44 for Homeless. And so what I'm saying is that we would be able to take that off the service impact list and we would return the PUF to the original 203,000.

Right now the PUF, there was a reduction of $160,000. And so

you're

saying that you found them?

I would go back to 203 use the balance to help toward the homeless reduction.

So in essence we take that off our service level impact and the first two which was the contract reduction are those now also taken off?

No actually excuse me Supervisor Wolf What she's proposing possibly is that the reduction in core mental health funding to homeless contracts would not happen. Period, the whole thing would be taken off. That's a list. However, the reduction in the psychiatric health facility costs which were originally at the $203,000 would stay at that $203,000 and they would not go down to $160,000.

Okay, because that $40,000 difference there would now be used to help eliminate the reduction in the homeless contract.

Okay? Let's look at it a different way. What are the proposed cuts that you're still looking at?

So what we're looking at is the $216,000 reduction in the acute beds we purchased at Vista. We would now purchase 4.2 beds In the out of county long-term psychiatric capacity, that's for people who go out of county for longer term care. This would enable us to purchase 14 beds there and then the last as Chair Farr says would go back to 203,000 so I basically would have three rows there of proposed Reduction still all right very thank you very much.

Thank

you All right,

okay?

Go ahead. Okay, so I'm sorry to bog us down in that. It's okay. That's

good to know okay Supervisor

I'm Lost and I mean I understand what they're saying but we get this today So I assume that later on the County Administrator will say This is what's happening because we haven't had a chance to really, and this is just what I've seen with mental health time after time. You know come in last minute whoop here we've got the money and then we wait through the year and we don't have it.

I don't think this is the appropriate time to bring that up but I'm going to again. I'll wait till comment time.

Thank you all right go

ahead

so to the next slide Looking ahead to fiscal year 13-14, preparing for the future. The proposed DPAGES budget assumes no increase in mental health funding. We've been very conservative in our projections for 13-14 on all of our revenue, MediCal as well as MHSA. During that year we project that we would use the remaining $4 million dollars in MHSA reserves that we have A budget gap of 4.4 will remain and that will be due to a $1,000,009 increase in salaries and benefits costs, retirement health benefits and expiration of wage concessions, $100,000 increase in services and supplies costs and a million five decline in available MHSA funds. That's partly attributed to the fact that several MHSA funding streams are time limited, and they would be ending.

And then a $900,000 decrease in the general fund contribution. As we look beyond to opportunities, we believe that there's reasons for optimism Again, with the county RFP and consultation there will be welcome assistance that can help the department build on system improvements. 12-13 state realignment changes are expected to bring more flexibility in the use of funds and we anticipate possible funding increases.

ADMHS believes that health care reform will have a benefit for consumers and for department funding. For single adults with mental illness The impact may be very positive, since now single adults can only receive Medi-Cal benefits if they are determined to be disabled. Under health care reform, Medi-Cal services will be available based on income. Persons at 133% of poverty or less will be able to receive some level of health care including behavioral health care.

ADMHS currently spends at least $5 million a year for uninsured persons, but we do not have adequate funding to cover these costs. Under health care reform it is our understanding that the cost of health care for clients who qualify for benefits will be covered 100% by the federal government for the first three years with no local matching dollars required. And that would be a big benefit to the uninsured clients in our department, not only for their mental health care but for their health care. So that concludes my remarks.

Thank you Dr. Dietrich.

Any questions for Dr. Dietrich at this time? All right do we have public speakers Ms. Stroud?

Madam Chair, I believe we will go through the rest of the budget

units. We'll go ahead then and we will go to our next department which is Child Support Services. Thank you.

Good morning Madam Chair and members of the Board of Supervisors. I'm Carrie Topliff, Director of the Santa Barbara County Child Support Program. It is an honor to be representing a program that is a role model for the entire world community available to establish paternity and obtain financial support from both parents for every American child. Second only to the school system in the number of children served, Child Support enjoys strong bipartisan support and funding that is two-thirds federal and one third state funds.

Our annual budget is nine and a half million dollars. There are no county general funds in our program and the Governor's 2010 proposal to realign Child Support to county responsibility is not moving forward. We expect our funding to continue to come from state and federal sources. Due to strong political support for the program, child support funding has only gone down once in the past decade just now with the Governor's May revise a $175,000 decrease.

We are very practiced at shrinking our operations and have decreased by 40 staff through attrition and closed our Lawn Post Branch office as a response to rising costs over the past 10 years. Despite this serious loss in staff, we have been able to increase productivity due to our workload organization and use of new technology. Like every child support department in the country, our performance is assessed by the federal government. We have five performance measures and Santa Barbara made an improvement in and met its goal in each of the five.

We achieved 100% on paternity establishment, 89% in establishment of orders, 59% in collections of current 64% in collections on delinquent accounts. Collecting and distributing $2.89 for every dollar spent in the program. Of course, that doesn't begin to tell the human stories of the shoes purchased and the lunch boxes filled through our efforts. Of the $27 million in collections, $22.1 million went directly to families and $4.9 million was used to reimburse the government for welfare assistance made to some of those same families.

This year, the entire department created a five-year strategic plan to help us overcome our funding and staffing limitations with process improvement training and top-notch communications, all to further our customer service. We put a scanner on every desk and used a single sign-on technology that permits us to access over 18 different electronic systems without having to remember all those passwords. That's a very nice blend of security and efficiency.

We're continually trying to break through the mentality of, that's the way it's always been done. We know that nothing stays the same and that change brings constant opportunities for new approaches. To keep that idea front and center we have a standing process improvement team that is always ready to pounce on the latest brainstorm. The state has been a good partner developing automated reports to identify cases that have hit glitches and we've created a special team just to resolve the issues that are identified this way.

We are expecting our service levels to remain constant in fiscal year 2012-2013 thanks to the dedication and commitment of our knowledgeable staff. We will continue to probe for process improvements, make technology enhancements and fine tune the organizational structure. In fiscal year 2013-2014, we expect to resolve the funding net gap that comes from rising costs as we have in the past by not filling positions as they become vacant and by relying on technology our staff and increasingly our customers. A successful future requires partnership with our customers, and we are training them in our ever-expanding customer self-service tools and payment methods as well as using cell phones and outbound dialing to make sure that important communication is communicated timely.

We'll continue to bring our best efforts to the needs of the 15,000 families in our caseload with expected collections and distributions of $28.6 million. Financial security has been identified by the Center for Social Policy as one of the five protective factors necessary to keep families strong and children safe. At the Child Support Department, we will continue our commitment to this vital goal.

Thank you and please let me know if I can answer any questions.

Thank you very much for your presentation. Any questions from the board at this time? Comments? I guess you gave the Board all of the information they needed, thank you so much. We'll go ahead next and hear from Public Health.

Madam Chair, members of the Board, good morning. I'm honored to be here before you today to present the fiscal year 2012-2013 proposed budget for the Public Health Department. The Public Health Department mission is to improve the health of our communities by preventing disease, promoting wellness and ensuring access to needed healthcare. Our proposed operating budget is $79.6 million which is reduced from last year's operating budget of $84.1 million.

The General Fund contribution to public health is about $6.9 million, which is 8% of our budget and represents a decrease of 13% from last year. We're able to absorb this decrease in general fund this year because the difference is being supplanted with one-time realignment funds due to a change in the way realignment revenue is accounted for by Public Health and the Auditor's Office.

We are budgeted at 483.3 full-time employees, down from 493.5 last year and down 81 FTEs or 14.3% from fiscal year 05. We have a number of key accomplishments over the last fiscal year. We implemented some major technology projects. The electronic health record was our most important initiative. It is already showing positive results, reducing paperwork, increasing efficiency in communication, allowing faster approvals, giving patients clear written summaries of their visits and care instructions. We expect to see improved quality of care, reduced medical errors and other benefits over time.

We initiated electronic prescribing so our providers can electronically send their prescriptions to the pharmacies. It's faster and reduces the chance for errors due to illegible penmanship. We are awarded funding for a patient-centered medical home demonstration project. This is a new model of care that is more comprehensive, accessible and assigns patients to a personal provider which allows for better coordination of all aspects of care.

It will help our patients become active players in their own healthcare and improve both the quality and safety of the care we provide. We received grant funding and implemented a diabetes initiative using a team of nutritionists, health educators, pharmacists and medical providers to get better health outcomes for our diabetic patients. We established disaster medical supply caches across the county so we can better meet local needs in a disaster or emergency. The caches have masks, ventilators and medical supplies to support alternate care sites that can care for 50 patients for one to two weeks.

We implemented an electronic patient care record for 911 medical responders so they can electronically send patient information to the hospital even before they arrive at the emergency room. We increased animal license sales, so more pets who stray can be quickly returned to their owners and to increase rabies vaccination rates. We purchased new equipment for the public health lab which allows for faster influenza and tuberculosis test results so we can provide timely treatment and control the spread of disease.

We set up on-call hours to provide emergency death certificates to accommodate people who practice religions that require burial within a certain time frame. We raised funding and completed the preconstruction phase for the Lompoc Animal Shelter renovation in order to make the facility more customer accessible and friendly, as well as safe for the animals. We initiated a breastfeeding peer counselor program for first-time moms in our Women, Infant and Children Program. The peer counselors use phone calls, text messages and face to face contacts throughout the pregnancy and first year of life to support breastfeeding which has been proven to have tremendous benefits for both mother and infant.

We are awarded National Children's Alliance Accreditation for the Sexual Assault Response Team in recognition of the quality services we provide to victims of sexual assault. While we are not proposing service-level impacts due to general fund reductions, we are recommending changes for efficiency and business reasons. Implementing our electronic medical record will result in reduced staffing needs. We will save $427,000 by reducing 5.2 positions in medical records and $168,000 from reducing two positions in data entry.

While our radiology program has provided convenience and high-quality services for patients at our Santa Barbara Health Care Center, it is no longer cost effective. In the coming year we propose to eliminate the program and the needs of these patients will be met through an agreement with community providers. This will actually provide patients access to an expanded range of radiology services with more affordable fees.

This change will save $237,000 and reduce three positions. Due to changes in the county's medical and economic environments, we have seen in some areas a decrease in our patient visits and revenue, particularly at our Santa Maria Women's Health Care Center. In response, we are exploring various options and planning to adjust our practice through service and staffing modifications. No services will be eliminated but alterations in the practice model and staffing will be considered.

Preparing for the future. In addition to providing high-quality public health programs and essential healthcare services, we will focus on a number of key issues and projects for the upcoming year. Mitigating our budget gap. We will be watching our expense and revenue trends closely and have developed a budget plan with both short term and long term potential actions in order to ensure our fiscal stability.

Evaluating the Impact of Healthcare Reform. The Supreme Court ruling expected this month and the elections this November may change the landscape for healthcare reform. If some version of healthcare reform does not go forward, this would create significant challenges for the community and county departments such as public health and ADMHS due to increasing numbers of uninsured patients.

If health reform does go forward as currently proposed or in some modified fashion, this will have tremendous impacts across the county for our residents and health system. There will be significant additional workload for DSS with outreach enrollment retention and utilization needs for public insurance programs. ADMHS and Public Health Department will likely see greater numbers of insured patients, which would be a benefit. But we could also be secondarily affected in a negative way if the state responds by reducing funding streams that are currently allocated to counties for indigent care.

At this point, the uncertainty makes it difficult to predict the full potential impact. But we will continue to evaluate the opportunities of federal health care reform as they become known so that we can respond quickly and appropriately to meet the needs of our patients in the community. While we are looking at reductions in some areas, we're also exploring the possibility of expanding select services in areas of need as part of our patient-centered medical home efforts. This will also make us eligible for additional financial incentives and increased revenue.

We will further expand our electronic health record system to provide a way for patients to access their computerized records and to set up remote provider access so that physicians and healthcare partners such as the hospitals can access our electronic patient records and exchange medical information. We look forward to continuing to improve outcomes with our Patient-Centered Medical Home demonstration projects.

We will continue to increase patient cash collections at the time of service for those able to pay We'll be implementing a fitness promotion and obesity prevention plan to address the fact that over half of Santa Barbara County adults, and a third of our youth are classified as overweight or obese. This effort will improve the health of our communities and prevent chronic disease in the future.

This initiative will also be coordinated with our own county human resources efforts to develop and implement a wellness program to maintain and improve the health of our workforce. We will complete the renovation of the Lompoc Animal Shelter, which will benefit the public, our staff and the animals housed there. We will continue our efforts to enhance public health emergency response through a countywide earthquake exercise.

This is a very exciting time for us in health care with major initiatives that will improve the health of our communities. While we continue to face budgetary challenges, we will maintain our focus on providing high quality core public health functions and essential services. This concludes our presentation. Thank you and I'm happy to take any questions.

Thank you so much Dr. Wada and to all of your staff and employees. Any questions for Public Health? Supervisor Gray

Dr. Gray?

Not yet.

I've got a promotion.

That's coming.

Great job, Dr. Watt and thanks for your wonderful response whenever we need anything. Yesterday at the beginning when we started talking about budget overview it was indicated that there is going to be 87.4 increase in staff and 44 of that increase in staff was to go to health and public service. Of that 44 How many are, will you be having in public health and what are they?

We're actually reducing our number of full-time employees in public health. We're going down from last year's number of 493.5 to our recommended 483.3 so we're actually reducing our number of FTEs in public health.

So that 44 I think Ms. Waller is gonna answer me now

CEO Waller. Chairwoman, Supervisor, those two departments were our social services and our mental health departments that had increases that were a result of vacancy factors that had been previously budgeted and are no longer budgeted so we can get that information and send that to you very quickly.

Thank you. The other question has to do with the electronic health records, which is a fabulous idea. I was in Sacramento two weeks ago and one of the things that I attended had to do with the delivery of health benefits and how important it was to access all of the possible benefits for the folks that are in our system. For example SSI, if someone qualifies for SSI How do we help them make sure that they qualify? And will this electronic recording make it easier so that if I'm a person representing someone who wants to qualify for SSI, can I in fact access that information a bit easier so I can get those benefits.

Sure. Madam Chair, Supervisor Gray, our electronic health record is really for the patient records during the visits to our clinics and so when someone is applying for SSI or other benefits they often need a copy of those records as part of the process and so we do have that in paper form now when we supply copies but we will not have it electronically and more comprehensively.

So that's a good thing? Yes. Very good. Thank you. That's my questions.

Thank you, Supervisor Gray. Any other questions? Chairwoman, I think

Tom has the answer to Supervisor Gray's question if you'd like that now.

Okay, why don't we go ahead and do that and then we'll go to Supervisor Carbajal.

Chair Farr, Supervisor Gray, the 44 employee change in the health departments was Mental Health 14 and DSS 30. And there's actually a summary for the public. There's a summary of staffing in the back of the budget book, it's the very last portion of the budget book.

Supervisor Carbajal?

I just wanted to thank Dr. Wada and his team. Your department is always just so responsive and I just wanted to recognize that you guys do a really good job.

Thank you Supervisor Wolf. Thank you Dr. Watt on your efficiency and business decision impacts. You mentioned the Santa Maria Women's Clinic and I think we had talked about that at one of our previous meetings because I had expressed some concern about that. I think it was maybe the elimination of OBGYN, so with the way I'm reading this and hearing from you just now it sounds as if there has not been any definitive decision made in that you're looking at the staffing.

So is that correct?

Chair Farr, Supervisor Wolf that is correct. We are not considering eliminating any services we are considering sort of right sizing based on the community needs and we're also looking at other potential services where we may actually expand in Santa Maria so again we're looking at different options at this point and nothing is confirmed

okay Dr. Wada, on a personal note I want to express my condolences on the loss of your mother and I know this has been a difficult time so thank you for all your work and while I'm thanking people I also want to thank Dr. Dietrich for her presentation and Ms. Toplaff as well. Thank you very much.

We'll echo those comments. Alright, I guess we don't have any other questions at this time. Thank you so much Dr. Wada and your team. Now the next department we will hear from is First Five.

Good morning Chair Farr and members of the Board, it's a pleasure meeting with you today to review our budget accomplishments in the past year and goals for the coming years. Joining me today is Wendy Sims-Moten, our Manager of Fiscal and Business Services. In this report, I will be highlighting the accomplishments that have taken place within First 5. Our work is always mirrored by the impact of the economy on families and services that support our youngest residents.

This year we are represented as a department in the Health and Public Assistance Functional Group. Prior to this time, we were represented under general county programs. The total operating budget of First 5 is $5.1 million. Of this amount, $3.9 million is from Proposition 10 allocation and $1.2 million is from additional state and foundation grants and the First 5 Strategic Reserve.

The amount of grant funding frequently increases during the year due to additional grants being received. There is no general fund contribution and we have 14 FTE's at First We focus our accomplishments of the First 5 staff in four areas that are aligned with our strategic plan. Funding and leveraging, evaluation and accountability, technical assistance and training, and serving as a convener and partner.