Board of Supervisors — 2018-04-18

Call this meeting to order. Roll call, please.

Ms. Wolf?

Here.

Ms Hartman? Here Mr. Adam? Here Mr. Lavinino? Here

There's no CEO's report.

Chair Williams, members of the board, we have two requests to speak this morning. We're going to start in Santa Maria with Mr. Caldwell and then come back to Santa Barbara for Ed Kolaski. Mr. Caldwell.

Chairman Williams, members of the board, I'm Andy Caldwell representing OLAB. On Monday, you know I gave you some comments about the renew process. And what our issue is as I mentioned during that general public comment is that your number one cost are employees in terms of salaries, benefits and pensions. That's 60% of your budget. Property taxes are somewhere near 90% of your discretionary revenue.

If Renew 22 doesn't hone in like a laser strike on the number of employees and property taxes, then you're literally rearranging the deck chairs on the Titanic. Now I'm not saying that they may not get there eventually, but you can't be trying to save millions. You need to be saving tens of millions especially when a recession hits because they always do hit. We always have boom and bust cycles.

And the other thing that Supervisor Adam has always brought up and continues to bring up is this issue of mandates You need to be going through every single function the county does and asks, is it mandated or is it not mandated? Can it be privatized? Should it be privatized and or should it be abandoned altogether. And I know in an op-ed that I'm sure you rolled your eyes but in an op-ed I brought up something that a major function of what you do is fulfilling state and federal mandates via pass through monies. But the state and the feds don't pay for your pension losses They may pay for the upfront costs, but when you lose a couple hundred million in a stock market crash, the county taxpayers end up paying the pension losses for people that were actually de facto state and federal employees.

You've got to figure out a way to get out from under that burden. Because you only supply maybe a 5 or 10% match. The state's paying 90% of their salary because they're mandating the service and you get left holding the bag for ten, 20, 30, or 40 years for a pension loss. And then finally revenue growth, the property tax, the positive side. Mike Brown when he was CEO, he used to put in the budget book maybe we need to start some new community centers. Maybe we need to let mansions be built on the Gaviota Coast.

Wineries, greenhouse, oil development, the positive revenue side I see nothing on that side of the ledger. Thank you.

Today's talk, I call you can't make sense out of nonsense. Can you dim the lights so that it can be seen? Anyways, thank you. They ruled at SBAR that our second story is located solely over the garage in violation of guideline 4.7. You can see that it's not solely over the garage. It's over the garage, the living room, part of the living room, dining room and kitchen laundry room.

And yet nobody can explain to me how is that solely over the garage? I mean that's what they found, that that's solely over the garage. And if you flip to the next one, they also found that... Can you switch to the next one Jackie? That our old design which was solely over the garage is identical to our new design which is over the dining room, the kitchen, laundry room and the garage.

So can somebody explain this? I looked on the website, and I'm trying to figure out what the mission is of the Board of Supervisors. And there they say that the Board of Supervisors is to provide services to the people of Santa Barbara in response to their need for healthy, safe and prosperous environment. To me all they're trying to do is get an extortion payment. I can't get this passed unless I pay an extortion payment. How much am I supposed to pay?

You know, it's supposed to be for the healthy environment. Kicking me out of a public meeting, having a guard come down with a nightstick towards me to kick me out of the meeting, getting him behind me so he can slam me across the back of the head, is that for our safety and welfare? Is it for our safety and welfare to run a scam? We come in the fifth meeting to present this drawing.

They wouldn't let us do it. Alex is there, he won't let us show it. Now I go down and talk before the Board of Architectural Review, and they won't turn the mic on. Before they used to just erase portions that they didn't want us to have public. Now they won't turn the mic on. You know, they go down and they change the minutes of the meeting. They wrote the minutes for the fifth meeting before the meeting occurred.

They said that's identical. Can you flip to the last third one? You know we got somebody who is honest here. We've got somebody who is basically a crook here. And we've got three other members here who personify this don't hear anything, don't see anything and don't speak anything. This is the mission of the Board of Supervisors? Does anyone really do anything?

This is why my neighbors say they're all corrupt. They just put it in one bunch, they're all corrupt because this is what the function is of the Board of Supervisors not to hear anything, not to see anything and not to do anything. That concludes public comment.

Chair Williams, members of the board. This is an item from Public Works to the Board of Directors of the Flood Control and Water Conservation Districts regarding Public Works Director's Report on Emergency Response Actions from Impacts of Flooding and Storms in the Continuation of Emergency Actions. This involves first district and so we just need a motion to approve this item.

Can I get a motion?

So moved. Second.

Motion by Hartman, second by Wolfe. All those in favor please say aye. Aye. Opposed? Thank you. Now we will go on to public health's presentation

Good morning. I'm Vonda Renoso, Director for our Public Health Department. With me today are members from my executive team. Both need no introduction. Suzanne Jacobson, amazing CFO and Deputy Director for Administrative Division and Susan Client Rothschild, Deputy Director for Community Health. This morning, I'd like to present to you information regarding our six budget programs and our department's operations for current fiscal year as well as plans for next fiscal year.

One of the key challenges is the changes in federal policies and priorities that may impact funding and services to our health centers and community health prevention programs. One of the emerging issues is our department's new role in cannabis licensing. Our environmental health staff will be developing new policies and procedures so that we can be in alignment with state and local requirements. In addition, we will be collaborating with local partners to collect data and to respond to health impacts due to cannabis.

Renew 22 and essentialism framework, these two Initiatives is prompting us to re-examine our activities and bring them into alignment with our mission and scope of work. And this is especially critical for emergency preparedness and response efforts. For recent events, we estimate that about 178 staff were involved with the response and recovery efforts totaling about 1,200 hours.

I'm sorry, 12,000 hours. We will continue to build the capacity to respond in our department but we will also need to strengthen collaboration we have with community members and agencies who may have additional capacity and jurisdictional authority to support emergency efforts. Our proposed operating budget is 90,000,006 and with approximately 10% general fund contribution. Our staffing is at 524.1 FTEs which is a decrease of 12.3 FTEs. Our expansion request is for $227,000 for three additional FTE's and I'll explain that more later.

Capital projects, our proposed capital projects will cost around $910,000. These projects will address HVAC issues in our San Antonio building and maximize space in our three health centers and finish our safety and security initiatives.

Ms. Reynoso? Yes. Dr. Reynoso?

Yes.

It's Ms., right?

It's either.

It's doctor?

It's doctor.

Oh, sorry, sorry.

I'm comfortable with Vaughn as

well. Well yeah but we're out here in front of everybody and... See you leave for 10 seconds and you're already trying to hijack the meeting. You know isn't the fact that we have a San Antonio building how old is the San Antonio building do you know?

So urban legend says that it's about 100 years old. And so yes, it's old and our failing steam. It's very old and it's not so much air conditioning although that's an issue. It is the failing steam heating system and the complexity

of it. Steam heat? Do we burn coal to get the heat or make the steam? How do we do that?

It's a

boiler

system.

Okay. Natural gas I hope.

I'm not sure.

Okay, anyway, I guess my point behind this exercise here off-ramp is that's just maintenance right? That's not a capital expense. That's just replacing existing systems that don't function right?

So we have about $90,000 reserved for the study. And then about $500,000 as a goal and placeholder for when we have to revamp the infrastructure and make modification.

Well maybe you're the wrong person because I know that this may not be your area of expertise although you may have multiple areas of expertise. Why would we pay $90,000 for a study to replace something that's pretty known quantity? We have the building and we have the HVAC system that we have. How come we can't just call the guys who engineer these systems and say maybe we need a new one?

Supervisor Adam through the chair, we've been working very closely with general services for probably about a year on this. And as Dr. Del Renoso said, the building and the entire campus is about 100 years old and we like to refer to them as our historic buildings. That building in particular, when it was refurbished I believe in the 80s they decided to keep the existing steam heat system which was there with the original hospital.

And I think part of it is they're not certain that the building itself can handle the kind of venting and everything that would take to replace. The HVAC system. So they really are going to have to bring in an engineer to actually look at the building structure and give us options about how to move forward.

Okay, so they're actually do have to do a study? Absolutely. Okay, because that seemed fairly unreasonable to me $90,000 to replace something that's existing but maybe that makes sense yeah Mr. Pontus you have a You look like you're tied to a tree back there and you can't get up.

Supervisor Adam through the chair. It's one of your

favorite projects?

Negative, no it is not one of my favorite projects at all. Several as noted before by the director several of the facilities out there are probably exceeded their useful life but we're doing our best to keep them up and operational so I think general services has that plan together they definitely need the engineering study to make sure that the system that they're designing uses as much of the old system as possible and makes it more energy efficient and does what it needs to for the building. So we think it's fair and appropriate, and you'll be seeing that coming through the board.

Okay thank you

Sources of funds for our department. This slide offers a brief description of our revenue sources, and the top two sources combined make up 74% of our revenues. These are charges for services which accounts for 53% of our revenues. These funds are mostly MediCal, Medicare and the Pharmacy 340B program. And the second source is Intergovernmental Revenues, which accounts for 21% of revenues. And these funds come from more than 35 state and federal grants and includes our 1991 health realignment.

The remaining sources make up 26%. Uses of funds, this slide contains a brief description of uses across our six budget programs fairly consistent with previous years. 52% of our operation budget is in the five healthcare centers. The remaining 48% is spread between disease prevention and health promotion. At 17%, regulatory programs and emergency preparedness at 10%. Administration and support at 10%, animal services at 6% and indigent programs at 5.

Staffing summary We have a net decrease of 12.3 FTEs from- Mr. Chair?

Dr. Reynoso, we have one question before you go too far into the next slide. Supervisor Wolf?

Thank you, Mr. Chair. If you can go back to use of funds. And just so you can prepare for my question about the animal services, the renewed 22, the reduction in hours. So I see here that animal services, the cost is 6% of your total budget. So when you get to the renewed 22 piece and the reduction of hours it would be important for me to know what Your anticipated cost savings would be for that.

And then also, what revenue might you be eliminating with the reduction in services? Thank you Mr. Chair.

Please proceed.

Okay, thank you. We have a net decrease of 12.3 FTEs from current fiscal year. This is due to the state's implementation of the whole child model system of care that will shift case management of our Medi-Cal eligible children in the California Children Services Program to Send Cal Health. This is an anticipated event that the state and the counties have been working on for the past two years.

And one unfunding of a vacant administrative office professional in animal services. Operating revenue, there's not a significant change in our operating revenues. General fund contribution. Our general fund contribution remains at the same level. Anticipated accomplishments. We've been quite busy this year, but like my colleagues I could be here for the next hour and still have plenty of things to share. But given that we are on a limited timeline, the following two slides capture the major successes that we are particularly proud of. I'd like to highlight a few on these two slides. We began renovating the Carpinteria Health Center to expand our capacity. What's really remarkable is that we remained operational during the construction and during the freeway closure.

And with all that went on during the last four months, we were still able to successfully launch our new electronic health records at the end of February after two years of planning and preparation. Lastly, on this slide. Last November in partnership with Behavioral Wellness and CEO's office we organized a workshop for professionals on health impacts due to cannabis. Our joint efforts resulted in securing two nationally known experts as keynote speakers and a full house.

During the Thomas Fire, our emergency preparedness team coordinated with partners to distribute approximately 350,095 masks. Our environmental health services team inspected and removed household hazardous materials from over 1,200 properties damaged or destroyed in Thomas fire and debris flow. And at the last count that's over 10,000 pounds of household hazardous waste.

Our animal service team sheltered more than 1,800 evacuated animals during the Thomas Fire and rescued about a thousand animals during the storm and debris flow. These are some of the highlights that we are particularly proud of. Objectives. The following objectives are continuance of our efforts to effectively and efficiently deliver services to our community. Making improvements at our health centers, incorporating strategies to build resiliency in our patients and clients, and continuing our efforts to ensure a safe work environment and safe work practices.

Additional objectives include implementing a new fee schedule for environmental health services, and our goal is to bring it back to your board by January 2019. We'll also be working with veterinarians to increase the number of dogs licensed. And we will be returning to the board to seek direction to convene a work group comprised of key partners to address access to safe and clean field sanitation.

Performance measures, we've met most of the targets set this year and we hope to improve our performance via quality improvement processes for our next year. Renew 22, we have several initiatives currently underway to improve revenues. The IGT conversations with SenCal and other counties about the feasibility of us capturing additional revenues via public health intergovernmental transfers. We've been able to re-engineer public health patient billing process with the launching of our new electronic health records like Dr. Gleghorn mentioned on Monday. We're pursuing reimbursement or funding for non-emergency medical transportation for our clients and patients.

We have several proposals that are consistent with board policy or direction, and that is the environmental health services fees mentioned earlier as well as beginning to work with behavioral wellness and social services by examining our current referral process and practice into the other two departments. The joint effort reference here though is noted in future year implementation slide.

One proposal that needs guidance from your board is our plan to modify operations in animal services. Our proposal is to modify the public shelter hours to be Tuesday through Saturday with one late evening. We phase out public spay and neuter clinics with community partners picking up this service, and we renegotiate MOUs with partners by asking them to take on more activities. And we have initiated those conversations for example with the Humane Society and the cities. The pros of taking on this initiative is that we will be able to have full staffing on each day with after work hours, which may be more convenient for the public.

We will increase opportunities for partnership and collaboration with limited duplication and redundancy. There are community agencies and partners that can, that are already doing the services that we can lessen. The cons, changing contracts and agreements, negotiating them may be very time consuming. And changes to work schedules for staff can be stressful initially.

The next step we need to clarify the schedule meet with bargaining units cities and other partners. Future efforts that may be worthy to examine in order to address efficiencies and effectiveness include looking at our clinical labs in the future. And again, joining efforts with behavioral wellness and DSS to improve linkages for new patients and clients. Service level reductions, we have no service level reductions. However as mentioned earlier the state will be shifting the case management of California Children's Services, Medi-Cal eligible children to Send Cal Health. There is a corresponding then decrease in our allocation in the CCS program so this means that we will be eliminating seven positions.

Four CCS case worker positions and three AOP 1, 2 and senior positions. Two of the AOP positions were approved for the early retirement program leaving five staff who will be receiving layoff notices. However in preparation for this event, this transition we have been holding five vacant funded AOP positions for these employees so that they have the option to continue employment with the department.

Expansion requests. We're asking for a senior epidemiologist position to conduct surveillance and epidemiology for chronic diseases, behavioral risk factors and injuries. This is a needed position so that we can improve our capacity to systematically collect, analyze and interpret health related data needed for planning, implementing and evaluating public health practice. And to address the emerging health issues such as cannabis use. This is also a key position needed for us to advance our work in becoming a public health accredited department. We're also asking to convert two extra help medical assistant positions to regular positions, and the increase noted here is really due to their cost of benefits. We're moving them from extra help to permanent staffing.

In summary, to address key challenges and emerging issues and to accomplish our objectives we will utilize the following strategies. We will be planning for changes in funding and pursuing aggressively new opportunities. We will be building new partnerships and strengthening the ones we have to launch health promotion projects and efforts. We will be utilizing quality improvement processes to guide our practice so that we can be more effective and efficient in what we do.

In closing, this quote captures the spirit of our department. Public health is the science and art of promoting healthy lifestyles, preventing disease, and protecting the health of all communities. We can achieve good outcomes when our practice is grounded in data and best practices. But good outcomes are also dependent on our relationships, our partnerships with each other, with our clients, with our patients, with other providers and practitioners, and with policy makers. And this is the art of what we do in public health. Thank you.

So we have a couple questions. One is the Supervisor Wolfe's question about cost savings from the animal services change, what you project or estimate that would be? I just had a question about one of the performance measures. The percentage of WIC infants exclusively breastfed, Exclusively, how is exclusively defined in that sense? Is it just that they're not on formula or is it that you pump once and you're disqualified.

I believe that infants exclusively breastfed means that they are totally on breast milk. And this 35% is actually a huge significant. The state average, I believe, hovers around 21%. Wow. Okay,

thank you.

And I will defer to Susan who will respond about animal services.

Supervisor Wolfe through the chair. In terms of animal services, we're looking at modifying the hours so it would be an addition of night hours on when weeknight and it would be having full coverage on Saturday. So right now the public can come in Monday through Friday business hours and Saturday but since that's six days a week and we have staff that work five days a week, it means a couple days a week were not fully staffed. And one of those days is Saturday, which is very difficult. That's when a lot of the public comes in. So by modifying the hours we'll make it for the public to come in five days a week Tuesday through Saturday full staffing at the front to really give them full service and have one weeknight evening to meet again the public's best needs.

We feel like by doing that the approximate savings would be about $95,000 because we wouldn't have to bring people in to help cover the sixth day.

Okay, well thank you for that. I guess one of my concerns was that I always, and I'm going back to the study that we did. And one of the statements that was made was access to the public for animal services. And certainly when we see the numbers during an emergency, the public absolutely enjoys and appreciates the work from Animal Services. But you are reducing hours, and you must be if you're saving $95,000. Otherwise I don't understand where your savings are coming from. And then the other part of that is from the report was the importance of Sundays being open to the public mostly for adoptions and so forth.

So Supervisor Wolf, through the chair. We've looked at this a number of ways and the American Humane Association report did talk about the importance of having a weeknight open to help serve the public better. So it is a change in hours. What it means is that people are coming for adoption. We will not be fully open six days a week for adoption. We'll be open five days. One of those will be later and on Saturday we'll have full staffing but we will still be open on that sixth day for people who are picking up their own animals. In other words, that won't stop. But by not having six days we won't need people at the reception and that means we won't need to bring in extra help and other staff to help cover that time period. That's where the savings is.

So we're considering both how can we save costs as well as really serve the public better? It's doing a little less hours, but it's doing it better because we're doing it when the public really wants our service. In the evening and then having the full staffing on the Saturday which is most helpful to the public. And we've been talking to our partners about this like ASAP and others and wanting to coordinate those hours as much as possible.

Okay, all right. Thank you for that. I think just intuitively I always thought Sunday would be more beneficial but it seems like you've done outreach and then the other question I have is that it sounded like it needs board direction. Does it need formal board direction before this goes into effect?

Supervisor Wolf through the chair, my understanding is we need board direction to make this change. We would also need to approach all of our cities. There's contracts with the cities about what our city hours are. We'd need to approach the union because this would be a change in work hours for our staff. So there are lots of steps to do this but yes, the support of the board would be an important first step.

Let me just move on to something else that I think is really significant and very positive, and that's on your performance measures. The number of Medi-Cal eligible residents who select public health as basically their home base for care. When I served on CENCAL and at the beginning of the Affordable Care Act, that was an important issue making sure for our county that we were able to keep most of our patients. And the fact that the numbers have continued to expand in that the estimated actuals for 17-18 is 25,000, I think is really remarkable.

And that also goes to that coordination piece that you were talking about, Dr. Minoso, about working with social services and behavioral wellness and everyone working on that same goal to get people signed up for social service benefits, Medi-Cal benefits. So I think that coordination is extremely valuable. The other thing I wanted to bring up, and I think you may have mentioned it but that has to do when I visited Franklin Clinic maybe it was last year.

You were starting to bring in, I think with behavioral wellness An office where there would be therapy also at the medical clinic. Am I recalling that correctly? Okay, well I just want to say that is a brilliant move. I know some of the clinics, the other non-profits are doing that and I think it's really important that our public health department do that and I just wanted to congratulate you and your staff for doing that and And the other clinics and it may be, but I just. Go ahead.

Supervisor Wolf through the chair, also I wanted to note that with your support we were able to expand our footprint at the Franklin Center. So we were able to get the additional space that we needed for our behavioral wellness components. Thank you. Oh, I remember

that. You had to do that with the city? Yes. To get that additional space.

And you are correct. We have integrated Behavioral wellness services in our Santa Maria, our Lompoc, our Franklin, our Santa Barbara as well as in our Carpinteria locations. Excellent that's

really good to hear and then finally I just you mentioned about the disaster that we all experienced. So I wanted to express appreciation to public health for I know you're working with other departments in looking I think it's important to understand why the beach continues to be at a level where it is closed after so many months. So, I look forward to getting a report on that as to what our next steps might be.

I think that' s it for now. I look forward to more discussion about the animal services because I guess just in summary Mr. Chair we spent so much time working Advocates, and I think that's due in large part to the fact that you and your staff have really worked with folks to get us to where we are right now. And so I would hate to see us move backward. And so I hope whatever changes are made or done with a lot of input from community members without making any kind of what may be a drastic change in my view. Thank you Mr. Chair.

Thank you Mr. Chair, I have two areas I'd like to ask about and make some comments about. And the first is animal services and I think this is an opportunity for us to talk about work program and priorities. Increasingly we see people relying on service animals and animals for comfort. And what I'm seeing in my district last week, two vicious dog attacks, one in the Santa Ynez Valley, one in Isla Vista.

And I think it would be helpful to when people experience that and you're called out, have something in writing that you can actually provide them about how the process works. A follow up call the next day, they're traumatized. They're not fully, I mean it's a really awful experience to go through so I think it might even be worthwhile talking to our victim program in the DAs office just how you handle but this is really important that government be responsive and help people through this process and help them understand.

So I would encourage you to do that. My second area of inquiry work program has to do with adverse childhood experiences. And this is going to take me a few minutes to explain, but last night I watched a really great videotape that Supervisor Adam lent to me about horses. And it describes how horses, when they're hyper aroused that it changes biochemically in their brains. And then they're kept in stalls where they can't move, they're isolated socially.

They're given grain where usually they eat grass or hay. And if they aren't dealt with appropriately, they can develop behavioral and physical problems. Supervisor Adam did you want to add something to

my characterization? I think you need to explain hyper aroused to Supervisor Lavinino

because

I saw his brain going someplace else.

biochemical changes in the brain that flight or fight and when you're in that state constantly it creates behavioral issues. Thanks for helping me out there So what happens is horses get sick and they develop behavioral problems, and this is a whole system. And so we need to bring them back to equilibrium, bring them back to balance. What was so interesting as I watched this Monday, The lecture by Nadine Burke Harris, a pediatrician who works with children who are in this flight or flight syndrome.

And because of adverse childhood experiences and it's the same kind of thing they have these experiences and It affects the whole organic system, and it leads to problems in behavior. And it leads to physical illness now and then in the future cancer, asthma all these problems that you get later on heart disease stroke can be triggered by changes that happen early on.

So I'm really interested in the objectives about adverse childhood experience and what you're doing there. But when the trainer's talking about horses or when the pediatrician is talking about children, We need to eat well, we need to sleep well. We need exercise. Those are sort of lifestyle easy things. We have in our county and in many cities in our county a resolution that we passed healthy eating active living. And it seems to me that's the preventive aspect of all of this how we first of all prevent These fight or flight, hyper aroused in this disequilibrium state. So I think there is tremendous opportunity and as Supervisor Wolf mentioned the integration of behavioral wellness and public health but what more basically Dr. Harris is arguing, is that our problems in public health, our problems in behavioral wellness, our problems in public education, issue that we live in a highly artificial environment.

And so I am interested in looking at how we can create a collaborative to try to integrate our health and well-being for children, and identifying where we're having problems, and how we can work together to create a healthier environment for our community, and especially our children. So that's my pitch.

Thank you for your comments, Supervisor Hartman through the chair. With regards to adverse childhood experience so that is one of our objectives we currently have several champions. In our department in Maternal Child Adolescent Health, who are currently doing the screening that Dr. Burke Harris mentioned. In addition to that we have a pediatrician champion, Dr. Dodds in Carpinteria who is very passionate about ACEs as well. As a matter of fact after that conversation in the DA's office We had a side conversation about what would it look like if we piloted something out in Carpentria because of its size. We have our pediatrician who's engaged, we have our WIC, we have community organizations and we have SAMHSA. So it's a very doable situation where we can pilot something and see how do we get through the reimbursement issues?

How do we get through the lack of community providers, where we can send the children who need additional services. How do you resolve that? So we're really encouraged after hearing Nadine speak About leveraging resources and connecting the dots, because we like her believe that the dots are already there. It will just take relationship building and strengthening what we already have. So that's one track. The other track about the healthy eating active living so in Santa Barbara we do have a live well So that's a loose organization infrastructure of city, county and community organizations all vested in creating a healthier community. So for the past year that group has been sort Not very active, so I think that with direction from the board and infusion of resources and initiatives that we can resurrect that group to be more active.

So we have that skeleton group ready in the wings, so to speak.

Just a quick follow on. I would be very interested in pursuing that as well as, I don't know what the role of First Five or Department of Social Services or how this all integrates with non-profits but I think it's very important. Thank you.

Supervisor Adam? Well, I'm just going to say It probably doesn't have, and without hijacking the meeting to talk about a horse training video. It probably doesn't have no application to this whatsoever but I think you missed some of the point that they were talking about there and you and I need to watch it together and then we'll see where it crosses over into public health.

Well, I wasn't going to weigh in here but I do not know how to raise horses. But I'm learning the hard way how to raise daughters. The metaphor, whether or not it is relevant to horses. Supervisor Hartman's metaphor is very relevant to children at least from what we know about early trauma and I do think that it is solidly statistically It's validity is solidly statistically backed up.

And I think the question is, what kind of interventions so that we don't look at it as deterministic? That if you're among us that have a high score does that mean you're just- SOL, or is there interventions that we can use that screening tool? And I'm very interested and I'm really excited that you're looking at Carpentria to herald that movement. Supervisor Wolk.

Thank you, Mr. Chair. One thing I just getting away from this a little bit but on the requested expansions, the extra help issue for medical assistance seems very similar to what happened yesterday when public defender, I mean the district attorney was asking for funding for their extra help and I seem to recall that these positions are also on the Civil Service Commission agenda.

And, and I think just as a county we need to really be careful and look at these extra help positions and where needed make them permanent because otherwise there's going to be other implications either they're not going to be around or Maybe get in trouble, and we don't want to do that obviously. So I think this is a really good application. And then of course the epidemiologist I think is incredibly important.

I know we've talked about the increase of STDs in the county and certain other issues. So, I think having an epidemiologist for that and for that educational component that you mentioned will be vital. And both of these seem to come from non-general fund sources. And then finally just on the issue that Supervisor Farr Could have been Supervisor Farr, Supervisor Hartman. Are

you talking about me or Supervisor

Hartman? Supervisor Hartman, well I think that's the nice, this board consistently throughout the years has cared about our children and negative impacts to our children. And this is now gaining more prominence and I've actually taken that survey myself but It can't, one of the issues that seems so important to me is that parental education. That prenatal education getting parents ready and monitoring the parents and maybe identifying.

Through evidence-based testing and with social services, who are those that are most at risk? And do interventions early on even in the prenatal stage to get parents ready for when the children come. And providing assistance so that those negative impacts, of course some would be out of parent's realm I suppose. But I really believe that the parenting skills is so important in decreasing any negative impacts to our children.

Thank you Mr Chair.

Do we have any public comment on this item?

No request to speak.

Then we will move on to social services.

Thank you.

And just as an announcement, I think we can safely say that Agriculture Weights and Measures, Treasurer Tax Collector, Clerk Recorder Assessor and Auditor Controller will be after lunch and after closed session. So don't stress out, go do your other stuff. Don't use any county resources monitoring us for awhile.

Good morning Chair Williams and Supervisors. Daniel Nielsen, Director of the Department of Social Services with me today Deputy Director Terry Kinsellas, Deputy Director Amy Krueger, Deputy Director Maria Gardner and CFO Victor Zambrano The Department of Social Services is divided into three budget areas, administration and support, economic assistance and employment services. And the third area is protective services for children adults and the disabled.

Before I address our challenges and issues for the coming year I would like to note that unlike a year ago we are now in a position of stability as we move into the coming year with adequate funding for our current staffing levels. The department is using $3.74 million of one-time fund balance to fund ongoing operations, which every year for us is a concern but every year we seem to have some amount of fund balance to be able to use.

This compares the 3.74 million compares to 3.2 million that we used in the current year. Our fund balance is made up of 1.8 million dollars of restricted funds and 1.9 million dollars of committed funds. This $3.74 million will draw down approximately $14.7 million in state and federal funds. Although current revenue projections for 1991 realignment are anticipated to cover our county IHSS MOE obligations for fiscal year 18-19, significant concerns remain for fiscal year 19-20.

The state contribution towards the county offset of the total MOE cost will decrease from $400 million in fiscal year 17-18 To $200 million in fiscal year 1920, and the MOE will increase from 5% to 7%. It is unlikely that any potential increase in realignment revenues in fiscal year 19-20 will be enough to fully cover the decrease in state offset in the increase in the county MOE.

2011 realignment funds rely entirely on sales tax revenue and 1991 realignment relies on both sales tax and vehicle license fees. If the state experiences a recession as some are anticipating, both of these revenue sources would be significantly impacted creating funding gaps for our programs primarily in child welfare and in home supportive services. Our operating expenditures for FY18-19 are $172 million, a $4.9 million increase from FY17-18 adopted budget.

Our general fund contribution for fiscal year 18-19 is $9.3 million, which is the same as it was in 17-18. The 9.3 million dollar general fund contribution is 5.4% of our total budget and is used to leverage federal and state funds. We have budgeted 741.5 FTE's which is just 0.3 FTE less than the current year. The department is using $3.7 million in one-time fund balance for ongoing operations, which is 29% of the county's local match requirement and as I said before is made up of 1.8 million dollars in restricted fund balance and 1.9 million in general fund balance.