higher federal and state reimbursement. We able to shift budget within the um adult um arrowhead behavioral health initiative grant funding and receive slightly higher reimbursement shown under the miscellaneous line. Overall
expenditures were 6% more in the budget. Again, this was largely due to the increased social services program related cost, increased our home placement cost, mental health placement cost, both adult and children, and incre increased mobile crisis response program
cost. We had budgeted to use 566,645 thou uh dollars of fund balance. We have an axis of expenditures paid over the revenues received of $155,887. This is the amount of actual use of fun balance. Any questions? Ju,
>> Mr. Chair, please. >> Um, the miscellaneous, can you just give us general idea? So the under that line there aren't very many items except the um arrowhead
behavioral health initiative. That's funding we receive to support um our um adult mental health worker during 2025. Um there was um an opportunity to shift
funds from grant 11 what it's called it's a block grant brass grant related under adult mental health towards the support for salaries for the adult mental health worker. So that's why you
see an increase of um under that line. But um basically it um it was a change in the budget along the way and um we were able to charge salaries and French um rather
than um program supplies and that's why that is an at 148%. Normally in um thank you if that when you have a a significant expenditure in a particular area it becomes its own
line item and and so that's why when I look at miscellaneous because it is the highest of the overage 148% of what was budgeted and wanting to understand what is that
if it if it is largely from the the mental health component. Then I I'm I guess the question is why isn't that a separate line item that makes it clear when you're looking at it as opposed to having it lumped in with
miscellaneous? >> Well, because I've separated well, first of all, it's it's a large percentage, but it's a small dollar amount. Um and second I have to separate I've been separating um those financials between
federal and state county levy charges for services and miscellaneous just to display um how PH is is funded. Um that's a one condensed um picture of the all the financials and I'm going to get
further down into the greater detail for each department. >> Thank you. federal. Um so that graph represents where the funding sources are for uh public health and human services. And then um the other chart compares um
public health and human services revenues um against the county tax. So the first graph uh federal grants and aid made 21% of our revenue in 2025. State grants and aid made 25% of our revenue in 2025. Combined the federal
and state revenue made 46% of the revenues in 2025 which represent an increase of 4% from year 2024. Okay. fees and recoveries including reimbursement from health insurance plans and license fees made up another
6%. Small amount of revenue came from non-governmental grants and donations less than 2% and the remaining 46 of our revenue came from county tax. The second graph represents a comparison between the county tax and all other sources of
revenue between 2022 and 2025. Please note that in year 2023, 2024, and 2025, all other sources of revenue exceeded the county tax. >> Say that one more time. >> Except for year 2022, all the rest of
the years, all other sources of revenue are higher than the county tax. >> Okay. When >> any questions? Yeah, just going back to our the previous discussion about miscellaneous, where would that fit in the that revenue fit into the pigraph
there? The pie >> is that uh other grants be under other grants and and donations. Yes. >> Thank you. >> Yep. >> Any questions on this slide? Okay. the 2025 expenditures by department. Um
all ex all all of the public health and human services expenses fall into one of those departments. Economic assistance public health including the public health community grants it's an important note child care program and social services for economic
assistance their share is 21% public health 19 child care program 7 social services 53%. Any questions? Um I always try to um present the orchart for public health and human
services. At the time I prepared this as of January of 2026. This is what the staff um at public health and human services was. Of course, we've since had another change under behavioral health team and under
the public health team too with Avi Sukal joining the team as a public health supervisor. I'm going to start with the administrations. Since it was the administrative professional day on April the 22nd, I would like to acknowledge our administrative staff for important
work that gets done behind the scenes every day. This includes our director providing agency management and leadership and local, regional and state collaboration. The executive administrative assistant amongst various other responsibilities. The administrative assistant supports our
citizen advisory councils and maintains the public health and human services, social media and outreach. The administrative team also includes the fiscal services with one supervisor, a fiscal office and an accounting technician. We develop the budget, pay the bills, receive the revenue, operate
the social security or FP program, provide complex grant management and reporting, provide regular financial reports to the board. Kudos to my team for the work they do. >> They're here. Administrative allocation. Um the
administrative cost that benefits the entire agency is split between the three departments. That includes administrative wages for the um team that I just um um went over, postage, copy cost, office supplies,
phones, training, travel for admin staff, travel per DM for advisory council board members, fees to the state of Minnesota for the merit system, as well as funds transferred to the county general fund for courthouse office rent and county MIS cost and labor, liability
insurance, and annual ual audit. As I go over the details of each department, you'll notice a line item in each budget for an administrative allocation. As these admin costs are split proportionally between economic assistant, social services, and public
health team based on the aft >> based on what >> full-time equivalent. Hey, I got a question on the other Can you go back real quick? >> On some of these there's like dashed out like there's no >> That's a zero.
>> How come it's a zero? >> Um for Well, I'll take the um state auditor fee for example. Um we had not been charged fee. We we our um financials have to be audited just like
the county general from financials have to be audited by audit company. I used to be a state auditor, now it's a private company, I believe. Um, until 2026, um, our auditor had instructed us to budget zero for that expense as that was
paid from the general fund. Uh, in in in 2026, our auditor Brady Powers asked me to include an amount in the budget. So now we will you will see that that's not going to be zero anymore and we'll pick up our share >> from 2027 on that will not be blank.
>> I um I don't know about 2027. I'm still working on the budget. Um um we can either way we're going to budget. I'm just going to have to get a guidance from the auditor's office on whether that we're going to be paying a portion
or not. If that's the example you use, does that mean that we didn't get audited by the state, so you didn't have to budget for it? >> We did get audited, not by the state. >> Uhhuh. >> Um, but we did not have to pay for the audit. It was paid by the general fund. >> Got it. Thank you.
>> Yeah. Economic assistance department. Economic assistant team consists of one supervisor and four eligibility specialists who provide eligibility determination and revalidation reviews for many state and federal support programs such as cash and food
assistance, housing support, several healthcare programs, child care assistance and process applications for emergency assistant assistance and county funded burial support. Two case aid support provide uh direct support to this area as well. Child support
services in Cook County are provided through a contract with Carlton County. And I'm going next slide is going to show the financials for economic assistance team. The 2025 actual expenditures and economic assistant department were at 96% of the budget while the revenues
were within 95% of the budget. The biggest variance can be seen in the client programs resulting in 36% actual expenditures less than the budget and the corresponding decrease in federal and state revenues. The expenditures
exceeded revenues by $16,234. >> Uh, one question here from administrator trouble. >> Thank you. Um, plowman, can you explain the 64%. Is that down because client numbers are down? Um yes I'll next slide we'll go over that
or the slide over. >> Uh I want to go through the personnel a little bit. You you'll see that we're at 101%. And that is because >> we made a payment for our >> try to come back for that >> electronic health record
um software for both uh 2025 and 2026 and 2025. we when we get an invoice, we have 30 days to pay it. I didn't feel comfortable waiting until sometime um
past the 30 days to get into the 20 26. So that amount is um a little bit over $18,000. So that puts us at 101%. And and our expenditures exceeded the revenues by nearly that amount. So we
essentially would have broken even on the economic assistance team if we could say that um if we didn't pay the amount for electronic health record for 2026 back in 2025. Does that make sense? >> Okay. The funding sources for um um economic
assistance team, federal and state funding made up to 53% of the revenue received from the economic assistance. That includes that includes federal administrative aid which supported some of the payroll cost of staff providing the eligibility services for state and
federal programs as well as reimbursement for county paid client assistance. Fees and recoveries made up 2% of the revenue. The county is required to perform collections on behalf of the state and in return the state allows us to keep a small portion
and the reminder of the funding came from county tax. So federal and state funding is significant for economic especially the federal funding it's nearly 50%. Just want to make a note of that
>> and that's good. >> Yes. >> Yeah. >> Yeah. It's not coming from a county tax. So, Commissioner Gamble. >> Thank you, Mr. Chair. pla do you know not like you got enough numbers to have
to shuffle around and be mindful of but do you know how this compares like when you look at the support that if there's an allocation based upon population numbers or some other criteria but when we look at how much of the our tax base
is supporting you know these different departments just how that compares and the other thing is when it when it comes to recover recovery and fees if uh understanding what what that is and how that compares >> explainable. Yeah.
>> Um I remember going through a um exercise of finding that information about neighboring counties and other counties during the budgeting process. I can't quite recall if that was the budget for
2025 or 2026. Um the goal was to same to determine how much of public health and human services department as a whole and broken down is funded by county levy and from state and
federal. And I remember that the numbers were very similar for the other counties too. But I could um go back to those and try to recreate those numbers again for um more recent year. So I could do that.
But I remember that we were um we were not um any different from the other counties. Our levy was somewhere less than um 50%. Um in some instances some counties had levy higher than 50%. >> Yeah. And sometimes that that number
given our size that it's it's uh that impacts how we reflect as opposed to other counties because of our population. uh and the size of our county. The reason that it it's uh it's helpful is it it's sort of a checks and
balances thing. So, it's not like you're trying to put a lot of more work, you know, on your on your shoulders, so to speak, but it is something that when you come before this body that that you can show that and it it's an indicator and
and I know in in my past experience in doing budgets that I would use comparables based upon regions and based upon total budgets and based upon the nature of similar activity and those three components that in in an annual
meeting or for the a board that's looking at that they could look at those comparables and say why are we so different and so it was an accountability thing so I appreciate it >> and I remember going through that exercise and I will again and I will say that we were not different than other
counties in fact um our county tax was less than 50% which is good but I'm going to also um use this opportunity to say well I think looking back is important and it's it's good um indicator where we at
a certain time but I I'm concerned that going forward those numbers may not be the same because we are seeing changes in the federal uh spending and in a state spending that um I think we're sensing that county share is
>> going to increase. >> Yeah. And it's just an assurance to the community when when those numbers are seen and compared that says we're good stewards and we're doing a good job. If there's anomalies in that then that's
why people would question. But um I have a slide here that I can show. Um maybe I don't know if I can show it. I I'll try um comparing the our numbers for county tax over the years.
>> Um I could do that at the um end of the meeting here. >> Sure. >> Um I do want to go back to your question about the recoveries. Those are the medical assistance uh Medicaid program recoveries. Um in order for state of Minnesota to participate in a Medicaid
program, we obligated to recover um um funds remaining in a state of a deedent after they've um if they've received certain services during their lifetime. Now, um while we may recover a um
significant amount of money at some point, um we only retain a small percentage because um of the how the federal, state, and county share work. So, the majority of the funds are reported. We we report the funds to the
state of Minnesota and we get invoiced for those recoveries and we have to pay back the majority of the funds. >> Okay. Um other recoveries are under a food support program um and other uh assistance program overp payments
whether due those are due to um household error or agency error. We are still obligated to make recoveries but those as you may imagine those are small amounts because the assistance programs are not big in numbers um to begin with.
Um so we receive a small very small percentage of uh revenue based on those recovery. Same we make a recovery we uh report it to the state of Minnesota through our max system. They send us an invoice we pay it back.
>> Thank you for that context. Appreciate it. Um the next slide is going to show um the new applications in 2025 for assistance programs compared to the five-year average. Um those numbers for food support are
96, healthc care 58, emergency assistance 24, cash assistance 16. Total of 194 for 2025 where a prior 4-year average was um or
5year average was 234. And then next slide's going to explain um the question um administrator Christristen H uh about client programs. The cost effective um
so those are the three programs that um are listed under under financials. The cost effective insurance provided transportations and Medicare part B. Cost effective insurance allows us um people um to get reimbursement from the
state of Minnesota if it's determined that um their insurance they have with their employer or their whatever insurance they have is cost effective to the state of Minnesota. In other words, it will cost less for a state of Minnesota to reimburse a person certain
amount for their insurance premium versus if they were insured um through a a different um insurance provided by the state for those Crystal. >> All right. And the other side, was there
a decrease in the number of people? >> Correct. >> Okay. where we budgeted $117,000, we only had claims submitted to the county for 66,954. We receive 100% reimbursement. We have to go through a process of again
entering those in a system and then we get uh payment from the state of Minnesota um throughout their bi-weekly payment cycle. So, we're at 100% there. The provided transportation um is the second um item there allows community
volunteer drivers to assist eligible elderly clients with medical rights. Public health and human services direct bills and receives reimbursement from managed care organizations with reimbursement rate varying depending on the loaded unloaded mile and the manage
managed care organization the client is enrolled with. The reimbursement amount was uh at 87% for those cost. We never expect those to be a 100% because managed care organizations do not cover
the full cost of the travel um um reimburseed lower mileage in some instances and a higher um in some other ones. So it's um um at the end of the day we don't get 100%
like we do it under cost effective insurance and the um the goal is to be somewhere near 90 which we're at 87%. The agency is currently pursuing a contract with Medicica one of the managed care organizations providing coverage in Cook County with the goal to
be able to submit claims for services provided to medical enrolles. We are seeing that a lot of the um members of Dawa UKare members are now u getting transition to Medica. We had an
established uh billing procedure with UKare and with Blue Plus. Now we are working on establishing one for with Medicare so we can build Medic uh Medicare not Medicare. I apologize for those services as well. Um but it's not
um as um simplified process as with the cost effective insurance entering something in a system in receiving by weekly payment. You have to get credentialed. You have to enter in a contract with the managed care organization. There's some levels of um
work that needs to be done on the front end to begin billing for services which we are um actively engaged in healthcare access and Medicare part B. I've um we used to see um costs here and
reimbursement under a healthcare access program. Um we no longer administer that program because that has been transitioned to a company called MTM. um medical transportation management I
think it stands for we could have a long conversation about MTM and we're hearing that there is a little bit of a hit and miss with the administration of the program and the state is um correct me if I'm wrong looking into alternative ways to
administer the program going forward but for us what it means is we don't have to make payments to clients who travel uh to medical appointments and that's now handled by uh MTM. Therefore, we don't have reimbursements because we don't
have any expenses to bill for. So, these costs are only for Medicare Part B. Those are premiums that clients eligible for reimbursement from the state of Minnesota. So, we as our economic assistance team determines that they're eligible. We make the payments to the
client, submit billing to the state of Minnesota, receive reimbursement. you see a higher uh we have 102% because um at the timing of when the services are provided, payments were made and the revenue was received. We just have a
little bit more in this year. Um that likely included some u services that were back in 2024 which the revenue came just a little bit late after March. Any questions? As I mentioned earlier, the child
support services are provided by contract with Carlton County. Um case uh which Carlton County provides the following case intake and assessment. Establishing paternity, locating absent parents. Um establishing and enforcing
orders for child support aspecting on current orders. Um, there were 91 open cases in 2025. I think we're seeing a steady decline. I um I probably don't have any comment or
knowledge of >> I can add that um our counterpart in Carlton County who administers this program on our behalf will be joining us for the June PHS board meeting to provide more information. >> Why are we with different counties?
We contract out this service specifically because of I believe our small case load and the amount of staffing expertise that it takes to run the program. So rather than hire someone who would have less than a full-time
position here, we contract with Carlton County and they provide the service on behalf of Cook County families. >> Commissioner G. >> Yeah. Thank you, Mr. Chair. So when we track things and we graph things and we look at it, it's to inform us. And so in
that context when we look at the child support open cases much like we have when we have um uh you know huge variables depending upon the numbers again with a small population that it it can influence these graphs but we can see the
declining nature of it. What is it telling us? Well, that's going to be a good question for um for me while I'm looking at this, I'm saying, can we ask for reduction in the contract, >> but I think that conversation >> I think that would be a great question
for um his name is Dan. He's going to be joining us in June, but I would I would defer to him on that question. >> Okay. On the other hand, I know that what we pay Carlton County for a contract equals paying for one FD in
public health and human services. So, and because of all the different things um and challenges we have going on right now in public health and human services, I don't know that I would recommend bringing that in house. Um but um those
questions are good for um somebody who is an expert in the area who will be damp ski. He's very knowledgeable. What I know is I receive the performance um results from the state of Minnesota and we meet you in all the requirements and above and that the contract
increased once during the time I have been with public health and human services by $3,000. And I thought, you know, I for the work they do for us and meeting all the um requirements, I think that's um um money well spent. But um
this is a good question. I've been looking at the numbers going down and actually Grace and I had that conversation. I mentioned to her when I was I have begun working the work for um the 2027 budget and I with the smile on
the face I said I'm kind of looking at asking for maybe um decrease on a contract but I don't know we'll have to keeping a full-time person is probably not um it's probably for CH for Carlton County they're going to argue back saying well we have to have a full-time
person to do this work. So I I don't know um any more about that. >> Yeah. And um I'd say this is um doing good work. And
so we're asking it's almost like a getting paid less for doing better work sort of sort of situation. So I'm a little leerary of that, but it would be a good conversation to have. Administrator Treble. >> Thank you. Um, chair, I would just say that instead of um a decrease in the
contract, perhaps we look at remaining steady with the contract because most contracts for services are increasing over time and so the the decrease of clients is not significant but enough where I think we could engage in some discussions about that.
>> Mr. G. >> Yeah, I wasn't by my question, I wasn't implying that we should take it inhouse. I think that um especially as a smaller county that that the more that we can partner with people that have the expertise and we're going to be you know
talking about that with our crisis you know mobile crisis as well that we want to establish partnership with competent capable experienced individuals how we draft that contract and what's normal in practice in that regard if if
it's based upon a numerical assessment or if it's just simply a contract that says for services whatever it is this is our contract. We know what that is when we look at out of home placement costs. That's a variable that's very hard to
control. And so when it comes to budgeting it it's whatever we can do to clarify our budgets with a known figure is good when we have competent people that provide that service. In our leadership meeting the other night, our
county attorney commented that they're bringing things in house that we used to pay out for. And that that is a good thing for the county and the fact that many times the responsibilities that come underneath the county attorney if
we don't have the expertise or our workload is such uh then we we job it out. By bringing it in, it helps us control costs. It also increases our ability, our knowledge, and our experience to be better position for
dealing with legal issues as a county. So, that's an example where an assessment at some point says it's better for us to bring in house and we evaluate that. But I by no means in my comment was I saying that we shouldn't cultivate healthy relationship with
capable entities. But how a contract you know when we see significant change in that regard relative you think you're being paid based upon the amount of work and if we see a declining number then it doesn't hurt to have that conversation
but but when it's a variable um you don't want to be changing every year but you might over time change the basis under which a contract is written as long as it's considered to be best
practices in this particular area. >> And I I just want to make one comment. I think u for Carlton County um keeping the contract at the same level over the years with a very small increase of $3,000, which is um less than 1%.
Or less than couple percent. I think they have increased cost to have um um to keep their staff and to rent their building and to maintain things. So, um I think they're mindful of the fact um I've had conversations pretty um kind of
base conversations with Dan Prinsky and he he he told me, you know, it costs us more every year to have staff. So, for them to maintain the contract at the same level, that's a benefit for us, too. And it seems to be working for them, too. But I think um it that graph
does say something. So, I think it's good to um in the June's meeting to get some more information. I think we're all going to benefit from from that. Uh the social services uh team, it's comprised of three teams, adult home and community based services, children and
family services, behavioral health team. The adult and home and community based services team has one supervisor and five social workers each with a different case management or care coordination specialization providing adult protection waiver case management long-term services and supports
intellectual and developmental disability services mean choices assessment and one social services case who supports this team. The team also has several independent contractors who provide inhome support services to the aging population. The children and
family services team is the next column in social services. Um it's comprised of one supervisor. Currently there is no supervisor to that team. Uh and those responsibilities are performed by the adult home and community based services supervisor
Olivia Bonander. Two social workers providing child welfare and child protection services, family assessment respond and parent support outreach services and one child care licenser. The social services case also provides
support to this team as well. The behavioral health team um with one supervisor and two social workers providing children's and adult mental health case management, substance use disorder treatment coordination. The social services scale also provides
support to this this team. Contracted provider for this unit is the wilderness outpatient for comprehensive assessment outpatient treatment and in impatient substance use disorder referrals for all three units
of um social services. cost were 2% over the budget and revenue received was 4% more than the budgeted amount. $200,000 of fund balance was budgeted. No fund balance was used with the social services department returning 31,258
of fund balance as the revenues exceeded the expenditures by that amount. As we exploring options to restructure the department into 2026, several vacancies remain unfilled at year end
during 2025. This led to reduction of personnel cost and associate associated federal and state aid. The biggest variances were under the children and family services including our home placement expenditures
exceeding the budget with 122% of the budget amount due to the number of children in our home placement remaining at the higher level. There were 12 children in our home placement in 2025, 15 in 2024, 14 in 2023.
The mental health services expenditures exceeded the budget with 28% of the budget amount largely due to the adult mental health placement and state operated mental health facilities for client care with 47,296 expended children's mental health
placement for a total of $80,539 and expenditures related to a mobile crisis response grant which included electronic health record contractual obligations with bridewater formerly HDC for after hours and supervision and
other mobile crisis response grant related expenditures. Please note that the mobile crisis response expenditures are 100% reimbursible under the grant. So you'll see that on the revenue site too. Ad home and community based services
with 162% of the budget amount due to increased inhome support services for a sliding fee scale. You may remember that earlier this year, Olivia and Boner and I requested the board approve a revised sliding fee scale and a cost sharing
program to increase the client cost share of the program expenditures and reduce the levy impact. Increased carry BI waiver services um um those however are 100% reimbursible
between the Medicaid program and the marriage care. I'm sorry between the Medicaid and the client obligation responsibility. Um we've also reestablished a process of
billing clients for their waiver obligation and spend down amounts. While that's not a significant amount in the agency's budget, it's a requirement that we need to uh continue to do. Um and in
order for those clients to continue to qualify for the programs and receive services on the revenue side, children and family services, some increased funding under the family first prevention state program, that was a fairly new program.
Our allocation for 2025 was $10,000. Employment and trading um increased revenue um by 4%. the SED program, the substance use disorder, lower reimbursement revenue while we still learn how to use the electronic health
record program implemented the beginning of the year. And the mental health services reimbursement for a mobile crisis um response grant again for electronic health record contractual obligation um and other mobile crisis response
related expenditures. All in all, the revenues exceeded the expenditures with the social services contributing back to the fund balance instead of using um the budgeted um amount. Any questions on this?
>> Mr. Campbell. >> Yeah, thank you, Mr. Chair. Plman, is the money that you recovered um a significant amount of money. Was that is that in the 2026 budget or is that
was that reflected in 2025? >> That is reflected on the 2026 as well. >> It's not included here. >> Yeah. >> Thank you. >> Um the recovery was made at the time that we could record uh still into the previous year.
However, those services provided um were for a prior year and not 2025. So I couldn't allocate those to 2025. Instead I put them in the current year of 2026. >> Okay. Thank you. >> Social services are funding sources.
>> What year is this? >> 2025. I apologize. Federal and state aid made up 36% of funding for a social services revenue fees and recovery funded on 11. This is from building health insurance for client waivered services care
coordination targeted case management. Small portion came from the other grants I um was explaining a little bit ago about the adult um I'm sorry I keep saying adult but it's the arrowhead behavioral
health initiative. My apologies. and the remainder came from accounting tax at 50%. Uh some stats here for the social services team. Uh that is the social services staff
hours by program area for year 2025. Um the increase in the time recording and particularly the program related time was identified as one of the main recommendations in the report prepared by Megan Moss and the Birch Park
consultant. The agency has implemented guidelines and policies to assist in achieving higher percent of reported time and higher percentage of program related time. Crystal, >> can you give me an example of what a nonprogramming time is?
>> It would be a training uh meeting. Um sometimes our intake um when you're not when you're not responding to an actual intake and you're just um on an intake um while you're trying to manage some um
other tasks um there will be some nonprogrammer related time. >> Mr. Hamilton Yeah, thank you, Mr. Chair. This is an interesting graph to look at. Um, but it is because it's focused on
2025 from a department head standpoint. If I'm looking at this, I would look and I would say whenever both an allocation of dollars or time, I would compare this to see how this is
using different years. So when I look at what 2024 is, what we're experiencing now as we monitor 2026 relative distribution of hours, it tells us something. if there's something that has changed in our environment, so to speak.
I'm talking if we're looking at ours um it helps us to be good stewards by making that comparison evalu like I think if we look at the mental health we're probably seeing a
significant increase in ours and we might also see that translated to dollars but when we have change either on the state or the federal level and we're looking at this graph in dollars we can see the effects of that in
overall budget analysis, which is really good information if you if you want to have evidence-based budgeting. You're looking at these figures and drawing conclusions based upon what you know is changing in the culture or the environment. >> So, I will say um this data comes from
SSIS and time reporting in SSIS was probably the biggest recommendation in Megan Mo's report. We do have a work group that's looking at making improvements to SSIS time entry. We are tracking the time entry practices by
staff and meeting with staff to follow up on their time entry every month. So, this is an area that we are tracking very closely. Um, and we are we do have a small group within the department that's looking to make improvements. So, >> thank you.
>> Yeah. And it sounds like already there's been significant changes um for 2026 and maybe we won't see quite the shift in numbers until 2027 but um but it'll be exciting to see. >> The first thing you're going to see is a non-programmer related time. Uh first of
all um what you're going to see is more time reported in general. However, we so I keep track of um every month the staff has until a certain period of time to report the time in SSS social services
information system and I run those reports and u put them in a spreadsheet and start comparing. So what we're seeing already in 2026 is that with less staff we on track to record significantly more time in general in
SSS. Um the next goal for us is to decrease the non-program related time and increase the program related time. >> Administrator Treble. >> Thank you, Mr. Chair. Plowman, can you talk briefly just about how tracking time impacts revenue?
>> Um so first I'm going to start with the tangible ones right away. Um the more waiver case management, the more targeted case management, that's direct revenue for us. We get um billing, we build the state and the managed care
organization based on time record staff enters in SSS. Those rates are um in some cases significantly especially under the targeted case management. We get um uh $500 in some instances per um
um occurrence. So, and more time, more program related time, direct correlation to um um increased revenue to um some of our grant allocations are based on time program
related time reported in the social services information system. It's an elaborate explanation and calculation that um I'm not prepared to um go over right now but um uh the program related time is taken
into consideration when money is allocated. So two money right now and one money right now is a revenue from the services we received two uh in the future
allocations based on time reported now. >> Thank you Mr. Chair. Thank you Plowman. And the reason I asked that question is because we anticipate like Plumbman has stated that the cost share for the county is going to increase um what we're hearing is quite significantly
over the next few years potentially. Um, and so it's really important that we're entering our time in SSIS so that we're collecting as much revenue as we can to offset that increase in the the cost share as we're anticipating. So the team is working really hard on improving that
and like plumbing had mentioned that was a or Grace had mentioned that was a recommendation from Miss Mo as well. >> Mr. Gamble. >> Yeah. So another way of understanding that would would that be that um when we track our time and our time is
reimburseable based upon a certain number of dollars that if those dollars that we get reimbured reduce then it means that we have to be sure that we're tracking everything because everything is going to matter when there's a
reduction. So be sure that you're getting your time tracking correct because there's no wiggle room there relative to the revenue. So, and and I think that if I'm making connecting the dots correctly
here, that we received a letter of commenation saying that uh we're doing a good job of submitting our reports on time and if the reports are reflective of what in fact is true, then we're doing the best we can relative to
reimbursement. >> So, I believe that was regarding the um the letters from DHS that I mentioned in our last PHS board meeting. That was for our fiscal team fiscal reporting. So they're slightly different. >> Um the fiscal team submits reports on a quarterly basis. And what we're talking
about here is social service staff entering time in a software system. >> Okay. Thank you. >> So for the fiscal team, we're at 100%. >> And and so for the time recording, we're working towards 100%. We still try.
>> You're squirming. >> Well, I mean, I think nobody's 100%. Let's be honest. >> All right. 99.99. >> You're doing a good job. >> Um, but back to the hours, and I don't want to overstretch that. I take what's in SSS. I cannot um um manufacture
numbers or make numbers different than what's recorded by staff. So what I'm looking at is I'll I'll tell you what I'm doing right now is I take at the end of every month the cumulative numbers um that I entered in SSS and I compare the difference um between what was recorded
at the end of March with what's recorded in at the end of April. We look at what the percentage of nonprogram related time is versus the entire time. I make an adjustment um for staff. Oh, that's a good um um explanation, too. Uh paid
leave um uh oh, I shouldn't say paid leave. Paid time off is also entered by staff in SSS. Um but as a nonp program related time, >> so I have to make that adjustment in SSS. So we can see the true um
nonprogram related time that staff is reporting because it wouldn't be fair to say uh well your pay time off is program related time where it is not. Um so there is a lot of things that um but basically we're comparing again monthtomonth
um cumulative uh what the percentages for program related time non-program related time and um also compared to e time >> in other words to our um >> payroll um recording we each staff has
to enter um their work time in a system in which payroll uses to make payments to staff. So I compare those staff those hours in SSS to the E time hours. E time is the system >> to see how how what percentage of those
hours were entered in SSS. So I feel like on a fiscal side of things I um exploiting all the options that I have. >> Is this printed somewhere? this like cuz what I'm seeing is this
but what I was given a link to doesn't match this. So is there a way where I can get what you're showing us on the screen? >> Yeah, >> I'll send out those slides. >> Thanks. >> The financial report should be included to the agenda. Yeah. And that um that
should be included there too. But we could send >> Thank you. I when I say we edit it because >> it's just a different format I think like >> page nine >> has that graphic
>> but it's smaller and >> all right sorry public health team this is the public health team with one supervisor for public health educators to meet all six areas of Minnesota public health responsibility within the local public health act. The public
health team provided regional collaboration, grand writing and contract management, emergency preparedness during the pandemic. the the public health team played a major role um in vaccine planning and implementation, case investigation and
contract tracing and liaison to the schools and businesses as well as the coordination of many community volunteers with a shift to building and maintaining infrastructure promoting health activities and behaviors and other prevention work post pandemic
using contracts with South Mountain Clinic and Northure Health Cook County provides several additional public health programs such as the home care sliding fee program, child and teen checkup, family home visiting, and wick
women, infant children. As a reminder, the ship program is fully administered by the Cook County Public Health and Human Services while it was contracted with South Mountain Clinic in the past. the public health um costs were at 95%
of the budget. The revenue received was 8% more than the budgeted amount. No use of fund balance was budgeted. No fund balance was um used with the public health department returning 33,965 to the fund balance as the revenues
exceeded the expenditures by that amount. Note that um revenue under the personnel line was at 120% due to the increased revenue from federal estate grant um state grants available to the
public health team through um the community health board. Any questions on that? public health funding sources. In 2025, 57% of the funding for public health came from the federal and state grants.
That number was 52% in 2024 and um less than 1% of them from non-governmental grants and donations and the remaining 43% from county tax. >> Sorry. Um, this says including the
public health grant. Is there a slide or a picture that shows what the >> the recipients of the public health grant funds? Yes. >> Okay. >> A couple slides now. Uh, next slide will show you the hours by areas of public health
responsibility. Um poor infrastructure 35% healthy communities 50 infectious disease less than one environmental health 4% preparing and responding to emergencies test 10% assuring health services 1%. Uh
this is a good example of uh time reporting. We move to 100% time reporting with the public health team few years ago when I became a fiscal supervisor. Um I met with Grace and I said we need to move to 100% time reporting because um we have grants that
are available to us and we can utilize them and Grace agreed and um we have we in 2025 we are returning um to fund balance by 33,000. We're using more state and federal funds by 4% than the
year prior. Um so it's a good example of how time reporting makes a difference. Any questions on that? >> The public health community grants are awarded to community organizations through a competitive annual grant making process. $190,000
were awarded in the year 2025. Um as a reminder the subcommittee of the public health advisory um committee makes funding recommendations each year which is presented to the human services boards are made in line with the goal set forth in the community health improvement plan.
These represent areas of essential community service that would go on field without support through the grant making fund. And this is the list of the 2025 recipients of those um public funds. Any questions on that?
Wait, sorry. Was there like a grant application? How did you determine >> So, every year there's a grant application. It typically opens sometime in June and then closes mid July. Um,
and then there's a group of members of the advisory councils that has a they have we go through the application and there's a score sheet and then that group of people scores the applications um and then brings recommendations to
this board for a vote. >> Understood. >> Also, my bad. I just got here today so you Thanks for answering my questions. >> These are good questions. >> Great questions. Yeah.
uh in 2026 we um lowered that amount to $150,000 and I think without getting into um okay Grace is saying I got to keep moving forward. Um so basically in the 2027 my
recommendation will be to keep it 150,000 and not increase it. Yeah. All right. Next slide is the child care program costs were at 98% of the budget with the wage subsidy program utilizing 82% of the budget. Revenue received was
56% more than the budgeted amount 366,645 of fund balance was budgeted with the child care department using 204,876 of fund balance as the expenditures exceeded the revenues by that amount.
Note that the expenditures and revenues under a provider assistance line were both over 100% 142 156 respectively due to an increase in available state and other grants. So the wage subsidy is
levy funded. The provider assistant and supplies is grant funed. >> You said wait provider assistant is grant funded. >> Yes. and supplies >> and then what that's like the cost of the employees and then what are the supplies?
>> So that provider assistance and supplies represents grants that we received from deed to support the startup and expansion of childare businesses and then there's also two smaller grants to support providers. One is to a
mentorship grant and one was uh to support family, friends and neighbors who provide child care. However, those grants will be ending in 2026. So, we will we'll see a significant reduction of expenditures or virtually no expenditures and no revenues.
>> I imagine a lot of grants are ending. Correct. >> Um not a lot of grants. >> Is that going to impact our county or you know, you can tell me later. >> I think that's 20. >> Um there's grants that we receive that are competitive. So the landscape for
applying to competitive funds has definitely changed. >> Um but then there are grants that we receive year upon year and they're sometimes referred to as block grants. So that hasn't changed marketkedly. So it's a little bit of a mix.
>> And uh overall all departments that made up the public health and human services saw increase of actual expenditures and increase in revenue. This resulted in 500 $155,887 use of fund balance while $566,645
was budgeted or we used 410,758 less than what uh we budgeted. The total unrestricted fund balance as of December 31st, 2025 is 3,125,945. On the next slide, I'm going to explain what the fund balance is.
Because county operations rely on property tax levy, the office of the state auditor requires us to hold reserves reserve account that is no less than 5 months of the budgeted and operating cost. 5 divided by 12 equals
42%. This requirement allows the county to maintain operations during the first few five months of the year before the first half of the property tax collections arrive in May and are distributed to the departments. A healthy fund balance also allows the county to fund unbudgeted expenses that
arise and after the budget um has been set. The county recommended fund balance for public health and human services is 42% and the general fund target is 75%. Um the next slide here
um the so the blue um is the budget in green the available reserves that PHS has currently and the 42% is recommended. So the green bar should always be higher than the red bar. To know how much to keep in the
reserves, we look at the our annual budget. Again, the blue bars represent the annual budget going back to 2021. The red bars represent 42% of that budget, which is how much PHS must hold in the reserves to meet the first five months of expenses. The green bars
indicate the actual amount of public health and human services reserves for each of those budgeted years. It wasn't all that long ago when our fund balance fell below the state required minimum. I remember that. Um however in years 2021
and 2022 due to the increase in plant expenditures and an increase in third party billing efforts we had recorded an excess of revenue over cost resulting in return to the fund balance. I mean you'll see the green bars getting in one instance higher than the budget amount.
So we had a fund balance higher in the budget. Um we began using some of those that fund balance with budgeting um 656,566,000 um between year 2023 and 2024. In 2025, we also budgeted 566,000 of reserve
funds in the event of a budgeted out our home placement and the child care subsidy grants. While PHS still has a healthy fund balance in against the barest required minimum reserves, it was my recommendation to the PHS board. The
2026 budget does not include any fund balance and it will be my recommendation in 2027 as well. Um there is some level of uncertainty that I think we need to be more conservative. >> Mr. Campbell.
>> Thank you, Mr. Chair. So, um I'm assuming that the fund balance um is invested like our county fund balance is so that there's a return on that investment. Is that correct? >> I I don't have um the answer to that. I
believe no because I would have seen an interest or any income coming. Um and ours whatever we spent um the beginning of the fund balance whatever our revenue expenditures are under over the end of the fund balance
is the difference between both. So I don't see um our auditor doesn't tell me add $1 million of interest um because we got invested the money. So I believe the answer is no. >> Okay. I mean, that's interesting to me
from the standpoint of uh if if there's a state statute or a recommended best practice that prohibits investment of fund dollars in public health human services or not. That would be a question to ask. The other thing is if
you look at um the return on investment that we have in our county fund balance that um certainly if we have the ability to keep the fluidity the liquidity of those dollars and yet be earning money
on that money that would seem to be logical. Um in the leadership recent leadership meeting uh there was a discussion about um endowments and trust
funds which of course there's different entities within the county that are looking at that. And even years ago, it was suggested that if if if we don't look at this revenue source from the standpoint of trusts or endowments, uh
we're going to be in in a position vulnerable because of the lack of funding through the tax and spend model. And so that would be a question I guess I would ask is can we take those fund balance while maintaining the liquidity
and yet be earning money on that money which speaks to the fact that if we have an endowment or trust fund it is contributing to try to lessen the burden that is the result you know falls on the levy so to speak.
>> It's a good question. I don't have access to the bank account uh for public health and human services. I my role is just to accomplish I guess that's a a question I would ask ask Brady or find out about but >> Commissioner Svin. >> Thank you Mr. Chair. Um from a quick
search it um with that question it says PHS funds allocated to a county tribal nation or state agency in Minnesota may not be privately invested in financial markets. They are public strictly regulated operational grants and
subsidies that must be used to provide direct public service, cover administrative costs and run specific county programs. So that's just a real quick search >> and that's a speaking directly to fund balances >> to fund balance in Minnesota. >> Interesting.
>> Minister Trouble. >> Thank you, Mr. Chair. I have sent a message to Auditor Powers as well. So hopefully we'll get a response from him and then we can um perhaps report out at the next meeting. >> And I think I think the magic fund is a
public fund, not a private. And so that's where our fund balance, the general fund balance is. And I would I would well, what do I know? But I'd be surprised if the PHS fund balance wasn't wrapped up in that,
just accounted differently. >> Yeah. So, so it goes to the any interest would go to the general fund. >> Yeah. Yeah. And the other thing is is that when we're looking at this, especially in the budget process and following that leadership meeting, which
is county leadership monthly gets together for the public and uh discuss issues. And we were discussing child care at the last meeting. And part of the recommendation is we should be looking at an endowment. And it goes
back to recommendations that I've heard uh relative to finding new funding mechanisms. The thing that's attractive about that and did contact um extension service yesterday to ask that they forward the information on the gentleman
they made the presentation to extension so they could make that presentation to the leadership group. um that if if people believe in a particular service uh they can give that money voluntarily
to establish a fund that then funds those services. And that model is a is a good model because it it's it is people who share the value or the worth of something that contribute voluntarily.
Yeah. And we have some of those funds in PHS. However, they are restricted funds and not unrestricted. They have a specific purpose that can be used for um one example was the Mcnite fund and um we
have some other smaller funds to the um heart fund. um that was but there again uh have very specific um purposes that can be used for and what you're seeing here is the unrestricted PHSS
fund balance can be used for any reason um to deliver the services while the other ones can't >> and and I understand the nature of restricted funds but but uh what's good about that is if you look at the difference between levy and and between
endowments or trusts is that people give their money to something that they specifically believe in and those dollars are restricted for that provision or that, you know, service that's provided. And uh so as opposed to
when we when we levy, there's multiple things. Some people believe it and some people don't, but the levy is the levy. And uh so I I I would agree this is when we're looking at fewer dollars and and more services which we hear every year
we we need to look for new ways of trying to fund these things and uh that certainly is an option. >> I just wanted to explain what unrestricted PHS fund meant for those who um don't have a good understanding. So
that is the financial report for 2025. um our budget to actual financials. Um any any questions? >> Can I ask you a question about the slide before this? >> I'm sorry. >> Can I ask you a question about the slide before this? >> Yes. >> When I look at this, it looks like in
2026 that if this continues, we're going to have a problem going into our reserves in 2027. Um that's why I recommended in in 2026 to the public health and human services board that we do not use fund balance
and we reserve all the funds we can um so we don't run into that situation. >> Oh, so the recommendations already been made. >> Oh yeah, the 2026 budget has been approved >> and I'm going to make the same recommendation for 2027. We do not use formal fund balance. We only use in the
form of fund balance in 2022. Um I'm sorry 2023, 2024 and 2025 because if you see in 2022 and 2023 I mean our fund balance was too high almost >> right >> um it was higher in the budget so we
would levy up funds while we were um we reduced the levy impact by reducing the requested levy by using some of our reserves. >> I see >> that make sense? >> Yep. Makes sense. Thank you. >> And Commissioner Gamble had a question too. >> Yeah. Yeah. It wasn't a question, just a
comment. I really appreciate your your work and um uh walking us through this, the detail uh and the ability to respond to questions, um it builds confidence. And if I could borrow a phrase from the
uh insurance industry, I would say we're in good hands with plumbing. >> Thank you. >> Well, thank you. Uh if I may, uh I appreciate the comment. I just want to say that we have a lot of good staff
doing a great work in PHS and what I'm doing here is presenting the work done by many others. Um so while I appreciate the comment, I think it um it's a testament to all the work that everyone else is doing. So thank you.
>> Thank you. >> Thank you, Plum. >> Sorry about taking so much time. >> No, that's just fine. That was all of our questions. >> Surprise, surprised. >> Next. >> Uh, excellent. Um, thank you again,
Plowman. And, um, just for every round's awareness, our next item is the mobile crisis response proposal. So, we'll do a little shuffling and, um, we can move on to that. >> Wonderful. Well, thank you so much, Plummen, for your presentation on the
2025 financials and for all your work in compiling accurate data year upon year. so we can see trends and also detail as to where the financial picture is for our department. I appreciate it. I will welcome Cree Cree Larson is the
executive director of First Call for help. First call for help. Um Cree and I will be co-presenting today on mobile crisis. Um and at the end of the presentation we will be making a request of the board that uh first call for help
become the provider of record for mobile crisis response in Cook County. Um so sure I'll take the little ticker. We do have a brief PowerPoint to get us started. Um, so I wanted to I know that
the the PHS board has heard about Mobile Crisis year upon year and I do want to make sure that we just kind of ground back into the basics of what the service is, the importance of the service, how we're currently delivering services in the community and who our partners are
in um administering mobile crisis locally. So, mobile crisis are trained teams that provide 247 response and services to individuals experiencing a mental health crisis. This could be in their homes, in the community, or in
other sites outside of the usual clinical setting. Mobile crisis teams can address and resolve mental health emergencies, cope with immediate stressors and suicidal ideiations, identify and use client strengths and available
resources. Work with individuals, families, and providers to address immediate needs, develop action plans, and connect to needed services, and begin to support clients in returning to their baseline level of functioning.
Why is mobile crisis important? Um, I will mention before I go into the importance that it is a statutoily required service. So throughout the state of Minnesota, um, mobile crisis providers must be either a county board operated entity or a provider under
contract with the county board in the county where the service is provided. Um, why is it important in a more global sense? It can prevent situations from escalating into emergencies that require hospitalization or law enforcement. It's
a vital piece of an integrated mental health system. And it's also a connection to ongoing support to provide stabilization and a link to additional resources to help address root causes and long-term recovery for clients.
It's not a service that's ever provided in isolation. So this type of work requires uh a village and in our case that village is both local and regional. Uh we work currently with Brightwater Health, formerly HDC, to provide clinical supervision to our mobile
crisis responder who's sitting right there, Sarah Eisenrike. Um they also provide after hours um and uh weekend coverage for mobile crisis. So it is a 247 service. And what we have right now
is we have staffing during business hours Monday through Thursday. So those other times we have Brightwater helping us to respond via teleaalth. First call for help. Um we're about to hear much more about First Call for Help, but they
do currently work with us in that they are the regional 988 call center. So when crisis calls come through, they come through first call for help and then they are transferring those calls to our local responder or Brightwater
depending on when the call comes in. Um the Arrowhead Behavioral Health Initiative is a regional joint powers focused on behavioral health services. Some of the grant funds for this work are coming to us through the ABHI. Um,
and they also provide sort of a community of practice for regional behavioral health staff. Locally, we have Sawtooth Mountain Clinic, Grand Portage Human Services, Northshore Health, and the Cook County Sheriff's Office who are all important partners in
the work. We do have a local um coordinated crisis response team that meets to um improve our workflows and support one another in developing a robust mobile crisis system locally. So this service has been provided
inhouse. Um this it came to us as a pilot coming out of the pandemic. Um and at that point uh Cook County PHS opted to administer daytime mobile crisis reser services here in house. Um we have experienced challenges and those have
included building up that programmatic infrastructure to meet licensing standards from DHS. There are stringent requirements that the state sets forth as to what it means to be a licensed provider of mobile crisis uh response services and I will give a huge shout
out to Andrea Orest who's done a incredible amount of work in making sure that we're meeting all of those requirements within our department. Um staffing the program um we are very fortunate to have Sarah here with us.
We've al Andrea has also served as a responder in the past, but it is a challenge to staff a 247 365 service with the um with the staff we have in our department. Um
and part of that is balancing mobile crisis with the multiple other programs that we operate within PHS. So I've already spoken to what our current service model looks like. We have a a 8ft FTE staff providing
services Monday through Thursday during regular business hours and that is um that can be an inerson response and then the clinical supervision backup and after hours mobile crisis response coverage is contracted through Brightwater and that would be via phone
or teleaalth. >> So real quick, so staff works Monday through Thursday and then on the weekend it's someone else. So like on Friday to Sunday, it's someone else. >> It's through Brightwater. So we don't have a staff person within our department that's on call um outside of
that Monday through Thursday time. So you can still call and you receive service, but you receive service through teleaalth because the staffing at Brightwater is staffed out of their duth office. So um that's how the service is provided and we've applied for an
alternative response. How did you come up with that? That seems like it's >> the way that we've come up with that is really we we do understand that having an in-person response is always the preferred option, but it is we haven't been able to staff outside of um the 32
hours a week that we have right now. But why was it Monday through Thursday and not like Friday through like why isn't the person where crisis is more likely to happen because no services are open but it's like it's on days that everything else is open.
>> We've been we've have the staffing that we have been able to to find and to incorporate within um you know the schedule that we have. So, I mean, I think it would be ideal to have, you know, weekend in-person coverage,
overnight inerson coverage, but we just have not found staffing to support that. So, that's that's kind of where we're at with with it. So, we've been able to be creative and work with Brightwater to help us provide some services even
though they are not always in person at this point. Um, so this is sort of what we're looking towards when we look towards the future. So, First Call for help put together a proposal to become the provider of record. What that means is that they
would be administering all the licensed mobile crisis response services on behalf of Cook County. So, we do have grant funds right now that are covering our expenses. And with this proposal, those some of those grant funds would transfer over to First Call for Help.
So, we would no longer be receiving all of the revenues we're receiving now, but we would also no longer be incurring the expenditures that go along with providing the mobile crisis response services. We would, however, remain a supportive partner. I think we're all very invested in seeing this service
succeed. Um, and so we would help first call for help build upon the foundation that we've created and the partnerships that we've fostered over the past several years. um so that they would be successful in in providing administering the service.
It I think this would be a beneficial model because first call for help as you will hear they have extensive programmatic expertise and could provide oversight to a critical behavioral health service in the community. The
plan is also for them to directly employ locally based responders with the goal of providing that in-person response whenever possible. Um, and internally, this would allow us within PHS to focus our efforts on strengthening the
additional program areas that we are um providing to the community. At this point, we are the only county in the Arrowhead that's directly providing the service inhouse. Um, and that is that was a choice and it's also a reflection of the behavioral health landscape here
locally. So, Brightwater, for example, is providing mobile crisis response services for much of St. Louis and and Lake counties. And um, while we are in the service area, we are also, you know, two and a half hours away. So there are
challenges just based on our geography and the the providers that um administer this service regionally. So um this would bring us in line with other counties in the region and also leverage that programmatic expertise that first
call for help brings. So with that I want to turn it over to Cre Laren to introduce herself and speak a bit more of the proposal that first call for help has put forth. >> Okay. Thank you for having me. It was a stunning drive up here again. I enjoy
coming up. Um so, um I'm K Larson from First Call for Help. I'm the executive director of that agency and we have been doing information referral resourcing and crisis since 1974. Um we were one of the two very first
crisis teams in the state. Um, we opened ours in 1999, well before the governor challenge in 2010, understood the importance of that evidence-based practice model. So, we've had many years ahead of time to hit some
bumps um and remedied them and figure out how to best serve rural northern Minnesota. Um, I thought it task county was rural. You're vastly more rural than us. And so um so one of the um the things that that I
wanted to um bring forward about our proposal is that um we our crisis lines answer 988 for the entire state. We answer the farmer's distress line for
the entire state. And um the other side of the lines are crisis lines, direct crisis lines like the ABHI. We answer 47 counties for that. So we I have the privilege to have like a bird's eye view
over how many teams have solved problems so that we don't need to create recreate any wheel. There's many teams that have had bits and pieces of things that I think could serve um Cook County. Well,
the model that we're proposing for you is much like Clear Water and Lake of the Woods. So, Lake of the Woods is vastly remote in and how they're trying to do services and they um locate residents
who live in the county and train them to be part of the response team in the location in which they live. Um I from from a view of our county, I believe every county has individuals that live
within the county that are passionate. They want to help. They want to be a part of the resolve. They want to be a part of of decreasing suicides in their county and they come with some skills, maybe some personal experience um and
are able to be trained to um to do that. And so that's what we're proposing um for Cook County. Um one of the reasons Itasa County and many other count every other county in the region actually has pulled away from
counties providing the service is that overload of tasks on top of the public health. Um sometimes some of the union contracts are a rub. Um, and that is problematic to budgeting and and many
other things. And that is certainly not a slam to unions at all meant that way. But it it can accidentally rub. Um and so contracting with us were able to break down those barriers. um not only with county individuals that
might want to work after hours and contracting with us, they're able to do while they're still a county worker or faith members um faith community members, local advisory council members, peers in our communities um that are
able to be trained to do this work. So Clear Waters entity um their program we default to that during storms. So we have individuals on our team. We have a team of 30 that they live in different
parts of our county. Um they might be up in Effie and Big Fork which is our most remote. They could be in Nashwalk closer to St. Louis. and they agree to be paged out when there's a crisis closest to
them. So that it's a quick response, it's a face-to-face response, which I believe is always the best response if safety um if it's safe to respond. Um I
believe in teleaalth when we can't get to somebody. um but face-to-face response to to um do a risk assessment to deescalate to put safety measures in place to really determine what's the best placement or
supports for this individual and using that clear water Lake of the Woods model um I think could be beneficial for your your county and that really um takes on the role of myself and Isa and our team
to work with all of the contacts that you guys have already built with Andrea and Grace, like the foundation is perfect for this work. I think our role is to come in and just do the lift to get it up um off the ground. And so
reaching out to all the townships, having township meetings, um district meetings, organizational meetings with churches and um dig down and see who is really wanting to be a part of the solution
um in your county and capturing them as assets, training them to be responders. Um, on my team I have 30 and I can tell you every single person on our team. Um, we've had experiences with mental
health, including myself. And that brings another level of caring and compassion and desire and dedication to a team, especially when you yourself have been in a dark time or a family member has been and you want to be there
for another family. And so the community and countywide assets are going to be core to making this um this lift um successful. >> Thank you. Okay, >> Commissioner Sterling. >> Thank you. Thank you for the
presentation. I attended at our emergency management meeting a presentation also. >> So basically we dial 988 if we're in an emergency. Is that the number? >> Who do we dial? So >> that is one way.
>> Yeah, that is one way. The ABHI, our overhead region has a crisis line number that comes directly to us to triage and dispatch out mobile crisis. If someone dials 988, that call will get to a
mobile crisis team um but in a um different way. So we're a 98 call center. So, if someone doesn't know your local number, you can dial the three digits of 988 and we do a risk assessment and determine where's the
correct service or resource this person needs and when does it indicate it's a high enough risk to dispatch mobile crisis. Um, so that's one way to get to mobile crisis. But um another effective way to
get to mobile crisis is by using the local crisis line number because that number lets the team decide what level of risk they want to respond to. It could be a medium risk where
someone's um having thoughts of wanting to harm themselves but not a plan. They haven't had any history. um but they're in emotional distress and callers get to determine their own crisis. It could be that a pet passed
away that wouldn't be a response to stabilize a mental health that if you called into 988 it would result in a mobile crisis. But if you call into your crisis line, the crisis team build gets to decide what they're responding to. Um
>> so what I'm getting at is what is the number? What is our local number then? Oh you >> I'll have Andrea. Well, sorry, Andrea. >> I should know it by heart, but we answer. >> 988 is so easy. >> 988 is so easy. It typically when we
give public presentations, we give 988 as the number because it's easy and memorable. And we do use the ABHI regional crisis line primarily with partners. So, if um >> if a partner agency like the clinic for example wanted to make a call, they
would have that more direct route. So >> okay. >> Um I would say for now 988 >> 988. Okay. >> Good. So then my next question. >> Do you want the number? >> Yeah. >> So the it's 8447724724 and that is the number that we put out.
Um we made mobile crisis response business cards for Cook County and that's the number that we put on the card because that is also the number that Brightwater currently advertises for mobile crisis. So, it's always the same, but in the end, 988 is an easier
number to remember. And I'll also say within this proposal, there's no change in getting to the service. So, for a member of the public who might be looking for mobile crisis response, the numbers stay the same. Nothing changes with that. In this proposal, we'll just
do better ed more, not better, enhanced education to make sure that families know what your access is. And it's really meant to be a no wrong door. >> No wrong doorment. >> If I may continue on. So my understanding is that all the local
folks here could step up and be trained. I don't know how would I handle something. Something's having, you know, a very bad day. I could probably talk them through a certain step. So the training would be really in depth so that I could handle someone who's ready
to jump off a bridge. How deep does this go for the training? The training is upfront and then ongoing. So we really have a very tight clinical supervision program where we meet weekly, >> okay, >> with like my team and it task county, we
meet every Wednesday 7:00 a.m. to 9:00 and that's where we get additional information. We talk about a call that may be happened. So in case that person might have been at home for the first time they needed the crisis, but the next time it's at the grocery store and
it might be closer for someone else to respond that we know um the best means to help stabilize that that individual. And so the training's in depth um the clinical supervision um is amazing and
then the one-on-one is as well. And I'll also add that there's a component to community mental health trainings that is separate from mobile crisis and will be retained inhouse. So Andrea's trained as a trainer for things like
psychological first aid or recently a comet program changing our mental and emotional trajectory. We've also done work to train local trainers for things like mental health first aid. So those those offerings will stay in the community and that would be for someone
who maybe isn't interested in going the full I want to train in as a mobile crisis responder but wants to know how to better help a friend or family member dealing with mental health challenges. So, it's a both and and there are multiple ways that we can we can train community members, but what KRE is
offering is really a much more intensive um kind of package of training for someone who would take on that level of of response. >> Any other questions right now? >> I just I just have a comment that as a retired social worker, they're probably
I'm not the only one in the community. People who have had experience might volunteer >> for something like that. Mhm. >> And they're actually paid positions. >> Um because this is a lot
>> and I think to volunteers are amazing and they do a heavy lift at my agency but not in mobile crisis um because it it's serious, it's intense. your time
and your experience is worth um has a a monetary value to it. And and I think when you're pace paying someone to do it, there's that commitment of yep, these are the days that I'm going to be available and then you're you're
contracted to be available. Yeah. >> Commissioner. Yeah. >> So, I have another comment. I have townships and you mentioned townships. So I go out there and I give a little bit of a presentation and then they say I'll get in touch with me who will get
in touch with Grace or vice versa. How does all that work out then? We get some names of people. Is there a time schedule that you would do some training if you had two people, one person? >> Absolutely. I we would come up and train one individual. Every single person is
going to be important. Um, and I think that first visiting with them about really what is it you're getting ready to bite off. I think being upfront is better than sugarcoating something and then having someone walk into something that's then traumatizing for them. And
so having a great discussion about the onboarding and what it is, what the training is, how we support them, what that looks like, managing personal life around being a part of a mobile team. Um, and then doing the training.
>> Do you have CPS on this board? >> I'm so sorry. Do you have CPS workers in this board on this call in your county? >> Call for help for child protection. Is that >> right? So, certified peer specialists. >> Oh, yes. >> Thanks. >> You you have them. Do we have them in
this county or on your county? We we have them in my county, but in this proposal, um we put in money to train PRS and PSS to make sure that if you're wanting to be a part of the team, you can become a
peer recovery coach, a peer support specialist. >> Um those are so important. Um and so built into this proposal is to build up that level of infrastructure underneath the team. Okay. Thanks. >> Thank you.
Prime Minister Trible has a question. >> Thank you, Mad. Thank you, Mr. Chair. I almost said Madam Chair. Um, I just wanted to mention again um our report from Miss Mo and Mr. Lee. They had provided some feedback about our our
mental our mobile crisis team and just looking at different ways to provide this really important and essential service for the community. So, I want to thank our PHS team and thank CRE for the work that you've done to really investigate and put together a very solid proposal on what this could look
like for our community members. So, just thank you, >> Mr. G. >> Yeah. Uh, thank you, Curry. Uh we had this presentation at our public health human service advisory uh board and um
uh one question I would I would have would be uh your business model. So if if we were to look at a visual which this morning we had a lot of visuals that sort of breaks it out so visually
we can understand how it works. mobile crisis that first call for help. When somebody calls, it's like who are they going to reach and then when it's at the local level, if that if somebody is then
dispatched, we'll say to work with somebody. But can you give us your your model as to how a response is uh handled >> to an inquiry? >> Sure. So if someone calls into the crisis line, we have trained counselors
that will triage um and so each um mobile crisis that we dispatch out has a triage of what they can take if it is absolute urgency. That is someone who's in the process of um ending their own life or or making
attempt to do it. That's like a 911 call if the scene's unsafe. um if they are at high risk saying I have a plan but I'm calling for help because I don't want to follow through with that plan that would then get um mobile dispatch out. So when
you sit in my call center it's almost like you're sitting in a little cockpit of four computer screens and when the line rings we know exactly the region or crisis line that's calling. It pops up the protocols, the resources, a call
log, and emergency services all at once automatically. And so if we determine that in Cook County a resident called in, they're at moderate or high risk, which I think both of those should get an in-person response, especially when
you're introducing a team to a county. Um we would then on the left screen shows exactly who's available for page out their number um and those are the
individuals that are um paged out to respond. Once they're paged out, we are able to off of their cell phone track them for safety to make sure that they're getting to the location and that we do a safety
call 60 minutes after they're there to make sure everything's okay. Because remote, it can be scary in a remote community and you might think you're responding to one thing on the phone, but when you get there, it could very well be something different. Um, we do
follow-up calls 30 or 60 minutes. The responder tells us which they prefer. If they do not respond to that check, we'll do one more time. If they don't, law enforcement is set out immediately just to protect everybody. Um,
when teams are first starting out, we like to try to send two people at a time. Um, and that's really going to depend on how quickly we can build up. So, if we have two individuals living here, the crisis is here, we'll send
both. Um, I think two eyes are are better than one always. There's safety measures in that and hopefully there's comfort in the person being responded to that it's really not law enforcement, it's someone trained in mental health. Um, we then as soon as someone's done
with the response, we ask them to call back into the center and let us know they're done. And then on a computer screening, we watch their vehicles or their cell phones leave the residents. Um, and then we know, okay, scene is
safe and clear. Um, those responses um are are how that process works. We answer about last year we answered 95,026 calls. Um last year >> state or the county? >> I'm sorry, excuse me. >> State or county? >> The state.
>> Okay. >> And so it's a pretty hammered out methodical practice of how um people are screened, dispatched, and then the follow-up services. Was that what you were looking for in a description of how
or not? Did I miss the mark? >> Yeah. Yeah. I think uh when we're evaluating this this whole mobile crisis and who we've partnership with when when we do that evaluation we've we've seen some nuance some things that help inform
us as to what what's most effective. Um uh first call for help originated in 1974. >> So you know you've got half a century of of experience and you're dealing with 47 counties. So in your presentation, we
see that this is something that counties are are availing themselves of because it works because we have experienced people and your model says this is this is how it operates and this brings integrity to to what the services that
you're providing. Um so all of those things are are very uh important components. So when you're when you're making a decision, which we as decision makers are making today, it's going to be based on what is the service that you provide, how do you do it, what's your
reputation, how much experience you have, and the credibility that reinforces what you do, I think, is demonstrated by 47 counties throughout the state that chooses to use the services that you provide. So that's the
assessment of the value of what you do. and we've had some experience that has showed us where we maybe are vulnerable in some areas and so we're looking for another option in that regard. The other component is the cost component and um
so if we if we look at the value we get for the dollar expense I guess if you could just speak to the cost component of this. >> Sure. So, we have two grants that currently fund mobile crisis work in Cook County. Um, one of them is
administered through the ABHI, the Arrowhead Behavioral Health Initiative. Um, and with this proposal, the funds that we're receiving through that grant would rather than come to Cook County, they would go to First Call for Help. So
there would not be a impact to our financials because both the revenues and the expenditures would be going through first call for help rather than Cook County PHS. >> Okay, Mr. Chair, as a followup, so we
have grant monies uh that are going to fund this service. Anything on the horizon that tells us what the future will be relative to the funding? there is a grant that's open for the next two-year period and th that grant will
again be applied for through the ABHI. Um so the funding is available for this next 2-year period and the grant period's open now. So I know that our ABHI director is working on that application and that in that application
the recipient of awards for Cook County would instead go to First Call for Hub. Okay. And and I I would say that um uh based upon the discussions, the presentations we had both at the advisory committee and and before us now
and evidently emergency management that um uh there's a proven track record. I think the number of calls that you taken demonstrates that that you have the experience uh with considerable volume and that there is an accountability and
a followup that brings integrity to that. Um I I think that uh in the presentation that was made before the advisory committee that uh the number of counties that you serve and the years of experience are what's you know bringing
confidence to a decision that would support that we would do that. And uh having said that, I'd be willing to make a a motion uh the motion that's before us that um the public health and human services board approved the proposal for first call for help to become the
provider of record for mobile crisis response in Cook County in addition to the language that also appears in this motion. >> Thank you, Commissioner Gav. We have a motion. Is there support? >> Support. >> Thank you, Commissioner Sullivan. I have a motion and support. Any further discussion? Commissioner Svin, was there
Was that for the Okay. Yeah, >> I was going to make a motion. >> Crystal, did you have anything you want question? No, I saw movement. >> Yeah, I was thinking of something. >> Okay. >> All right. Uh, all those in favor? >> I those opposed.
>> I'm just going to stay. >> Okay. >> Thanks. >> Motion passes. Uh, all eyes and one abstension. >> Thank you, CER. Thank you so much, CER, for being here and for your proposal and your presentation this morning.
>> Thank you. And we'll work to keep um the the commission each of you um knowledgeable about what's going on, getting feedback um because cookie cutter services from one county don't >> sure >> cover other counties. So, we'll morph
the the process and the structure as we go. And thank you for your time. >> Appreciate it. Thank you so much. >> Thank you, sir. have a brochure before you leave. Do you have a brochure? >> I didn't print. >> Okay, no worries.
>> I appreciate your website. Is there >> first call211.net? >> Yeah. Yeah. Yeah. I just wanted to know if you had print works better for me. You're good. Thanks. >> Take care. Thank you. >> Thank you. >> All right. That moves us on to our
director's report. We got five We got four minutes. Okay, I'll try to be quick here. And I have to apologize. I'm getting over a cold. So, if I sound a little off, that that's why. >> Um, okay. HR updates. We have two
currently posted positions for adult mental health case managers. We accepted the resignation of Sarah Dregwick, behavioral health supervisor, whose last day was May 11th. And I am beginning to look at the
recommendation from Megan Moe's report related to organizational structure and will plan to give a more detailed update at the June PHS board meeting. I've been creating a tracking tool that details the status of where we're at
with implementation of the various recommendation in Megan Moe's report. The tool should be complete in the coming month and I'll continue to share progress updates with the PHS board at our monthly meetings. The PHS advisory council and local mental health advisory
council will have a joint meeting on June 9th. We'll be reviewing the mission, vision, and bylaws of each group alongside the relevant statutes that guide our councils. And we'll be voting on whether to merge or keep separate the councils going forward.
Also related to our advisory councils, I'd like to publicly thank Jerry Liela for his many years of dedicated service to both the PHS and local mental health advisory councils. Jerry has stepped back from service on these councils as
he enters a new chapter in his life. So, thank you to Jerry. Um, Thrive Together, the online Cook County resource guide is on track to launch within the next month. We will plan to share the site with the partners listed on the site
first and then publicly launch the site with a media release in 3 to four weeks. Um, historically PHS has used a combination of grant-based and donated funds to purchase gas cards from Circle K, previously holiday. These were given
to clients in need per the discretion of our intake and social services staff. We learned this past month that Circle K is no longer issuing gas cards. We still have cards on hand, but once they are gone, we will not have the ability to purchase more. Instead, we're exploring
the logistics of opening a charge account with Circle K in order to assist clients as needed and continuing to maximize the use of the MTM programs for clients on medical assistance for non-emergency medical transportation.
This county has had gas cards, but they choose who to give them to. >> The gas cards are the way to access gas cards right now is through intake and social services. So, for clients who are using who have a a case manager with the
department, they're able to access gas cards through working with their case manager. >> Okay. Thank you. Um, and then finally, I'm just now getting updates from the end of the legislative session related to the work
that we do within PHS. Like during this meeting, I was receiving email updates. So, I don't have anything to share yet, but I will plan to share more at the June meeting related to what the end of the legislative session will mean for PHS
work going forward. And that is it for the director's report. Any >> questions for Grace? All right. Well, we have 30 seconds for our committee reports.
>> So, I think we'll I guess I open it up if someone has something that they they think needs sharing. Um >> I could just say quickly that the public health meeting was totally talking about what we just saw. So, that was a there's no nothing new there.
We've done some updates this past Tuesday, too. So, >> I just quickly say that uh our administrator was able to attend the Arrowhead Corrections board meeting and took a tour and then headed off to Wisconsin on
a busy busy day. But um it's always good when we have context and understand the organizations that provide services for us from the administrator perspective. So, All right. Thank you for going. Um,
all right. Well, with that, uh, we're going to move on to item seven, which is adjournment. We are adjourned. Thank you. On June 8th, >> okay, good luck. >> Yeah. my last.
>> Yeah. Have you already had the other >> experience? Yeah. Yeah. You know what's coming. Oh, >> well, that's exciting. >> Yes, it is. I'm looking forward to it. Okay.