De Depar partme tment nt of of Hu Human man Se Servi vice - - PowerPoint PPT Presentation

PROPOSED FY 2019 BUDGET HIGHLIGHTS

County Board Work k Session

• n

De Depar partme tment nt of

• f Hu

Human man Se Servi vice ces

February 28, 2018

Vision A community of healthy, safe and economically secure children, adults and families Mission Strengthen, protect and empower those in need Ideal Culture

Customers are our highest priority, receiving quality, integrated services Employees are engaged and committed to continuous improvement Our organization is built on mutual trust and shared responsibility

Departm tment ent of Human Servi vices: ces: V Visi sion,

• n, Miss

ssion ion & I Ideal al Culture ture

Dep epar artmen tment t Initiativ itiatives es

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Departme tment nt of Human man Services vices

Cl Clien ents ts Se Served ved by Pr y Program am

Aging & Disability Behavioral Health Child & Family

747 - Nursing Case Management 552 - Independent Living Services 502 - Case Management 308 - Adult Protective Services 272 - Senior Adult Mental Health 1,942 – Psychiatric Services 1,604 – Emergency Services 1,389 – Outpatient Mental Health 988 – Jail Mental Health 272 – Substance Abuse 415 – Child Protective Services 279 – Youth Mental Health 273 – Child Advocacy Center 228 – Child Care Licensing 104 – Foster Care

Dep epar artmen tment t Initiativ itiatives es

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Departme tment nt of Human man Services vices

Cl Clien ents ts Se Served ved by Pr y Program am

Economic Independence Public Health

17,407 – Medicaid, SNAP, TANF 1,585 – Energy Assistance 1,516 – Housing Choice Voucher 1,229 - Housing Grants 251 – Permanent Supportive Housing 20,167 – School Health 4,088 – Immunization Clinic 3,556 – Laboratory Services 2,658 – Family Planning 809 - Dental Clinic

Dep epar artmen tment t Initiativ itiatives es

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Departme tment nt of Human man Services vices

• Promotes an inclusive, integrated child care system serving all Arlington families, especially vulnerable populations
• Increased availability, accessibility, affordability, and improved quality of child care programs
• 30 organizations, including providers, parents, non-profits, schools and government involved in leadership and working groups
• Draft Action Plan under review by community – approximately 500 comments received; County Board to receive final draft in Spring

Child Care Initiative

• Over 20 entities, representing law enforcement, courts, schools, providers, hospitals and local government addressing the opioid crisis
• Priorities are increased awareness, community education, expanded treatment access, naloxone dissemination and safe prescribing,

enforcement, and reduced supply

• Actions underway: 24/7 drug take back at 2 fire stations, April 2018 Town Hall meeting, 24/7 hotline through PRS (Crisis Link), community

naloxone training

Opioid Response

• Public Health initiative and campaign to achieve health equity through system changes by 2027
• Uses community feedback, health data, and national standards to identify how DHS can empower Arlingtonians and community
• rganizations to improve public health
• 35 entities representing health care providers, non-profits, schools, universities, foundations, law enforcement and local government will

analyze data and develop goals and strategies for addressing them through system changes

• 2,540 people responded to the community health survey - access to affordable housing, health care, and meeting basic needs are areas

for improvement

Destination 2027

Dep epar artmen tment t Initiativ itiatives es

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Departme tment nt of Human man Services vices

• 23 non-profits, DHS, schools, and the Arlington Community Foundation making improvements to the service delivery system for

shared clients and strengthening client voice

• Developing new tools to share information on programs and clients across agencies
• Addressing social determinants of health in Arlington census tracts with worst health outcomes

Bridges Out of Poverty

• Inventory County-supported employment and workforce development activities and programs across all departments to identify

redundant services

• Propose strategies to eliminate redundancies, create efficiencies and increase effectiveness in meeting desired workforce outcomes
• Improve collaboration, integration and performance between the public and private sectors

AC Works

• Mandated best practice that allows clients to walk in for mental health intakes with no scheduled appointment
• Increases client engagement, reduces wait time for first appointment, reduces paperwork and improves collaboration with partners
• Since initiating in December 2017, have doubled number of mental health intakes and eliminated all wait lists for initial appointments

Same Day Access (SDA)

Propos

• posed

ed Bu Budget get Chang anges es for FY FY 2019

FY FY 2018 Adopt pted FY 2019 Propos

• posed

Net Chang nge % Chang nge

Expen penses ses

$137,101,996 $138,794,705 $1,692,709 1.2%

Revenue enue

$39,610,153 $41,144,648 $1,534,495 3.9%

Net Tax x Supp ppor

• rt

$97,491,843 (71%) $97,650,057 (70%) $158,214 0.2%

Perma manent nent St Staff

705.52 FTEs 691.82 FTEs

• 13.7 FTEs
• 1.9%

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Departme tment nt of Human man Services vices

FY 2019 proposed revenue budget includes a $12,000 increase for new state-mandated client fees regarding testing for sexually transmitted infections.

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

OPTIONAL: An image or graphic can be used to help show, explain or quantify a proposed reduction.

DHS FY 2019 REDUCTION SUMMARY

Personnel Non-Personnel Total Reduction FTE FY 2019 Reduction $1,650,035 $557,101 $2,207,136 16.0 (11 filled; 5 vacant)

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Adm dminis nistr trati ative ve Supp pport t St Staf aff

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

 Public Health Division Office Supervisor ($95,603)

• Transfer supervision of seven staff to the administrative officer, increasing

direct reports from three to ten.

• Redistribute vital records requests & reporting, front desk support, as well as

purchasing & payables tasks to other administrative staff under the direction

• f the administrative officer.

 Director’s Office Administrative Technician ($81,017)

• Reduce capacity for records tracking, delivering & retrieving.
• Require program staff to track & monitor records independently.
• Enlist contractor to deliver & retrieve records as needed ($12,000 cost

included in FY 2019 impact). FY 2019 Change:

• $164,620

St Staff f Imp mpact act

• 1.0

0 Office ce Superviso sor r (filled)

• 1.0

.0 Admini nistr trat ative ve Technici cian n (filled)

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Eliminate inate Non-Ess Essential ntial Cont

• ntinge

ingency ncy Funding ding for r Behavior havioral al Healthcar thcare Division sion Contr

• ntract

acts

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• Eliminate non-essential contingency funding for Community Residences Group

Homes, Crisis Stabilization, Intensive Support and Living Services Contracts.

• There is no impact on clients or service delivery as vendors historically did not

utilize contingency funding in order to meet contract goals and outcomes.

• If contractual needs change in future years, funding levels may be revised.

FY 2019 Change:

• $80,000

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Pharmacy armacy Servi vices ces

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• By contracting pharmacy services, DHS will provide more efficient pharmacy
• perations at a lower cost. The pharmacy contract will include dispensing,

pharmacist consultation and medication subsidy assistance for an estimated $134,040 per year (based on market research). Expenses will be covered by reallocating existing, on-going grant funds.

• Client outcomes will improve by co-locating pharmacy services with mental health

and primary care providers through easier access to medications.

• Clinical staff will no longer conduct medication management in order to focus on
• ther direct client services.
• Proposal includes the elimination of two administrative technicians ($159,153)

and a reduction in pharmacy contract funding ($17,200). FY 2019 Change:

• $176,353

St Staff f Imp mpact act

• 2.0

0 Administrati tive ve Technici nician ans s (vacant)

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Empl ployment yment Servi vices ces and d REEP EP Contr ntract act Fundi ding ng

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• Administrative, education and training duties of the management specialist and program manager

would be absorbed by the director and remaining employment supervisor.

• Case management and employment coaching duties of the three eliminated employment

specialists will be redistributed to the remaining 13 specialists resulting in higher caseloads. If caseloads rise, clients will have to wait longer for appointments and receive less coaching.

• Management duties for 13 employment and administrative staff provided by the eliminated

employment supervisor will be transferred to the remaining supervisor.

• REEP grant reduction reduces administrative support and increases revenue by implementing a

revenue generating TOEFL class ($171,901). Reduction does not impact ESL slots or the tuition amount.

FY 2018: $4,650,774 FY 2019: $3,825,190 Change:

• $825

825,58 ,584

St Staff f Imp mpact act

• 1.0 DHS Progr

gram Manager er (filled led)

• 1.0 Managem

emen ent Speci eciali list (filled led)

• 1.0 Emplo

loym ymen ent t Servic vices es Supervis visor r (filled led)

• 3.0 Employme

yment nt Servic ices es Speci ciali alist t (2 filled; ed; 1 vaca cant)

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Publ blic Ass ssistance nce

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• Reducing one of 13 eligibility workers would not significantly impact the program

due to decreasing public assistance caseloads.

• The caseload of 700 assigned to this position will be redistributed to the remaining

12 eligibility workers. Due to the implementation of a more streamlined application process, workers will be able to absorb the additional cases with minimal impact. FY 2019 Change:

• $105,493

St Staff f Imp mpact act

• 1.0 Eligibility

y Worke ker (vaca cant nt)

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Deve velopment lopmental al Disa sabi bility lity Resi esidential dential Servi vices ces ( (DDS)

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• In FY 2016 and FY 2017, Virginia allocated additional Medicaid waivers to Arlington,

reducing the need for local funding for the program. Prior to FY 2016, Medicaid waiver funding was only available to support individuals living in residential institutions.

• The program provides safe, assisted living options to persons with developmental

disabilities so they can live in the community rather than institutions.

• The additional Medicaid waivers provided by the state will allow the county to meet

demand with less local tax support.

• In FY 2019, we project the addition of nine students into DDS programs. There will

be no impact on transportation or staff ability to absorb case management duties. FY 2019 Change:

• $300,000

Propos

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ed Red eductions uctions

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Departme tment nt of Human man Services vices

Public Health Division’s Community Healt lth h Progr

• gram

am

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• The management specialist’s clinic scheduling and health record quality assurance

duties would be transferred to existing nurses and nursing supervisors.

• The transfer of duties to nursing staff would increase the likelihood of scheduling

errors, reduce health record data quality and eliminate practice management process and procedure reviews to increase efficiencies. FY 2019 Change:

• $105,727

St Staff f Imp mpact act

• 1.0 Managemen

ment t Specialis alist (vaca cant) nt)

Propos

• posed

ed Red eductions uctions

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Departme tment nt of Human man Services vices

Labor borat ator

• ry Servi

vices ces

Servi vice ce Imp mpacts acts Budge dget Imp mpact act

• Closure of the laboratory includes eliminating four of six support staff and requires one of five

tests to be sent to a contracted laboratory for testing. The existing laboratory is one of only two operated locally in Virginia. Other jurisdictions rely on private sector contracts for testing services.

• Urinalysis, pregnancy, HIV and diabetes testing will be provided in-house by the remaining two

lab technologists. The wet prep test to diagnose gynecological conditions will be sent to a contracted laboratory.

• In the absence of lab staff, nurses and clinic aides will have to be retrained on specimen

packaging, storing and shipping protocols. Staff will also have to be educated on the protocols for preparing medical waste for transportation and disposal.

• Existing clinical staff will be required to perform phlebotomy duties in a back-up capacity

during times of high volume; this will reduce their time providing direct clinical, disease surveillance and investigative services.

FY 2018: $643,648 FY 2019: $194,289 Chang ange: e:

• $449,

9,35 359

St Staff f Imp mpact act

• 1.0

0 Laborator

• ry

y Section n Superviso sor r (filled ed)

• 3.0

.0 Laborator

• ry

y Techno nologi gists (filled) ed)

Propos

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ed Red eductions uctions

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Departme tment nt of Human man Services vices

Non-Pr Prof

• fit

it Requ equest ests

• ASPAN operates the year-round Homeless Services Center (HSC) through a county contract. HSC and RPC services will be out for

competitive RFP in FY 2019. The FY 2018 contract is $1.4 million.

• FY 2019 request is $117,426 – includes $18,000 cleaning, $46,926 staff fringe benefits and $52,500 administrative fee increase 6% to 10%.

Arlington Street People’s Assistance Network (ASPAN)

• AFAC provides emergency food assistance to clients referred from DHS. Contract funds are used for the purchase of food only.
• FY 2018 funding is $527,925 ($477,925 on-going; $50,000 one-time).
• FY 2019 Request: a) Restore $50,000 in FY 2018 one-time funds on an on-going basis and b) Contribute $150,000 - $250,000 towards

building renovations.

Arlington Food Assistance Center (AFAC)

• ANV provides support to Arlington’s 55+ population to assist them in aging in their homes and living active, connected lives.
• ANV received $30,000 in one-time funds in FY 2015 and FY 2017. Arlington provided no funding in FY 2018.
• FY 2019 request is to restore $30,000 in FY 2017 funding on an on-going basis.

Arlington Neighborhood Village (ANV)

Propos

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ed Red eductions uctions

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Departme tment nt of Human man Services vices

Non-Pr Prof

• fit

it Requ equest ests

• Thrive is a provider of same-day emergency financial assistance in Arlington County for people who need

help paying rent, utilities, medical bills, prescriptions, or transportation to work or medical appointments

• FY 2018 funding is $464,630
• FY 2019 Request is $50,000 to increase emergency financial assistance to in-need County residents. If

approved, new contract amount would be $514,630

Arlington Thrive

• NRC convenes 23+ safety net non-profits for the Bridges Out of Poverty initiative
• After receiving one-time funding of $25,000 in FY 2016, NRC raised $140,000 in the past two years
• FY 2019 Request is $25,000 to support non-profits to implement human services initiatives

Non-Profit Resource Center - Arlington Community Foundation

Propos

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ed Red eductions uctions

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Departme tment nt of Human man Services vices

Comm mmuni unity ty Ser ervices vices Bo Boar ard d Req equests uests

Young Adult Mental Health Therapist

• Position would provide therapy and

case management to adults aged 18 to 24

• Current average case load is 36;

benchmark for this population is 20-25.

• Estimated cost of 1.0 Mental Health

Therapist is $91,463

Peer Specialist

• Position conducts opioid outreach,

connects unengaged clients and supports community reintegration to recently incarcerated and hospitalized individuals

• Estimated cost of 1.0 Peer Specialist is

$85,135

Customized Employment Pilot

• Capacity of 4 persons with developmental

disabilities to find and maintain employment

• Program meets new federal requirements for

competitive, integrated employment

• Employment integrating the disabled and

non-disabled populations has better

• utcomes than sheltered programs
• Estimated cost is $120,000

The CSB identified emerging needs for individuals needing mental health, substance abuse and developmental disability

• services. DHS is reallocating 3.0 existing FTEs and utilizing state grant funding for an additional 2.0 positions to meet these
• needs. Despite substantial DHS effort, a significant need for staffing and programmatic support remains. The unfunded FY

2019 CSB request is $296,598; 2.0 FTEs.

DH DHS Ho Hous usin ing Pr Prog

• gram

rams

Hous using ing Gr Grants ants

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Departme tment nt of Human man Services vices

FY 2019 projected average cost per household is $605; total projected expenditures are $8.7M

1,219 1,302 1,299 1,229 1,214 1,198

1,100 1,150 1,200 1,250 1,300 1,350

FY14 (Actuals: $8.3M) FY15 (Actuals: $9.1M) FY16 (Actuals: $9.0M) FY17 (Actuals: $8.7M) FY18 (proj) (Actuals: $8.7M) FY19 (proj) (Actuals: $8.7M)

Households

Housing Grants: Number of Households in Program

Hous using ing Gr Grants ants

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Departme tment nt of Human man Services vices

The permanent supportive housing waitlist has approximately 35-40 clients who wait an average of 4-6 months before they can secure housing. Deficits in FY 2018 and FY 2019 will be absorbed by the DHS base budget.

Permanen manent t Suppor portiv tive e Housing sing

FY 2016 FY 2017 FY 2018 (Projected) FY 2019 (Projected) Available Units (as of 6/30) 217 236 246 256 Occupied Units - (as of 6/30) 178 190 200 210 New Units Serrano – 8 Spectrum – 4 Total: 12 Pierce Queen – 8 The Springs – 11 Total: 19 Clarendon Court – 10 Total: 10 Columbia Hills - 10 Total: 10 Average Monthly Grant $877 $887 $900 $910 Adopted Budget $2,064,870 $2,064,870 $2,064,870 $2,064,870 Expenditures $1,931,993 $2,031,812 $2,093,400 $2,211,932 (Over)/Under Budget $132,877 $33,058 ($28,530) ($147,062)