WEBVTT

METADATA
Video-Count: 1
Video-1: youtube.com/watch?v=uU_SyjgMRMQ

NOTE
MEETING SECTIONS:

Part 1 (Video ID: uU_SyjgMRMQ):
- 00:00:02: Meeting Called to Order, Consent Agenda Approval
- 00:01:05: Birchbark Consulting Report Introduction by Kristen and Grace
- 00:03:33: Megan Mo Presentation: PHS Organizational Operations Report
- 00:05:46: Acknowledgements to Contributors and Project Background
- 00:07:56: Project Background: Organizational Turbulence and Concerns
- 00:09:16: Areas of Concern: Policies, Budget, Services, Work Conditions
- 00:10:36: Project Goals: Checklist for New Director, Addressing Risks
- 00:12:29: Project Scope: Program Performance, Budget, Staffing, Planning
- 00:14:24: Presentation of Findings and Recommendations Begins
- 00:14:42: Public Comment - Commissioner Gamble Clarifies Opinion
- 00:15:29: Findings and Recommendations: Overall Assessment of PHS
- 00:17:10: Challenges Faced by Rural County Agencies Acknowledged
- 00:19:08: Megan's Four Categories: Operating, Administrative, Program, Leadership
- 00:20:46: Operating Practices: Policy Manual, Staffing, Intake Review
- 00:25:24: Operating Practices: Documentation, Time Reporting Issues
- 00:26:29: Public Comment - Commissioner Gamble on Time Reporting Importance
- 00:30:00: Public Comment - Commissioner Stoley on Modernization
- 00:32:29: Public Comment - Commissioner Gamble on State Comparison
- 00:34:14: Operating Practices: Rep Payee Internal Controls Needed
- 00:35:35: Operating Practices: Career Development Strategies
- 00:37:30: Administrative Practices: Office Support, Fiscal Areas
- 00:38:03: Office Support: NEMT Vendor Challenges, Calendar Sharing
- 00:41:15: Fiscal Services: Enhanced Budget Reporting Recommendation
- 00:42:36: Public Comment - Commissioner Gamble on Tracking expenses
- 00:44:14: Public Comment - Administrator Treble on Small Case loads
- 00:46:56: Program Practices: Behavioral Health, Mobile Crisis (Dave Lee)
- 00:48:35: Behavioral Health Unit: Peer Specialists, Residential Options
- 00:51:20: Adult and Home and Community-Based Services: Case Aid
- 00:53:45: Adult Protection Services: Enhanced Revenue Billing Option
- 00:55:24: Economic Assistance, Healthcare: Program Complexity Issues
- 00:56:59: EA and Healthcare Programs: Application Timeliness Monitoring
- 01:00:00: Children and Family Services: Always Most Challenging Unit
- 01:01:36: Children and Family Services: Documentation and Indian Child Welfare
- 01:05:08: Public Health Unit: Integration, Identity, and Continuum
- 01:09:40: Mobile Crisis: Alternative Provider Standards Needed
- 01:12:59: Concluding Remarks, Followed by Q&A Session
- 01:13:14: Public Comment - Crystal Questioning the Term Windshield
- 01:13:46: Public Comment - Gamble on Candid Staff and Wage Issues
- 01:16:11: Public Comment - Gamble on Masterful Presentation
- 01:17:31: Public Comment - Sturley on Board Understanding
- 01:18:37: Public Comment - Treble on Time Investment
- 01:21:34: Public Comment - Gamble on Departments
- 01:23:46: Public Comment - Question About Board
- 01:31:37: Grace and Kristen Provide PHS Response to Report
- 01:37:52: Review for best practices on documents from other companies
- 01:39:14: Thanks to team for SSIS help with system
- 01:44:15: Kriten provides what work the country is doing.
- 01:46:41: Public Comment - gamble on advisory committees.
- 01:50:02: Understanding Options moving forward
- 01:50:59: PHS Updates and Reports to Move into


Part: 1

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Thank you. Uh, good morning everyone. I'd like to call this meeting of the Cook County Public Health Human Services Board to order this Tuesday, March 17th at 8:33 a.m. Uh, first item is the approval of the consent agenda, which includes

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our meeting agenda, uh, minutes, uh, financial report, abstracts, and bills. Is there any item on the consent agenda? Anyone would like to pull or is there any change to our meeting agenda? >> Else yes, Rana.

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>> Oh, >> I was raising my hand for them. >> Oh, >> sorry. >> All good. Else enter. Commissioner S. >> Mr. Chair, I'd like to make a motion to approve the consent agenda as presented. >> Support. Thank you. We have a motion and

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support. Any further discussion? hearing or seeing none. All those in favor? I >> I opposed. Motion passes unanimously. Thank you. That moves us right down to our consultant report with Megan Mo of

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Birchbark Consulting. I'll pass it over to Kristen or Megan or Grace or whomever and we can >> Sure. Um, I'd love to welcome Megan Mo from Birchbark Consulting. She has been

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working with our department since last fall to provide a report on our organization's operations. That report is part of our board packet. Um, and she is here with us virtually this morning to provide a summary of the findings in

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the report. So, welcome to Megan. Not sure how the technology is going to work with the team's meeting, but I will leave it to Betsy to help us uh bring her up on screen here. >> I think it's flawlessly that's how it's going to work. >> Well, good morning everybody. And

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Kristen, I'm sorry I'm having a little bit of a hard time hearing Grace. Did she um >> Do you have a mic there, Grace? >> I do. Maybe better just speaking into the mic. Are you able to hear me better now, Megan? >> Yes. Thank you. >> Okay. I'll make sure that I speak into

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the mic. >> And Megan, as we get started, if someone asks a question at some point and you can't hear them, just let us know and I can repeat it for you as well. >> Okay, we'll do. And then I'm assuming I'm showing the presentation from my

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computer, correct? Okay. All right. Well, as somebody in the room said, we'll just uh cross our fingers that it's going to be uh smooth as silk here. Oops. Bear with me for just a second here. >> Mhm.

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>> No problem. >> That helped. >> Just waiting for the show to start here. same. >> There we go. Okay. >> Okay. Just give us one second on our end.

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>> So, is it still loading? >> Yes. >> Okay. Let me know when you're all set. >> We need one more minute here, Megan. Yeah, no problem. It's just amazing to me across all these miles that it can work at all. So, if it actually it's

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just floating, that'll be wonderful. >> There we go. All right. >> Okay. So, you got the title title slide up. Great. Wonderful. Well, thank you for the invitation to be with you this morning. And if nobody else has said it, um, happy St. Patrick's Day to

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everybody. Um, I am here, as Grace said, to walk through the report that I've been working on since last September for PHS. And I think my understanding is, like Grace said, you have a hard copy of the report in your packet. Uh, it is a

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lengthy report. So, I'm hoping the slide deck this morning will help uh, you know, give you at least a 5,000 ft view of the report itself. And, you know, I'll be summarizing some of the conclusions this morning. And of course there's tons more detail in the report itself, but hopefully this will give you

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a topline view um of of the findings and the recommendations I'm coming forward with. And um just welcome uh people at any point to jump in if you have questions. And again, I just appreciate the opportunity to be with you today to discuss the report.

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Okay. And hopefully I'm just trying to get a sense of how quickly the slides are loading on your end. Did the agenda slide come up? >> It did. And Megan, they're loading pretty quickly now. It was just uh we had we had to >> the initial >> correct. Thank you.

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>> Okay. Super. So whenever I'm um with a group of adult learners, adults, I like to start out the presentation by just talking about what are we going to be doing for the next period of time or what do I have planned for you? And I do want to kick off. A lot a lot of people

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um contributed to this report in one way or another. And so I did just want to take a moment to acknowledge that upfront. Um and then provide a little bit of background on what got us here um to the point of the the uh report being released in late February. And then

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we'll spend the bulk of the time on what does the report actually say, the findings um and the recommendations I have for you going forward. And of course, as we talked about earlier, please jump in at any point. All right. So, first first of all, I do want to thank all of you um for

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launching this report in the first place. And as well, uh a number of you sat down and met with me one-on-one to share your observations, your concerns, um your hopes for the future. So, I appreciate very much the time that you took to do that. It it did inform the report and was very helpful. Um, in

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addition, I think I met with every staff member who was available, um, certainly during the time that I was in town during the first week in December. And my sense in talking to staff is they were very candid. I don't feel, you know, certainly meeting with folks that

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they they held back. Um, I got the sense from meeting with folks that they're very invested in the success of PHS and, you know, shared what they had to say in a very thoughtful manner as well. So, uh, you'll see a lot of staff feedback reflected in the report today. Um, I

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also just wanted to acknowledge up front, particularly in the behavioral health section that I'll be speaking to later. Um, I was able to collaborate with Dave Lee, who is the former health and human services director from Carlton County. Many of you would have met him um, by this point. And Dave is a

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behavioral health expert. um that's really his area of expertise and has been Dave and I have known each other for a long time um in our roles with county government over time and I did collaborate with him on the behavioral health section so his a lot of his feedback and his work with community partners will be reflected in that

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section as well. Um, last but not least, wanted to thank Kristen Plowman of course and and your new leader, Grace. Um, really again thoughtful, smart group of leaders that you have on board and you know, particularly Plumman and

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Kristen just provided constant assistant for this constant assistance for this report to make it happen and their commitment to change was very obvious um, from the moment I I met them and started this project. So, I appreciate both of them. And last but not least,

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you you will see some local photographs both in their report and in the slide deck today and they're taken by a local resident um Jennifer Victor Larson. So just wanted to she's a friend of mine but also just a beautiful photographer so wanted to acknowledge her as well.

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Okay, jumping into the pro project background the next section here. I wanted to talk for just a moment and certainly this group is um as aware probably way more aware than the average person on the street about what brought us to this point. It it it has been a

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difficult time for Cook County PHS. I describe it in the report as organizational turbulence. I think that's perhaps an an apt description. Um as I think everybody's aware there have been several internal investigations that have happened um just due to

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complaints from external parties as well as internal grievances and matters other matters that you know were generated internally and my understanding is before I came to PHS there had been a fairly high degree of staff turnover including leadership

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turnover and then um you know some some damage that has occurred to the department through local press coverage and um you know just the internal status of the department wasn't as desirable as one would hope it would be in terms of excuse me being able to produce the best outcomes for the community. So that is

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what initially brought me to the county. All right. The areas of concern as uh authored by Kristen Treble House Halverma in a presentation she did to the county board prior to my coming on board. Um there were four different areas of concerns that she had

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identified prior to the project starting that I'm talking to you about today. um concerns about policies and procedures, lack thereof, um policies and procedures that were not pointing the department in the right direction. Um revenue and expense issues. Um was the budget doing

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well? Was enough of revenue coming in? Were expenses exceeding where they needed to be? That was another area that Kristen had initially identified. Certainly, the quality of client services is always primary in the minds of folks who work at um and operate PHS. And then the work conditions that staff

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were experiencing. you know, obviously were another concern as well that were brought to the four and Kristen identified during her presentation. So, just to hearken back to, you know, again kind of what brought us to this point. So, my understanding prior to my being brought on board is that the board the

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PHS board did act to conduct an evaluation of overall performance of PHS and that's when Dave and I came aboard as well as um an EIP consultant to talk about work culture issues. I don't really address those a lot in my report um because she the EIP consultant did a

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very comprehensive and I thought well done report. So I focus more on other areas of PHS in my report and I've been doing at this since September. So the goal of the project you know hearkening back to the beginning when I sat down with Tomman and Kristen and

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said you know what are we what are we aiming for here? Where do we want to be at the end of the day when this report is complete? And what we've been really been talking about is, you know, PHS only had an interim director at the time and then of course Grace came aboard toward the end of when the visit was

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happening and the report was going to be um delivered. But we've been talking all along about being able to have like a checklist or a handbook or a list of recommendations that the new director can use as they begin their new role. Um, and I was really focusing on areas

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where you would you had risk that wasn't being addressed currently or where PHS might could be said to be out of compliance. So, that was an area that was of primary focus. And as I was able to identify here and there a few areas where I did think there was some

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unressed risk, I didn't wait till the report was done and published. I talked to Palman and Kristen right away. um and some areas were able to be remediated remediated immediately um as they came up in the course of the report and I'll reference at least one of those later on um in one of the later slides. So, and

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then of course make like I was talking about with the checklist, making recommendations to assist um the board, uh Kristen, your administrator, and the new director coming in. Um, you know, time and resources are limited and hopefully drawing attention to areas that I feel would be helpful for you to

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have your focus in the first, you know, one to maybe two or 3 years of the new director's tenure. Um, was was the idea here. And in true social worker fashion, uh coming from a strengths perspective, uh I felt it was important to focus on

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the things that were going well at PHS as much as the areas for improvement. And there are I, you know, I'm definitely here to say today there are a lot of things that are really going well at PHS um and a lot of strengths that you're going to be able to build on um in the next phase of the department's work.

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Okay. in terms of the scope of the project. And again, again, another interesting photo from the Northshore here. Um, really all areas except for, you know, I didn't really put a focus on work culture again because that EAP report was going on, but basically

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everything else, program performance, budget, staffing, um, and strategic thought and planning in all areas of PHS was within the scope of the project. So, I did, as I kind of referenced on the previous slide, try to really focus on areas that I thought were the highest

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risk to PHS. Um, any any area where you had risk for, you know, there's non-compliance or operational things that weren't going smoothly, financial areas that could go better, I did look at those. Um, again, really focusing on the high-risisk areas. Um, I helped the county try and find where best practice

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could be adopted. Although, as I'd referenced, there were a lot of good things already going on in the county, and it's really just a matter of building out from where um PHS is at currently. And I do want to say upfront, you know, I have a as you saw from the report, 75 pages of recommendations. And

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uh you know, certainly don't I hope you don't conclude from the volume that there are so many things wrong. More uh more to the point, I just went into a lot of detail to help you figure out perhaps how to implement some of these changes if you choose to do that. But I do want to say upfront, I'm not assuming that anybody agrees with the

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recommendations or conclusions that I'm coming in with. Um, and I'm not assuming that you would necessarily move forward on all of them. This is I certainly have a long background in Health and Human Services, County Health and Human Services. Um, but like anybody else, I have my own opinions and you may feel

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that um, the agreements or conclusions I've reached are helpful for PHS or not as helpful. And I assume that you'll do your internal own internal prioritization uh process when it comes to these conclusions and recommendations. Okay, let me pause there for a second.

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This next session section is the biggest section of the presentation today where I will actually be going into the final recommendations and the conclusions that I reached. Any any questions so far? >> All right, Commissioner Gamble. >> Yeah, thank you.

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Mr. Chair, uh Megan, uh Commissioner Gamble, I I would just say your last comment, you know, the recommendations, things that you put in there that uh you're you're not assuming that that we're going to take your your opinion and opinions, I think, need to be

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identified independent of of your knowledge and perspective that you bring to this process. And while I appreciate the humble statement, I I also recognize that we in our position as decision makers rely on the expertise and the

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recommendations that come from a founded basis and that gives credibility. So it's not simply an opinion. It is it is a qualified opinion. So >> yes, Mr. Chair and and Commissioner Gamble, thank you for that

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clarification. I appreciate it. No other questions. Thank you. >> Okay, I'll keep us rolling then. This is, as I said, the findings and recommendation section. And I don't know that you really need a closeup of snowflakes. I'm I'm told you're very familiar with them. But here it is. It's

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kind of unique and interesting. And I did want to note up front here as I dive into the findings and recommendations section that these are I was in town, as many of you know, the first um week of December. Um, so there's a little bit of a time lapse here of what I I've been working since September, was on site in

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December, and then the report due to its length and detail was completed at the end of February. So, um, just to give you a sense of the time frame, most of the recommendations and conclusions are are based on what I saw in December and they may now many of them are probably

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in process and underway already. um which is a great sign but also kind of you know dates the recommendations put it that way. All right. So um you have in your executive summary um of your report in the first couple pages there there's a

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large table that lists out in summary form all of the recommendations with with just a little bit more detail than what I'm going to cover today. So you have sort of the big report that has high level of detail. the table has I would say a fairly low level of detail and then get today is again it's just

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that summary topline information. So if um in my brief brevity today if you have additional questions please let me know. Okay. So overall just again at a high level um before we get into the any programmatic or more detailed

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recommendations I did find that despite the challenges that I discussed earlier um that have been happening at PHS over the last period of time many things are going well and I think at a foundational level the right things are in place um in order to use that as a launching pad

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for forward progress and moving forward from here from the phase that you've been in. I did acknowledge upfront in the report and I I'm a metro-based person. I'm from the metro area originally, but I have worked in greater Minnesota, I would say fairly extensively, too. And I I can tell you

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right now, there's no metro county health and human services director who would want to be a small county health and human services director because it's really challenging. Um, and there's always unique difficulties in implementing programs and making changes in sparsely populated areas. And I just want to acknowledge that upfront. And I

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think a lot of times the work of a of a small county public health and human services agency and its leaders is to try to find a way to carry out mandates or community expectations, community needs um in the best way you can, doing the best with what resources you have available. So just want to acknowledge

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that upfront. Um so really that's almost just like a a I'm your cheering section for you. I I see some of the complications that you have to deal with when you're doing things on a small scale. And they talk about that to some degree in the report. Um but I'm confident you can make progress on a lot of fronts even if you don't have a ton

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of resources. Um in terms of for example in the metro area, the number of providers we can choose from um to implement any service that that is either mandated or we desire for it to happen is a really marked difference between um even regional centers and and small rural counties.

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I do want to just say upfront and um hopefully this came out a bit in the acknowledgements as well that um I have obviously worked in depth with your new leaders. I'm confident about their ability and as I said they've been very changeoriented from the first time that I met them. So wanted to say that

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upfront and as I mentioned earlier since that December and February time frame I'm aware that PHS has begun begun to implement a number of the recommendations already and I'm assuming they'll be speaking with you about that at the end of the report here as well. Okay. So Kristen had her four identified

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areas where she felt focus was needed to improve operations at PHS. I have my four too. I categorize them a little differently. Um, but I think you're going to obviously see a lot of overlap between the two. Um, and the way that I'm talking about the recommendations, I just want to clarify up front with what

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these four main areas mean. Um, first of all is operating practices. And this is just, you know, day-to-day how how is the basically how's PHS operating as if it were a business. You know, the the the daily in-n-out operating procedures.

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Um the next category which might be hard to distinguish from operating um I called administrative practices because it's really talking about within PHS the units that provide administrative services. So office support and fiscal how are they functioning. Um the next

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section which is a pretty big section um goes unit by unit through the different types of work that you do in PHS and talks about programmatically how are things going? Are you in compliance? Are you using best practice? Where are the focus areas that you need? probably for the next one to three years. And then

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last but not least, uh you have had some leadership turnover. You have had an interim director and now a new director. And I think there are some areas where development would be helpful in terms of h how your leaders are practicing um their leadership and their supervisory skills. And I do make some

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recommendations around that as well. Okay. So, in terms of day in and dayout operation of the department, um I really felt and I know this was sort of Kristen's number one area that she identified when she was talking about her four areas with you um back in the

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fall, but PHS, I couldn't agree more, really does need a comprehensive and updated policy and procedure manual with everything in one place. So, I'll give you one example. um having a truly updated policy and procedure regarding data practices and how data practices is

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going to be dealt with across um Minnesota chapter 13 u our famous local state privacy law here and the federal regulations that govern um data practices and privacy for people who are receiving substance use

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services. There's at least three laws that that govern this area for PHS and there there really needs to be a unified policy explaining how things are to be handled and staff need to be vigorously trained on it. And I think you know that that's just one example of a policy that

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I recommend that you have going forward. Um just one example of a policy. If had that been in place and had such a policy been being followed, you know, I think that some of the issues that you had would have been avoided. So certainly there's many other areas and I and I highlight a number of those in the

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report that I think you do need enhanced policies, but that's um just an overall recommendation as well. Um and again, your your table in your uh executive summary goes into more depth and I haven't always listed all the bullets that are in your table as well,

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but these are I think the main ones that I want to make sure to to call out for you. Um, I did have some questions particularly from board members as I met with you one-on-one about whether uh PHS was overstaffed, understaffed. What did I think in terms of your current staff

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complement? And I found I think that PHS is staffed at about the right level. Um, you know, obviously if your if your case loads uh, you know, increase dramatically or decreased dramatically, you may want to take a look at that. That doesn't usually happen unless there's a pretty significant law change.

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Um, but my thought is that you do have a number of vacant positions that you're not currently using that you probably do need to fill. Um, but and I've discussed this obviously with Grace and Kristen. I'm not sure in all cases that the way that the positions are currently classified is the best way for you to

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use them. And I have specific recommendations in terms of the vacancies that are there and how I would recommend for them to be reclassified. And generally what I'm looking at is trying to make sure that people like eligibility workers and social workers are able to u be working on things that

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only that job class is able to do and finding ways to for those staff people to receive more additional paraprofessional help so that the time that the social workers and eligibility workers as an example are on the job they're working at the highest and best um task that they can be working on at

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all times. So that's been the focus of some subsequent recommendations that you'll see. Okay. And then one overall operating comment. I really took a close look at your intake and social services. I do think it runs well the way you're currently doing it, but I did provide

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some different options um of how it could be improved or restructured. And you know, there's some issues with the um staff rotating through social services intake. And it's a, you know, disruption is probably too strong of a word, but it does provide some cause

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some disruption for staff because they have to do a big block of time on intake when otherwise they'd be out, you know, serving their clients directly. And it also results um in not always having, you know, the social services programs are so deep and you need so much

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knowledge to be able to to operate them successfully. and the rotational pattern you have currently is not always resulting in having the maximum program knowledge available at any one time. It really depends on who's rotating through intake at the time. So, I'm trying to find a way, you know, for intake to be a

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little dis less disruptive for staff and also to make sure there's more programmatic expertise on tap at any one time. So, again, if you never change anything with intake, I think you're doing it just fine um the way you are. Again, it's a challenge in small counties where you don't have intake specialists like we do in the big

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counties. Um, but there might be some different ways of looking at it that could again help you have more programmatic programmatic expertise on tap on a day-to-day basis. Okay, continuing with operating practice practices a big issue. Again, this is

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one that um, you know, identified upfront, but uh, certainly Plum and Kristen were very aware that documentation is lacking in social services. there were some specific issues with documentation and children and family services that were kind of a high-risisk situation that um certainly

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I think Kristen and others suspected was the case and I did agree that there were some immediate documentation issues that needed to be dealt with in children and family services and my understanding is they've since been remediated. Um but there's an issue across social services with the lack of documentation and

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documentation and time reporting or revenue generation go hand in hand. So, if you're not documenting well, um, then your fiscal unit can't turn around and bill that social worker's time. And that's incredibly important for social services agencies to have that those

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outside sources of revenue. So, those two issues are very deeply connected. And I'm sorry, was somebody trying to ask a question? I thought I heard someone jumping in. >> Nope. >> No, >> that was a cough. >> Commissioner Gamble, that was a question. >> Yeah. Um, >> okay. if I could.

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um in my first term which was uh back in 2013 I began and public health human services um uh from your perspective and I you allude to it in in in your document uh to some extent but uh the

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documentation and time reporting uh critical especially in a community like ours when our tax base is so small and so the revenue portion Anything that is legislated that allows us to get revenue

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in partnership to fund the services we provide is critical. And our ability to do that in in a way that is both efficient and um contributes to that financial base is huge. And it was an issue that we

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discussed very often. and um uh trying to work in partnership so that it doesn't seem like you're uh attacking the department when it comes to the accountability factor, but just looking for ways to try to maximize the return

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that we get for the services we provide. And so during that course of time and here in this term recognizing that in some areas we we really need to find ways to be able to generate that revenue

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so that we can demonstrate that we're really good stewards of the opportunities that are presented to us. And in situations where we have unfunded mandates or that the proportion isn't right, uh we need to learn to advocate on behalf of small counties like ours

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that don't have the financial base to be able to provide these services. So just that observation to your comment about documentation and time reporting. >> Yeah. So Mr. Chair and Commissioner Gamble, I couldn't agree more. And the

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the way I talk about it in the report is there are several areas of risk here. There's the financial risk that you're talking about um where you're overly dependent on local levy and you need to be bringing in more revenue from other sources, but also there's just from a practice and a staff safety and a client

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safety standpoint. If your workers aren't documenting everything they're doing on a case, it's really problematic. um you know what if somebody's covering child protection and there's no documentation in the system about a particular child protection case. How

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are they supposed to provide coverage when that child protection workers out of the office? You know, just day-to-day concerns like that where if there's nothing in the system, you can't provide the best service for your community. It's it's concerning. And what I like to talk to staff about and what I've worked with staff on in

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the past in past roles that I've had is just to talk about what what does good social work practice look like? And good social work practice looks like assessing someone's need, creating treatment goals based on the need that you the person has identified and then

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providing and documenting services that demonstrate that you're meeting the assessed need. And if you take all those three steps as a social worker, you don't need to worry about revenue because the revenue will just follow. If you do provide good social work, we get paid for good social work from medical

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assistance. And really, I think what Plowman in particular and also Kristen have been saying all along about the need to document more effectively and generate more outside revenue is spot on. So, I really support the work they've been doing to try and get things, you know, on a better track with

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documentation and time reporting. and it will pay off quite literally. >> Um, so another question comment from Commissioner >> Story. >> Um, good morning Megan. This is Commissioner Stoley. >> Overarching all of the uh problems that

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we have is a word called modernization of our system and um I am on the public health and human service committee when I go to the legislature and we are just round and round with that. So I can't say that there's any big um success in

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modernizing our system because according to some legislators it's going to be up to 5 years. So that means we need a lot of patience when it comes to investigating certain all of the cases. And I you know I'm just feeling really

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bad for everybody whether it's Hanniban County or smaller counties because we all have to do the same thing. So I guess I don't know if you have any suggestions as how we take a little bite into this or just realize that this is where we are with our system in the

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state. >> Well, Mr. Chair and Commissioner Stoley, thank you so much for rec recognizing and acknowledging that issue. It is a huge one especially I will say with our two green screen mainframe systems um that folks are interacting with on a

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daily basis maxis and MMIS that are cobalt based um the time has come and really left decades ago when those systems should have been replaced. Um I think people are in some ways reluctant to have them touched because they actually do kind of work on a day-to-day basis and they're pretty reliable. Um

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but absolutely and I the same could be said for SSIS the social services information system that where the documentation that I'm talking about needs to go into it's a hugely complex um piece of software. It's Windowsbased

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but doesn't work very well. So I just you know on behalf of the workers I just want to say thank you for understanding that issue and for your continued advocacy. I don't, you know, we've been trying to advocate for decades and I don't know what the magic's going to be, but I think continuing to deliver that

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message um is very important and I appreciate that you've been doing that. Thank you. >> And Commissioner Gamble has a question comment. Yeah, to that to that point and I know it wasn't it wasn't part of the scope of this this study, but it is

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something that as Commissioner Starley has noted and each of us commissioners are are well aware of and it was a primary topic at the legislative discussion this year that modernization is important. So when the governor came

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out and said that it'll be uh 2020 2032 and that we're going to research this and come back with a recommendation. My question to you would be again it's not part of the scope of this study but it is inherent in the problems that we face when it comes to efficiency and time and

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stress is the issue of what states do it well. Could we not learn from somebody else? That doesn't mean we have to invent the wheel from scratch, so to speak. >> Well, Mr. Chair and Commissioner Gamble, I think that's an excellent suggestion,

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particularly when it comes to um SSIS, again, the social services information system. That system was built initially to comply with a federal requirement to report on foster care data for the state. And all 50 states have that requirement. All 50 states um do

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eligibility for for MIP, their version of Mip Tannif, right? They all do it for Medicaid at some level. Um across the nation, you know, these are big federal programs that people are administering. So, everybody has to come up with some

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type of solution um you know to to um execute these programs properly. So, um there's got to be a better solution somewhere. probably not the perfect solution, but I certainly hope part of that process will be looking around the country to see is there something better going on than what we have currently

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>> there questions? >> No, no other hands right now. Thank you. >> Okay, great, great comments. Thank you so much for your engagement on all of this. Um, okay, continuing with operating practices, rep pay services. I don't want to spend

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a ton of time on this cuz it's a relatively small chunk of what you do. Um, but this was actually a concern brought up by staff and I agree with it that you don't have the proper internal controls in place for this program right now. Basically, what it comes down to is

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that the client's worker should not be the one authorizing uh rep payee and then you know delivering that to the client. um you need to have two separate people involved beyond the fiscal department to make sure that that authorization is appropriate. Um again,

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I talk in detail about it in the report. There seems to have already have been a level of awareness that a change was needed. I think this is another example of you don't have a ton of staff and so um existing staff have been trying to play multiple roles to make sure the service gets delivered for your community members. Um, but there does

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seem to be an internal awareness that something needs to change. Even before I was talking to staff and I think this is something that's now that it's been raised formally, I think this is something that's underway in terms of changes as well. So, I'm confident this one's going to get resolved. Um, the other and I think this is the last

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operating recommendation I have. I think we're shifting to administrative after this. I am recommending um just because you've had some um staff retention issues that your HR department and your P NPHHS or employee relations I think you call it um that you look at developing career

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development strategies. So one example I give in the report is looking at things like having a um office support specialist one two and three separate grades or three separate job classes. social

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worker one, two, and three, right? Um eligibility specialist one, two, and three. And the different levels would be based on years of experience. Um if someone goes back to get additional education, they might go up to the next level. And it's just a nice way over the

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years, not only for people to say be a social worker and receive, you know, pay increases over the years. Obviously, that's very nice and people appreciate that. But being able to acknowledge that somebody did put more work and more time into getting experience into getting

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education um and someone is able to move across that those different job classes over the time that they're with a department um is a way to to attract and retain staff because they feel like over time, you know, they are their career is proceeding and their efforts are being

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acknowledged. So it's again more difficult to pull off in a in a small county because you don't have that much staff. But this is a common practice. It's done in merit system and it's done in a lot of large counties um to be able to again attract attract and retain staff. So I've given some specific

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examples in the report of how you could approach that that and again as long as it's their merit system is a good a good resource um for how it's being done elsewhere in the state. Okay, I think I'm going to keep us rolling unless there's more questions. Just dive dive in. >> Sounds great.

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>> Shifting to admin. Okay, shifting to administrative practices. So again, the focus here is really on the office support and fiscal areas, the areas that provide administrative support to to help all the programs be delivered on a day-to-day basis. Right? So there's actually 10 recommendations in the

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report relating to office support. I did not include them all here, but I wanted to highlight some of the main ones for you or ones that maybe need a little bit more explanation. Um, it was very clear in talking to your office support staff who interact with this vendor um that your non-emergency medical services,

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non-emergency medical transportation, sorry, I should say, that your NMT vendor um is challenging to deal with, is challenging for your community members to deal with. Um the state is working on a solution to this, but you're going to be kind of, if I can say, stuck with this provider for a

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while. Um unless you decide to make some changes in the interim until the state solution is is available. Um I can tell you we use the same vendor in the metro area and I don't want to name names, but um I think the challenges that that um your community members are experiencing interacting with this member uh with

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this vendor are pretty universal. So, I think a decision just needs to be made on is there another solution that's possible to get you to the statewide um substitute for this vendor. Uh or do you need to do something in the in between time to help this vendor be more easy to

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deal with from a from a consumer from a client standpoint? Um because it's challenging and it's frustrating. So, that one's a little more complicated. This one's pretty straightforward. Um I do think you should share your Outlook calendars agencywide. I think it's important for supervisors to know where their staff

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are and what they're doing. I think it's important for the front desk to know if staff are available based on their calendar. And it's just a beyond just being an an ease of serving people, you know, step that you can take. It's also a safety concern. You know, if a staff

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is out in the field visiting um a client and they were supposed to be back 45 minutes ago and you haven't heard from them, but their calendar tells you where they're supposed to be, then you know whether there's a safety concern and you need to contact the staff and make sure they're all right. So, this is a step that would be easy to do and I recommend

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that you that you take it. So, specific to the office support unit, it's kind of um this and this often happens with office support units. There's there's a couple of different supervisors who are sort of task supervising for different reasons for office support and then a formal

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supervisor who's across the unit which is as I understand it's currently the director not sure that's the best arrangement. So I'm suggesting that you create a lead worker position within the office support unit just to deal with the fact that there's sort of multiple supervisors. There's some positives to

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that in that they get direct direct task supervision from the program areas that they're working in and I wouldn't um eliminate that, but I do think there could be a clearer sort of chain of command within that unit. So, I'm suggesting you look at this lead worker for that purpose. And then I do I think

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just in talking to office support staff, they've been very open that they have additional time available that they could be busier at their at their jobs currently. And you know, none of us like to hear that. So, let's be as efficient as possible. There's plenty of work to go around. There's more that office

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support staff can be doing. And I made some specific recommendations in the report about some tasks that I would shift to them that open up other time that could be um better used directly serving the community. So, that's again, there's six more recommendations in the report, but those are the main ones I

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wanted you to know about. In terms of fiscal services, I think things are really running pretty well in your fiscal area. In fact, fiscal I think in some ways is is definitely trying to lead PHS in the right direction. It's difficult to do sometimes from a from a small fiscal

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unit compared to the rest of the staff in PHS. Um the one recommendation that I have is that they um start to create a particular report, a different report for you than what they do currently. You know, typically in health and human services and let's be honest, specifically in the human services

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areas, there's some areas your of your budget that are high dollar amount. typically across all counties in the state that I think as commissioners you really do want to keep an extra special eye on. They're things like um out of home placement right tends to drive budgets. Um you know the amount of

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dollars that you pay for someone for example to stay at Anoka Metro uh regional treatment center or Moose Lake or you know wherever they happen to be. Those are just two examples of services that can really go get out of control quickly. And I think as commissioners um

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I if I were in your seats I would sure want to know um where are these sort of key items that tend to drive budgets where they're at. You know you get that whole big report but I think a more focused report where you can look at the key areas of expenditure and revenue and keep an eye on how are our staff doing

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with this new documentation piece is the revenue coming in on the other side so that you can really see how those line up. I think that would be helpful. So I was suggesting that that Palman and his staff work on that. We've got a hand here, Megan from Commissioner Gamble. Yeah, Megan, on that point, when we go

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to the our budget process and we're talking about public public health human services, that particular area that you're referencing when it comes to inh home and the travel expense um that we're required to provide as a service.

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We're always trying to determine whether or not we can save any money based upon what our experience has been when we have a year when we have high expense in that area. And so we're basically guessing and uh it depends upon whether we want to feel good about reducing

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dollars and then finding out we're spending a lot more than what we had hoped for. So your recommendation is is well founded in that it allows us to track it so that we have a better handle on it because it does affect us

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significantly relative to to our overall budget. >> Well, Mr. Chair and Commissioner Gamble, I I couldn't agree more and I think, you know, I wasn't even really suggesting that um fiscal show you a trend line. Where were you at in this area last year and the year before? How does it

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compare, you know, based on March 17th or March 30 at the end of first quarter? How much have we spent of our out home placement budget versus 3 years ago? Um, are we way out of whack? Are we on track? I wasn't even thinking about doing having fiscal do a trend line for you, but that could be really

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interesting, too. And I can tell you in a big metro county where we spent a whole lot of money on out of home placement, we adopted a strategy of kind of having like a four-year rolling average for how we would budget for out of home placement. So we would always liken it

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internally to trying to trying to budget for snowplow services. So in some years you may have a ton of snow and you blow your snowplow budget. Other years, you know, it may be warmer and it doesn't maybe it rains or sleeps more than snows and you don't need as much in your snowplow budget, but over that four-year

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rolling time period, you have kind of an average amount that you budget for to make sure that you have enough, but you're not overbudgeting. And I recommend that you do kind of take a similar approach to some of these high-cost areas like out of home placement where you look at gosh, maybe we had a low year, but let's not let's

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make sure that's a pattern before we really reduce the budget significantly and look at some type of a rolling average when you're looking at um how to budget for those areas. And certainly having the type of report that I'm talking about will help you become more focused on again the specific issues. You know, we always want it's we all

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have a tendency to want to focus on the amount of paper clips we're purchasing or staff travel or so, you know, or training when we're trying to cut budgets, but there are really just a small handful of things that really drive health and human services department budgets. And these are the things that I think um having an

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enhanced awareness of will be helpful. >> Um administrator Treble Helmer has a comment question too. >> Thank you. Um, Megan, I I I just want to say I agree with this recommendation, but I want to add just the caveat that in Cook County because we have such a

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small case load um in comparison to the metro area that we could have one case that has a significant appropriate out ofome placement cost and that will shift our trend line significantly. So,

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I just want to >> put that out there because, you know, I I agree with tracking it and monitoring it, >> but one case can really >> shift our numbers and and may be an appropriate need. >> So, just want to make sure the board is aware of that as well.

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>> Commissioner Gamble. >> Yeah. And just to follow up to that, I think um the tracking it and recognizing just the one case can be significant. It's just how we're managing that case. I think we had an experience here that we we

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recently ran into and um we try to do be dutiful and diligent but we were sort of stuck and I I think things that um as long as we have practices and policies in place that help us to minimize the impact of that I think that's our fiscal

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responsibility but um yeah it is challenging because it just takes one or two and we can really be so the projections um aren't helpful when you're trying to

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follow trends because it it is just the one that can really throw us off. So I think the benefit is is monitoring it so that we can ask the questions. Is there any other response to this that helps to mitigate the cost? And

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>> yes, Mr. Mr. Chair and Commissioner Gamble, I agree and that was really the point of the recommendation is just for you to be monitoring it so you're able to ask questions, but I I also agree with what uh what Kristen said. I I think this is a small county issue in particular that if you get one or two

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cases and this issue, this specific issue actually also comes up in the EA section that I want to talk to you about. Um they get they have like quality measures done for them all the time. And if they have one case that goes wrong of the of the four or five

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that they were rated on, they get a bad percentage simply because something went wrong with one case. Where in the metro area, if something got messed up on two or even 10 cases, it wouldn't be really be reflected in our percentages because there's the numbers are so huge. So, I

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do think that that's a valid point that that Christian's raising. And just cuz the numbers are large large in a particular instance doesn't mean that things are being mismanaged. In fact, they may be a man be being managed completely appropriately. Again, as you said, Commissioner Campbell, just the

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awareness I think is helpful. >> So, >> okay, I'm going to I'm going to keep us moving if that's all right. >> Yes, please. >> Okay. So, now we get into the program practices area. So, we're on the third of four already. So program practices um

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this focuses on behavioral health and there were three recommendations in this area and again I worked um extensively with Dave Lee on this behavioral health work and we'll talk about mobile crisis separately. There's a lot of issues going on with mobile crisis currently. So this is just the main behavioral

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health unit. Um this is where I was talking about maybe vacant positions that you have currently. This is one example of where I think you should look at potentially using them differently. So something may be classified currently as a social worker like a case manager position. Um but I do think hiring pair

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of professionals could be helpful here. So I had a have had a series of discussions with your your leadership about looking at bringing in what's called a certified peer specialist. One or more certified peer specialists. And again these are a pair of professional workers who have lived experience of um

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living with mental health issues or substance use concerns. They're in recovery. They've been stable in recovery for a period of time and they have special training that leads them to be able to function as a as a peer specialist and these staff are able to do they're very effective. There's a lot

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of research supporting their effectiveness. um a lot of counties are using them and have been using them for some time um to fill these roles. And I do think um having some of the staff available again would enable your social work staff to focus on the things that only they can do which is you know for

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both practice and revenue reasons is where you want them to be. So one of the big challenges you face again another small county issue is a lot of windshield time. There aren't really residential services available. So, for example, someone's having an issue with their mental health symptoms

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increasing and they need to live outside of their normal housing for a period of time until they can get stabilized. Really, the closest services are in Duth or two harbors. And it's just um you know, when someone's really in need of services urgently, it's it's tough to

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have to drive that amount of time and for staff to have to go back and forth. So, if there's any ability to look at residential options closer to town at some point, I think it'd be advantageous. Um, I'm going to leave it there because I I there's a lot of challenges that go with that that we don't really have time to get into, but

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all I'm saying is if there's ever the opportunity um to add a better that's not in a locked, you know, hospital ward, I think that would be helpful. Um, I do think, you know, given the um small relatively small span of control that your supervisor has in this unit

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that even if you fill some of these positions, that supervisor can can also carry some cases. So I just again I'm looking at workloads as I go through and this is one unit where I thought um that it would be appropriate for that supervisor to carry some cases as well.

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So no major concerns in that unit. Um continuing with pro program practices the adult and home and community based services unit. Um things really going pretty smoothly in this unit overall. Um it does help that this unit has had a supervisor and the behavioral health unit and you know it has a newer

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supervisor which is great and you're working to fill your supervisory positions but it is amazing uh after a period of stability uh stability of having a unit supervisor um some positive things can happen. So um there were five recommendations in this area in the report here we're talking about

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three of them. Um, another paraprofessional position that you have in the department is a case aid. And case aids can be of enormous value in helping social workers make sure that they're spending their time um doing social work practice, which is billable activity. And I I don't think you're

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using your case aid as effectively as you could. So, one of the suggestions I had made was shifting some of the case aid's work that they currently do, the office support staff who would be able to do um some of what the case is currently doing and deploy the case differently to have them really working

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directly with community members. Um, and the case is organizationally located in this unit, but they theoretically provide help across the social services units. And I think that is happening, but I think it would be helpful to re just reook at that and think, gosh, now

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that if this worker has additional time, how might they be used most effectively across the three units? >> Okay, the second bullet I kind of already covered where we were talking about policy and procedure. Again, having a really clear policy about how

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data can be shared. This is particularly important for behavioral health and this adult and home and community based services unit because there's so many clients in common. Um often times they get services from both units. There's usually one worker that's kind of the lead worker. Um and you have to do that

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in some cases due to the just the mandated responsibilities and the complexity of the programs. It's very common to have for workers or for clients that have very very very high intensity needs to have two workers. Um, but they have to be able to share information. And so developing a way

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that every so that we're not violating any federal laws, but information can be shared properly in order to serve the person in the best way. That's, you know, an example I used at the top, you know, from your policy and procedures manual that would be helpful. And the last recommendation, um, there's

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another way of billing within adult protection services that you're not using currently that has the potential to generate some outside revenue. Um, Plumman is aware of this and we've talked about, you know, anytime you add

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another um, sort of programmatic way of billing, it's complicated and it's complicated for workers to learn how to do it correctly acumentation correctly across different areas that they're working in. Um, this ended up being a source of a pretty significant

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amount of revenue in big counties. I think Plummen and Grace and others will be taking a look at whether it has the potential to bring in enough revenue. um that it's worth trying to implement and have staff learn how to do it correctly. Um it's not a huge departure from from how they're documenting currently. So,

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they probably could um but just figuring out um the places where it is appropriate to bring it into the service that you're doing. Um I think it could be worth a look at to see if it would generate enough revenue to be to be worthwhile. and the VAD TCM that just means um

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medical assistance case management for people who are VA vulnerable adults or DD developmentally disabled and not on a waiver. So it's a way of billing case management um for that specific subop and I I think your unit supervisor

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Olivia is well aware of it too. Sorry, was there a question? >> What's TCM? Oh. Uh, targeted case management. >> Thank you. >> TCM, targeted case management. >> No other questions. >> Excuse me. >> Yep.

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>> Okay. Shifting to economic assistance and healthcare programs. An incredibly complicated area of work. these staff. Um, you know, you have a a bunch of newer staff in this unit and it's very difficult for them for staff of any tenure in this area to ever feel like

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they know enough because they work in so many different program areas and they all have unique um eligibility criteria and rules. And so it's incredibly complex and then the eligibility criteria and rules are changing all the time with legislative and federal

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changes. So, um, if you see these staff in the hallways, give them a pat on the back because, um, they're really working hard and it's, like I said, it's hard to ever feel like you know enough about the programs you're working in. In big counties, we have people specialize. So,

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you might just be working in childcare assistance, you might just be working in MIP, you might just be working in emergency assistance, but in your department, you're really not big enough to specialize. So these staff, it it's complex enough for somebody to just have to work in the childcare assistance

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program, for example, and know all the rules and all the eligibility criteria, but your staff have to know those across many programs. There's really not a way they can do it and specialize much more than they are currently. Um, so anyway, just to acknowledge up front the complexity of the work that gets done in

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this unit. Um, sorry, I think this one's mislabeled. Okay, you know what? Let's skip. I mislabeled this one. Um, this is for the the recommendations for EA and healthcare programs. So, there's six

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recommendation areas. Sorry, those slides are mislabeled, including um continuing to monitor the timeliness of application processing. So, um, you know, in EA and healthcare programs, they're dealing with people who have a lot of issues with meeting their basic needs. So they might be applying for

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SNAP for example. Supplemental nutrition assistance program has been in the news a lot lately and it's really important to turn around those applications quickly so people can eat, they can pay their rent, they can put gas in the car to get to work. Um I think your staff is really doing a pretty good job again

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with the level of program complexity they have to deal with. Um but it's just always something to to be watching and I think that your supervisor in this unit does have her eye on it. But if there any barriers arise to being able to turn applications around timely and within state and federal, you know,

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expectations, I think that's something that you'll want to look at. Do you have enough staff? Do you need to specialize things further so that the programs are more manageable for your staff? It's always a challenge. Um, implementing regular case reviews is going to be important. And I think the supervisor in this unit is well aware

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that this is kind of the next step she needs to take with supervision. She's got a whole bunch of newly trained staff like I said who are relatively fresh to the county within I think 3 years is the most longest tenure one if I'm saying that accurately. Um so now that she's got them trained up to a basic level she

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needs to do case reviews. So it needs to go back into individual cases and spot check things across all the workers across all the programs cuz that's the way you really catch something like gosh I don't think this worker is understanding this one specific rule. She's applying it inaccurately and then

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you retrain. based on that and gosh, I I'm a little unclear on, you know, these two workers seem to be um applying a certain rule in a certain program differently. We need to call the state and ask for clarification on the way that we're supposed to be doing that. Those case reviews are really important

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part of supervision. And I think they do now is an appropriate point to be implementing some of those. And it's just a way of spot check whether the training that your staff has received um is really sinking in and whether there's and helping identify areas for further training. And last but not least, u while you're

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advocating for for uh modernization of systems, which is an incredibly important piece we like we talked about earlier, um I think this unit would also appreciate if you advocate for what we call administrative simplification across the programs. So, I'll explain that just by saying rather than having

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one eligibility criterion, income and assets for this program and a different one for this program and a third one for this other program and a bunch of different entry points for getting on medical assistance, the more we can streamline eligibility requirements and rules across programs, the more quickly

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and more accurately staff are able to do their jobs. um it's just a kind of a relic of uh the legislature and when these programs went into place that they have all kinds of different criteria. So what sort of poverty quote unquote means in one program versus what it means in another can be very very different. So

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the more again streamlined we can make those the easier it will be for staff um to effectively do their jobs. Okay, I'm going to shift back to children and family. Even though this one is unlabeled, these are the correct children and family services recommendations. There's seven of them

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in the report. And this is, as I told your leadership, children and family services in any county for all time is always the most challenging area. Um, they tend to children and family services units tend to attract newer staff, more junior staff who then do

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child protection for a while and then move on to something else because it's difficult to do that um service. across your whole career. It's very traumatizing and nobody likes to see bad things happening um to kids in your community. So, people don't tend to stay a long time in children and family

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services, but so there always tends to be a lot of turnover in these units. Um, again, similar to economic assistance and healthcare programs that we just talked about, um, there's a lot, it takes a long time for an individual child protection worker to come up to speed due to all the training that they need to have, um, that's provided

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through the state and then real world practice in a supervised manner until they can come up on their own and be autonomous and providing services like with a lot of support, but relatively autonomous. Um so I just you know a caution to say um this unit can be

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operating a lot better than it is currently but I do expect that this is the area where you're always just as an organization probably going to have a lot of turnover and u will need to be paying a lot of attention to. So, of the seven recommendations, the top ones that I just wanted to discuss with you today,

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um there was an immediate documentation problem in this unit where there was um a significant amount of missing documentation on some cases and some cases in the system that needed to be closed as well. Um again, once this was identified, I brought it to your leadership right away. They already had

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a sense that some of this was happening and were on top of it and, you know, were able to further identify and remediate the problem right away. And then going forward um once there's a policy and a procedure on documentation and time reporting um these staff need

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to improve their documentation for the future based on just in terms of the quality. It needs to be done number one but the quality needs to be better as well. And once you have um you're moving forward on some recommendations around documentation and time reporting um they

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need to be doing following the expectations around that. Um I think you're probably aware um IQUA the Indian Child Welfare Act um the county PHS is currently under a program improvement plan from the state

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regarding the Indian Child Welfare Act. Um there's a plan that's been developed to address the concerns raised by the state with Grand Portage and others. And I know uh even since I've left PHS, there's been some additional training going on around um just really tribal

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relations and understanding uh history and culture of Indian tribes to assist in practicing better um in partnership with Grand Portage across child welfare cases but across the whole agency as well. So I think um there are

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some significant improvements that need to happen in Indian child welfare practice. There's specific rules and timelines and expectations for Indian children that are separate from um other children that we may be serving. Although that's going to be changing as well coming down the pike. There's going

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to be enhanced um and similar expectations for serving all families that will require active efforts which is one of the specific things that's different about serving Indian children. instead of uh you know offering reasonable efforts as you do with most children, Indian children requires the

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agency to offer active efforts to reignite the family. Um as I said soon that's going to be the case for all families but for right now um it's specific to Indian children. Um so there's definitely some practice that needs to improve around this subgroup

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subop in your community. Um, and this in order to be effective, you really have to continue to have a good relationship with Grand Portage. I think the previous supervisor of this unit um did a good job reaching out and connecting and communicating with Grand Portage and I have every reason to believe that will

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continue and I think is continuing. Last recommendation I just want to highlight from Children and Family Services is this is one of the areas where I think um some additional case aid time could be helpful. These workers also um drive st drive clients back and forth to two harbors and to duth uh for

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different appointments. That's just one example of where a case might be able to be pro um effective in providing transportation so the worker can be in the community continuing to serve their case load. Um so just one example. The case does help currently with this unit, but there's a lot more opportunities

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that could be could be used going forward to be more effective. Okay, I think we've got one more slide after this just to give people a little road map here of where we're at. In terms of your public health unit, um

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they have five recommendations in the report, but I think you're going to see when I start talking about these that these are of a slightly different nature. um they have to do with kind of more organizational pieces and how public health is is perceived by uh the department itself and the broader

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community. Um that you know of course public health work is more grant-based. Um currently some of that's going to be changing as well and they seem to be doing a good job carrying out their responsibilities in the community. The unit is very cohesive and the supervision in this unit has been really strong. That makes a huge difference.

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Um, typically what we see with health and human services agencies when they're combined is that a lot of times the the EA staff, the economic assistance staff, the social workers, the office staff, they don't always know what public health does, what they're responsible

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for. Um, and I think it's it's especially challenging with PHS because you've got public health now. They're all seated in the basement where everybody else is upstairs. So, there's a physical separation as well. And I I understand why that needed to happen, but it just kind of in some ways kind of enhances

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the problem. But just making sure that all the staff, regardless of what they do in PHS, uh knows and understands what public health does, understands the value of it and treats them like insiders within the department. not and I don't think I'm

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not raising this to say that I think anybody's being exclusionary or not, you know, not being friendly or outreaching to public health, but I think it's just it's a pitfall. It really can't be of health and human services agencies for that public health mission to kind of

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get lost in the swirl of all the things that social services units have to take care of. And yeah, just making sure to be deliberate about including the public health um unit in everything the department does. and having a better general understanding of their work I

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think would be helpful for everybody um because it is on a continuum. We may be serving people who have uh substance use and behavioral health problems but public health is actively involved in the community in preventing suicide and and helping people understand what mental illness is and how to get early

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assistance and getting help for mental health concerns. Um, so just being able to for people to understand the continuum of work that's going on in health and human services, I think would be really valuable even internally. So some questions were raised by the public health unit in specific about

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whether I thought that it would be useful to separate public health and human services back into separate departments. I am not recommending that. I'm recommending that you continue to operate PHS as a combined health and human services agency. I think there's a lot of benefits from public health and

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human services being together. Again, back to my first point, just so long as everybody understands that the work you're doing across the agency's on a continuum and everybody understands what the other person's doing and how they all add value. Um, how you can be more than the sum of your parts, I think it can be very valuable to be together. And

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as well, just as a practical matter, you've had difficulty um, finding someone, you know, to hire for your health and human services director position. I don't want to leave you with the task of now if we separated out having to hire two department heads in a relatively small labor market. So there's just some practical reasons why

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I don't think that's a good idea either. And last but not least in terms of public health recommendations, I think with some of the, you know, organizational turbulence that we were describing earlier, um there's been some conversation in the community about public health did this, public health

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did that, there was something inappropriate that public health did. Um, and I think it's that public health term is being stated sometimes in the community as a shortcut for PHS when I think public health would rightly point

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out that it was kind of the HHS side of the agency that was potentially having some some struggles in recent times more so than the public health side. And yet public health's name was being repeatedly used in the media as sort of the perpetrators of whatever was

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happening. So, I think there's there's there's some sore feelings about that. And so, I I think the solution is just um for everybody to kind of discipline themselves to say PHS or say public health and human services when you're talking about your your HHS agency

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rather than just shortcutting it to public health unless it is something specific about public health that you're talking about. So, hopefully that one makes sense. Last but not least, mobile crisis is currently organized underneath Grace in

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public health um or when Grace was the public health supervisor and um it's a difficult program for small counties to be able to implement effectively and I think your community has really been grappling with the best way to operate

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mobile crisis services locally. And this is for people who are having a a behavioral health crisis in the community who might in the past need to have gone to the hospital. Um the hope is that by having a mobile crisis responder and ideally mobile crisis responders go out in pairs to help the

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person in their home that we can avoid having to remove them and have them go out of home. There's a lot of reasons why that doesn't always result in the best outcomes. And it's, as we were discussing, it's financially costly when we could be using those resources more effectively to help a person um reduce

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their symptoms, reduce the current crisis, and stay where they're at. Um so some spec there's a bunch of specific recommendations around mobile crisis, and this is a continually moving issue. So these are of any these are the recommendations that maybe are quickly

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becoming out of date. Um, but things that I do think you should look at pursuing is there's the ability to apply for what's called alternative provider standards. So, a short way of describing this would be to say, um, you know, Minnesota has X requirements for mobile

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crisis services in terms of what you need to provide in the qualifications of staff. There's an acknowledgement that in smaller, more rural counties, you may not be able to meet all these criteria. So, you'd make an application to um I think it's still the Department of Human Services. Um some of these services are

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switching back and forth between state agencies and you say, "We can't meet these and here's the the reasons why we can't meet these criteria, but we're still going to be able to provide a good quality of service. We just need to be held to these provider standards rather than these as a small rural county just

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based on your labor pool, etc." So, I do think that's something regardless of the direction of mobile crisis um and what you specifically try decide to do locally in terms of the response model that you're going to use and who's going to be providing the service that that could be something

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that could be helpful to look at. Um, I think this was in the plans anyway, but just to clarify that, you know, when I was there in December, there was not a a permanent behavioral health supervisor, and I am recommending that you shift responsibility for mobile crisis back to the behavioral health unit from public

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health. Um, at some point in the future once that new supervisor gets their feet on the ground. And then this is one of those services where working with local partners is incredibly important. Um, and I know, as I said, there's a lot of work going on in this area to try and figure out with a a lean labor market

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and and again, a lot of windshield time, some very deep rural communities, um, how do you make this service as viable as possible because it is an incredibly important and I will also say mandated piece of the behavioral health service continuum that you need to have in place. Um, so I think there's a lot of

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positive work going on in this area and I'm excited to see where you land and um, you know, what you're able to figure out for your local community with respect to mobile crisis. >> That is the last of the recommendations I was planning to cover with you today.

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So, I'm going to pause again and see if there's any further questions. assuming maybe I'll do a time check too with Kristen >> and Grace to make sure we Is that okay if that if I open it for questions, additional questions? >> Yes. >> At this point, >> um Crystal had a question.

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>> Yeah. I just want to know what windshield time means. You said it like twice. I don't know what that means. >> A lot of driving. >> Oh, driving time. >> That's it. >> It's a cute way of saying >> Yeah. Uh, >> I try to always be entertaining in the

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early morning. >> Well, you've succeeded. Yeah. Thank you. My goodness, >> Commissioner Gamble. >> Yeah, Megan. Um, I think it's I don't think I know it's important to acknowledge and and you stated it

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upfront in your presentation. Um, the participation of staff and public health and services and the fact that they were candid. uh you don't get that in organizations especially if if there's some cultural issues or some problems.

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Uh a lot of people are protective and they aren't as open and forthright which doesn't contribute to uh the you know the process of being able to determine what in fact is true. And so uh really

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kudos to our staff for being candid and willing to be open. The other thing in our conversation was that um perception or statements that are made relative to why people leave public health and human services and I think in our conversation

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um there wasn't any mention that it was a wage issue that I recall and in your interviews you just referenced the fact that nobody has raised it as being a wage issue and you've identified some of the reasons

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why people leave just because of the stresses that uh humanly are are are are difficult to deal with uh in some of the situations you find serving in public health human services.

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>> Well, Mr. Chair and Commissioner Gamble, I did not specifically do any analysis of where your wage your your reimbursement system, your pay ranges line up with um statewide averages or local competitors, so to speak. Um I can

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tell you that as staff were being candid, they did talk about just sort of the broader community issue of there being a m mismatch between what local jobs pay and what, for example, local housing costs. And that was a significant issue and concern brought up by a number of staff. Now, does that

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mean that the county is underpaying staff? Not necessarily. I think it could be a broader just structural issue in your community, but I did want to be open that I did not do specific al an analysis in terms of a wage study or things of that nature.

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>> Yeah. Thank you. >> Any other questions? Commissioner Gamble? >> Yeah, Megan. I just I just I had after reviewing the 75 pages and and going through it and looking at the detail, the presentation, the format, your

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friends pictures, all these different things, I I just wanted to make a statement that uh you and David Lee were involved have done a masterful job in presenting your public health and human services organizational review. Your ability to see into and attentively

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hear, coupled with your discernment, implicit understanding, and impactled thinking, is evidenced in the wisdom articulated in your all-encompassing, well- formatted, and actionable response. I'm thoroughly impressed and

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extremely grateful, and thank you both for investing so much of yourselves throughout this extensive process. Well, Mr. Chair and Commissioner, thank you very much. And I I'm delighted to hear the word actionable

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in your kind description because what I described all along was the hope that, you know, your staff would be able to go through and just make a list, which there is actually a list provided in the appendix as requested by Kristen and Grace to go through and check off as

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they're able to complete the different tasks that are identified in the report. So, um, I appreciate your comments very much and I hope it it does end up serving that purpose for you. >> Thank you, Commissioner Sturley. >> Thank you, Mr. Chair. Um, thank you too,

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Megan. As a board member, we are given information each month in our agenda and that's the information that we work with. And so I think that as a board member um it's overwhelming this report

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right now to absorb it all read it two or three times understand your presentation today and um if anybody you minister trouble need to come to any of board individually to help all of us

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understand where are the steps where do where do we start you know um I'm looking at more staff, more help, hiring people that we've been, you know, searching for. So, it's a I don't want to say the word overwhelming, but it's a big job.

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>> And so, I just want you to know and you to know that as we sit here, um, we're only as good as the information we receive because sometimes we don't know what questions to ask if we're not given the info. >> Thank you, Megan.

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>> Administrative trouble. >> Thank you. Thank you, >> Mr. Chair. Megan, I would just like to say thank you so much for your work on this as well. Um, I want the board to also know that Megan not only took the time to interview um, our stakeholders,

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justice partners, and staff and put this together, but since day one, she has been available to Plowman, myself, and now Grace for questions and assistance. like she mentioned, um there were several things that she raised in the early um first few months of her

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assessment that helped us to determine the next steps that we needed to take as a department and that has been incredibly valuable for us. So, I just want to say thank you, Megan. I also want to mention that Grace has prepared some comments about some steps that she

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has taken already. I have a couple things I wanted to mention as well. Countywide steps that we're taking to address some of the concerns and then also that we are going to continue to work on how do we implement these recommendations and how do we prioritize

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make sure that we're addressing the highest priorities first um medium and and the lower level priorities as we move forward to make sure that we can address all of the concerns that have been raised. Um, I want to also mention that I agree with all of the

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recommendations that Megan has provided. She made a comment earlier that we don't necessarily have to agree with her recommendations, which is true. However, I think Grace and I um in reviewing this report that we are in support of all of the recommendations and and truly do see

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this as the roadmap as we move forward. aside from maybe the restructuring >> and the re the re restructuring I think is going to take some work. Um Megan had put several different ideas and suggestions into the report and we haven't started to do that analysis yet

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but I do agree that there are ways that we can leverage staff differently in some of the using some of the vacancies in a different way. Um but what that looks like uh I don't know at this point. And I think we need to take some time and really really do some additional analysis in that space. And

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Megan is going to continue to work with Grace as a coach um to assist us in the implementation of these these recommendations as well. So as we start to look at the structure, I think we can lean on her as well and make sure that

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um what we're leaning towards makes good sense. The other the last comment I have is Grace and I met with staff and talked about these recommendations in the report as well and committed to ensuring that we're partnering with them and that we're getting their input as we move

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forward. So, as we look at the structure, as we look at the different recommendations, um ensuring that we're building that culture of of really partnering with them and leveraging their strengths as we move forward. >> Commissioner Gamble,

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>> thank you. Uh that's a that's a big question given what we have uh benefit from this process. I would I'd like to see this process happen departmentally actually the evaluation. It's like bringing in an efficiency expert. It's

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it's bringing somebody in that that knows the disciplines of that department and looking at things and looking at as an opportunity for us to find ways that we can work together, learn from each other to better, you know, the service we provide and our stewardship

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responsibility financially. So, this this is a great great exercise and u uh Megan has referenced you know best practices. She's also in her recommendations that can be very straightforward in understanding and then just determining

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application. The other is the where she gives us options. She has options in there. And so my question and I know Grace is going to make a presentation here is that we take this it's it's sort of the old idiom you can lead a horse to

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water but you can't make them drink. So basically we we're at the the watering hole right now and um what will we do with this and what will be the process um the discussion with staff and the communication that that's that's great

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and um the other thing I would say with the advisory uh committee for public health human services their involvement if in fact they are to advise it's how much will they be involved in understanding and

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making recommendations to this board similar that we do in other areas for land services and stuff where there's a board that goes through this process and I think if we've created that framework we need to use that framework to bring credibility to that organizational

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structure >> um one question I had was just uh about the um any recommendations for the boards. Um, this is largely focused on staff and and department and um, you

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know, I I would like for our board to grow and develop as well. So, I didn't know if you had any insight there, Megan, uh, outside of the scope, but we're we're part of it, too. So, >> well, Mr. Chair, I I guess I haven't

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asked whether um PHS board members go through any training about health and human services before they serve in this capacity. Is that a routine part of your orientation? I guess I just am not aware. >> Orientation, I would say, is uh on the

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job and uh monthly. uh we get reports and um presentations and and so it's it's you know learned over time but um there isn't a retreat per se for for PHS

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board. Um so that's a good suggestion. >> Our orientation basically the position we sit in our chairs when we arrive. Yeah. >> Right. Yeah. >> That's usually how it happens. We started many years ago in Ramsey County putting new commissioners. It was

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optional, of course, but putting our new commissioners through kind of a a pretty intensive curriculum >> over a couple days to just learn about health and human services so they could be in a position to be really active in in monitoring the department and helping

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the department move forward. Um, now again, that's a large county initiative, but could it be scaled for commissioners so that you I mean, at the very least, I think in your report, I don't know what page it is, there's a there's a glossery of acronyms. I mean, could you at least

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have the glossery of acronyms or or something as simple as that so that you as we're tossing around terminology like windshield time and MIT and whatever else, you know what we're talking about. >> Is windshield time in there? >> No, it's not. It's not windshield. should have been that's

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>> we call that WT. No, just kidding. >> I think it could be really helpful. I mean, commissioners, you you can go you such a broad scope of things you're responsible for as county board members. Um but health and human services is typically around a half of your budget,

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sometimes more. And you know, you need to feel fully empowered as as PHS board members um to act in your full capacity. So, I think it it wasn't part of the report, but to answer your question, I do think, you know, some more deliberate orientation to the department as you as

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new commissioners come in um to their roles could be really helpful. Well, and I was just kind of thinking in terms of the policies and procedures and the lack thereof, and I assumed there were policies, procedures, right,

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that were in the department that that were being followed because um >> we're an arm of the state and there are certain ways to do things. And so for me to learn about that uh that gap, I was

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like, "Huh, well, yeah, no, of course there's problems then." And um and how has this not been brought up um more strongly before? Like I've heard um a a good number of concerns about

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um the size of the department or the dollar amount spending. And it's all connected, of course, right, with the golden thread and um getting the the right right procedures in place, but um but I hadn't heard about uh the lack of

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structure before. >> Well, and Mr. Chair, maybe I should clarify the department does have policies and procedures. Um, but you have one policy over here and one over here and one in one instance you go by countywide policy and then there's the

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policies that you have to do healthcare applications and the bulletins you follow to do this. It's this. And so a lot of counties do have one centralized location where there's a policy and procedure manual. When staff say I don't

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know how to do this, they know that's where they go. And that's really what I'm suggesting. Thank you. Yeah. And >> to me, Megan, it's also it's policies and procedures, but it's ensuring that staff have the tools and resources that are available

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>> from the state to make sure that they're following statute and the requirements and doing their jobs as best as they can. So, it's it's on us as management to make sure that we put that together in a way that is usable for staff. >> Oh, and so then

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>> go ahead. And something that's trained constantly. I would I'm recommending that you train at every staff meeting. You have a policy of the month. You bring staff through it. You remind them this is how we do things the right way at work. So it's not just sitting on an internet somewhere, but it's something

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that's discussed and revised and people live it day in and day out so that you don't have issues with it really will reduce your issues with policy violations and and misbehavior to have that in place. >> Sure. Thank you. And and so I was yeah I was just um

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trying to think of what uh what could I have done differently? Uh what should I have done differently to work towards um creating a better system before this? >> You don't need to answer. That's just what I'm thinking. Uh Commissioner

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Gamble question. >> Yeah. what what I'd say to that point I mean obviously as elected officials I mean we've got certainly multiple levels where we do county governance and one of them is elected officials and um the

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training aspect the the um being refreshed being updated as things change that's part of our stewardship responsibility and trying to create a system that helps to accomplish that and we've certainly talked about it you know as Kristen's come in as our

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administrator about creating the structure that helps so that we can be the best that we can be. And uh we've said that we can have change and change over in personnel, but if we've created

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a structure that we're confident in, personnel can change and the structure will contribute to effectiveness. And so the issue of policy and a coordinated effort in creating structure is something that we've embarked on not

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just in this area but in multiple areas and it's a big job but the first place that starts somebody that shares that vision is committed and having the people that can facilitate that get behind it. So we need to create that that structure and that'll be both

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protective and it'll also contribute to efficiencies >> and I can speak to that a little bit in in my response here as well because uh I I feel like continuing to update you all on the board as to how we're proceeding is key and making sure that the

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information that we're giving you is the information that you feel like you need as elected officials to be able to do your jobs to the best of your ability is is I think part of providing those updates to you and having that communication with you as board members. So I think it's part of the whole change

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making process here. >> All right, that's uh all of the hands and comments at this point I think. Megan, thank you very much. um don't know if you want to stick around for um the next item which is um kind of the update uh to to the report.

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Uh admin >> that's all I was going to say. >> What were you going to say? >> I'd like to say if that's okay, >> please. Yeah. >> Yes, please do. Thank you. >> And again, thank you so much for your for your work, Megan, on creating this report and for your presentation this morning.

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Um, I think I will go into the next item on the agenda, which is the PHS response to Megan's report. I know Kristen also has some um items that she'd like to respond to from a county level. So, I'll start and we can kind of take it from here.

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>> Wait, did she leave? >> Um, she is still here, but I believe it's So, the meeting is not closed. She's just not on the the screen. Is that correct? >> That's correct. >> Okay, great. >> All right. So, I'm going to try not to

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read my whole response verbatim. The written response is here in the report for the board. Um, but again, just starting with gratitude, thanking all of you as board members for the investment you made in improving our department by consulting with Megan to complete this

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assessment. I think it really shows that you all value um the outside expertise that she brought to this process and the the the final product of having this report available to all of us and especially to me as a new director as a

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guide to to move forward. So, I really appreciate the the the vote you all took back in the fall to work with Megan and the the financial investment that went along with that as well. So, um, you know, as has been said by Megan, it has been a challenging year for PHS and

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really that work of creating change is challenging. I think it's important to recognize to the point of, you know, trying to involve our staff in the last all staff meeting, bringing this to you all as board members and bringing this to our partners as communities that

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making changes to our department is not something that I, as the director, I'm going to be doing alone. It's going to be something that is a shared process that involves multiple uh individuals, agencies, and and relationships. Um, and

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so I wanted to also really highlight our staff because they have been continuing to show up and do their best work each day despite all of the challenges of the past year and all of the the change and uncertainty that um that I know all of

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us have felt at different points in time. There are individuals who, you know, their names don't show up in the report, but they've really been going above and beyond for a period of of months now to make sure that the work on a day-to-day basis gets done. There are

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many people behind the scenes that are really committed to making this change and have really been stepping up and doing excellent work over the past year. So, I just want to mention that um because sometimes that work goes unseen. it doesn't show up in the pages of the report, but it's really been keeping

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keeping things moving on a day-to-day basis um and really making a difference to the community. I also want to thank you for the ability to continue to meet with Megan. I think being able to consult with her as we begin to make some of these changes and

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encounter roadblocks along the way and work through those with her expertise is going to be incredibly valuable for our department and for me. And I wanted to share um some of the things that we've already done uh because we have been

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working on some of these changes um for the last several months. And um I wanted to start with just mentioning our leadership team and the meetings that we have. So every week the supervisors and

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the director meet for uh 45 minutes. We we met for an hour and what we've decided to change is we meet for 45 minutes just to share general updates and then we follow that with 45 minutes that's specific to making some of the changes recommended in this report. So

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this is something that we started very recently um but it allows us designated time to make sure that we're addressing the recommendations in this report. So the way that we've been um the way that we're organizing that is that uh that 45

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minutes of making change every other week is more general where we're prioritizing and looking at kind of those high priority items first. The other is specific to time reporting and documentation because that is I see I see it as the primary recommendation

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that kind of overlays the rest of it. So, by carving out that specific time, we're making sure that it doesn't get lost in the the busyiness of the day-to-day operations of the department. We have dedicated time to talk as a leadership team about how we're going to

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implement change across the department. Um, the policy and procedure manual has been started. So, I will give a huge shout out to Erica Turns for creating the structure on the internet for that

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one centralized location for policies and procedures to live. Um, it's been started and we've started with an inventory of what we have, putting it into the internet. Um, and then asking for staff input on the gaps and needs

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that they see so that we can have a list from our staff um, as to what we need to begin to add to that inventory that we already have. So, it hasn't been fully implemented, but the structure is there and the process of developing a

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comprehensive guide to all our policies and procedures has begun. um for documents >> internet or internet. >> So the intranet is uh it's available to the department only. So um it's something that all of our staff will

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have access to for PHS. Um and then let's see I'm going to move to documentation. So we've been looking at uh best practices for documentation and not reinventing

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the wheel. So, we've gotten input from DCIFF, that's the Department of Children, Youth, and Families. We've also gotten input from our counterparts in Lake and Carlton counties. And this includes different models for specific time reporting requirements for staff.

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So, we're looking at what's out there so that we can choose what's going to be best for us. Um, there's been a ongoing data cleanup project to get our agency cases caught up within the SSIS system. This has been

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I will also give a huge shout out to Olivia Bonander who's really been leading the effort. Um, to go ahead. >> And if I can add to that as well, I would like to give a a great big thank you to our county attorney's office who

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has been partnering with Olivia on that as well. Yeah, that's been a huge undertaking and yes, thank you to the county attorney's office as well to make sure that all of the documentation is up to date. Um, and that project is largely

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complete at this point in time. There's also been we've created a data integrity team. So that's specific members of the supervisory team and myself to help with ongoing oversight of SSIS so that we can ensure that there's accuracy with the

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reporting that staff is inputting into that system. And then finally, we've improved onboarding and training related to client documentation and SSIS for social services staff starting with a focus on children family services since that team

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is relatively new. the two workers that work within children family services are new within the past six months to the agency. So starting with making sure that they have all of the training in order to document consistently and correctly was a priority.

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Um the rep payee recommendation we've also gathered example policies from other counties in the northeast region. There is a group of public health and human services directors for region three which has been a great resource for me as I get started because they're

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very willing to share um things that they've done that have worked well for them. So I've been able to um ask what they're doing with rep pay and again gather some information as to how other counties are structuring this service and that's helped us with our internal

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discussion on how to improve our current practice. We've also provided additional training and internal mentorship opportunities for staff that are engaged with providing rep payee services

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for the IQUA Miffa. That's the Indian Child Welfare Act and the Minnesota Indian Family Preservation Act. We hosted a two two-day courses which were attended by all social services staff within our department

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um in early 2026 and that was with the University of Minnesota Tribal and Training Certification Partnership at the University of Minnesota DUTH and they're planning to come back um in the summer to do an advanced course that

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would be a collaboration with um the county and also staff in Grand Portage. mobile crisis response. We are pursuing alternative provider standards with DHS so that we can provide services via teleaalth as needed with our partners at

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Brightwater and First Call for help providing backup. This is 247 365 mandated service and the way that we're able to provide it right now is really uh during business hours with our partners providing teaalth after hours

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as well as when we have a staff out and we don't have um that depth of staffing to have staff available in person for a response. So, we have submitted that to DHS and we are also um looking with our partners at how we might work

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differently together to make sure this service is as viable as possible and we're shifting a portion of the work back to the behavioral health team in the in the near future. So, that's in progress. Finally, for information sharing, we have been reviewing how we share

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information internally and across agencies to ensure that we have strong workflows in place to safeguard private information and to facilitate clear communication with all of our partners. So, my plan is to continue to bring

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updates to the PHS board at these monthly meetings and to integrate them into the director's report. So there's a portion of that report that focuses specifically on what we've done uh with regards to implementing recommendations from from this report.

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We also, as Kristen said, began to engage the PHS staff at our all staff meeting last week. And uh we will be talking about this report at a combined PHS advisory council and local mental health advisory council meeting which I

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believe is on April 16th. So the next steps that we're focusing our attention on are intentionally filling and organizing vacant positions in both children family services and the behavioral health teams.

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The recommendations at restructuring departmental leadership is a little bit further out. Um, I also want to make very clear that I'm open to feedback from all of you as board members as we begin this very

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long-term intentional work of improving our departmental organizations. So, please don't hesitate to reach out if you have suggestions for me as we begin. I'm very grateful for all your support uh for Megan's support, for Kristen's support, and for my predecessor

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Plowman's support in um really getting this work off the ground. So, thank you all and I'll turn it over to Kristen. >> Thank you, Grace. All right, I'll be brief. I just have a couple things that I wanted to mention that we're doing at a countywide level. Um, as many of you

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know, we have started some leadership training. We had a leadership opport training opportunity a few weeks ago, an all-day event for our supervisors, uh, managers and directors. We also have started to put training opportunities on

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our internet site so that as HR becomes aware of new training opportunities, staff have access to them through that site. Um that's something that had been done in the past and kind of fell off uh the radar for a while and so we've re

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restarted that effort. Um we've also worked with Judge Hanky and his team on restarting the children's justice initiative. That's a team that the judge is the chair of and responsible for through the judicial branch. Um but something that was um had not met for I

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think it was a little over a year as well. And so we have restarted that effort to look at our um our processes and child the child welfare space. We've had several meetings um thus far and expect those to continue.

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Um, as many of you know, we're also working on some of our HR policies countywide and we'll continue to do that work. And then the last two things I wanted to mention because Megan did mention this in her report and um and again today um making sure that Outlook

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calendars are up to date and and are accessible by um other staff especially supervisors, directors and managers so that we're ensuring uh we know where staff are located if there are any safety emergencies. So, I've communicated that out to our management

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team to make sure that folks are aware that's an expectation. And we've also started having conversations or I've started having conversations with the department directors about ensuring that um we're meeting with staff and providing performance evaluations and

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making sure that they're providing performance feedback and opportunities for them to connect um on a weekly or bi-weekly basis with all of their staff members. And so that's something countywide that I'm expecting from our leaders um here in Cook County. So

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that's all I have. >> Mr. Gamble. >> Yeah, thank you, Mr. Chair. Appreciate it. Uh thank you for that information. I'm wondering um in the discussions that are had are held

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uh in the advisory committee there are providers within the county that would have a vested interest in understanding how we might partner together and in how we realign some things. And so I'm I'm just wondering where the discussion

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takes place to benefit from that. Again in the advisory role, if the advisory committee discusses these things with those partners and then would come uh with a a synthesized uh consensus to a

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committee of the whole for a dis further discussion so we can understand how all of this is getting practically applied. There needs to be a process, I think, that incorporates all of that into our decisions.

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>> Sure. I think it's going to come on a kind of a case-by case basis because there are recommendations I feel comfortable making um within the department and then there are other department or there are other types of changes that I feel like the advisory councils could absolutely add value to

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uh in weighing in and providing their their opinions on what might work best for the broader community as we look to changing the way that we do business within our department. So I think um we will definitely continue to bring uh topics to the advisory council and then

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there are other items where you know for example you know SSIS and time reporting I feel like that's a good example of something that really is internal to our agency and I feel comfortable coming up with our procedures within the leadership team of PHS. So absolutely

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we'll be bringing um bringing items to the advisory councils when when we feel like the impact will will go beyond kind of our internal day-to-day. Kristen >> and in addition to the advisory council if there are or the recommendations that

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we need to extend beyond even the advisory council we'll be meet meeting with partners and working with them on potential solutions to bring forward and have discussion at like you mentioned the committee of the whole yeah >> or this meeting or with the advisory

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groups but making sure that we're working with those groups as well as much as we can as we move forward and we've started some of that with our mobile crisis >> work that we do. So >> yeah, thank you, Mr. Chair. I I appreciate that. I I would say that in the areas

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where the recommendations are and there's there's agreement on that as we go through this, we've just been presented that and you've welcomed any feedback that we have. But u the consensus really appears to be that we agree with the recommendations that have

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been made. when it gets to the options that are there to discuss when we look at those options then we just we need to see how the sausage is being made in the recommendation that comes back to this board and that's I guess those optional

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areas. I just like to see the thought process that has gone through in determining which direction we choose. >> Yeah, absolutely. We'll be sure to provide that context as we get to those decision points. >> Yeah. And it it it isn't a matter of of trying to control the operational nature

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of of things when within the department. We've been exposed to the recommendations and we've we've heard the affirmation of those things moving forward. It's just coming back and reporting as you suggest you do in those optional areas. It's just understanding how did we take the information we had

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and talk to our partners and come up with a consensus as a recommendation to the board. All right. Thank you for providing the the response. It's extremely helpful to see what's already happening and and just um

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um you know your commitment to uh the recommendations. >> It's very encouraging. >> Absolutely. Thank you. Uh I think we can move on to our director's report now. Okay.

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>> All right. Well, I want to be mindful of time. So, I'll give a I think I might provide most of these notes just as notes. >> I will bring attention to the org chart. So, we did have one staffing change this past month. We did receive and accept

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the resignation of Brenda Port who was our treatment coordinator. Her last day was a week ago, Tuesday, and we have posted for an adult mental health case manager, which is one of the vacancies on the behavioral health team. So, our hope is to interview for that position

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late March, early April. I'll add aside from the org chart and HR updates a grant update. Last month I reported that there was a temporary restraining order regarding CDC public health infrastructure grant which the

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federal government attempted to terminate within the state of Minnesota along with three other states. Last Thursday there was an injunction granted which keeps funding from the grant available to us as litigation proceeds. This is a grant we have within our

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department. We have uh roughly $21,000 remaining. So, we are able to continue to spend that funding which was slotted to run through October of 2027. Um I'll also um

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note that last Tuesday, Governor Walls announced a transforming human services initiative. Um this is very preliminary but there are items in that report that would impact counties primarily in how state and county share eligibility

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related tasks. There is a webinar that AMC is putting on next week that I believe all the commissioners received an invitation to. I'll be attending that and watching as that um continues and I'll continue to bring updates as that proceeds uh through the state

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legislature to the board. Um, and that's all I have for my director's report. >> All right. Thank you very much. We have one item uh under items for board action, and that's the purchase of service agreement with the center for

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alcohol and drug treatment. Um, any questions on that? Any further information wanted to provide? This is a standard annual purchase of service

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agreement for us to be able to access uh detoxification services through the center for alcohol and drug treatment on behalf of clients. Um and it's not there's not a dollar amount. It's build as we are using the service on behalf of

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clients and they're actually billing client insurance when possible. So >> it's budget neutral. Um, well, I believe so. It's dependent on the use of the service. Um, and so it allows us the ability for clients to

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access that service who are working with the county. So, um, clients are they're billing clients insurance when that's available. So, it's it allows us the ability to access the service. There's not a cost associated with the ability

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to access the service. >> So, that would mean if Yeah. Okay. >> It's not a sliding scale or anything. I mean a sliding scale mean we would pay part of it and the client would pay part of it. But if bill we bill for the services rendered then it's budget

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neutral. But other than our time >> commissioner Selvin, did you have a question? >> No. >> Oh make a motion. >> Yeah. I was going to make a motion. >> Please go right ahead. >> All right. I'd like to make a motion to approve the purchase of services agreement with the center for alcohol and drug treatment.

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>> Thank you, Commissioner Selvin. We have a motion. Is there support? >> Support. Thank you, Commissioner Gamble. We have a motion to support. Any further discussion? Any hearing or saying none? All those in favor? >> I. Those opposed? Motion passes unanimously. Thank you very much. Uh we

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don't I mean this never happens, but we don't have time for our committee reports again. Um so we'll if there's something very pressing that needs to be shared, Commissioner. >> Yes. Thank you, Mr. Chair. Just corrections. Um um item E, childcare solutions, that's commissioner Gamble.

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>> Thank you. >> And then the item um J the healthc caring >> committee u we do not meet anymore. So you can delete that. >> Thank you very much, Commissioner Gamble. >> Yeah, thank you Mr. Chair. And I just make a note we might have all received

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this notification from ANO. There is a um an online presentation 1 to 2:00 today transforming human services initiative and uh so just if we saw that that might be something that again would

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help inform us as to what's going this is the central regional meeting agenda and that's the topic for today's meeting at 1 to two and that that link would be online in your email if you receive that. >> Thank you. Yeah.

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>> All right. Well, in that case, um, we are adjourned. >> Great. >> Thank you. >> Thank you.