Annual Report

2014 Aging & Disability Resource

Center Alcohol & Other Drug

Abuse Birth-to-Three/Children’s

Long-Term Support/Family Support

Children, Youth & Families Community Support

Program Economic Support Mental Health/Crisis Comprehensive

Community Services Regional Aging & Disability

Resource Center

TABLE OF CONTENTS

02 Message from the Director03 Board of Directors04 Funding/Expenses by Target Population05 Aging and Disability Resource Center

07 – Information & Assistance Specialists08 – Wellness & Prevention Activities09 – Aging Program Highlights10 – Elder Benefit Specialist11 – Nutrition Program12 – Transportation13 – Adult Protective Services13 – Budget Counseling/Representative Payee

14 Alcohol and Other Drug Abuse16 Birth-to-Three/Children’s Long-Term

Support/Family Support18 Children, Youth & Families23 Community Support Program25 Economic Support28 Mental Health/Crisis30 Comprehensive Community Services31 Regional Aging & Disability Resource Center34 Staff Listing38 Organization Chart

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MESSAGE from the DIRECTOR

TO: Members of the Green County Board of Supervisors and Citizens of Green County

On behalf of the Green County Human Services Department and Human Services Board of Directors, I submit this 2014 Annual Report as a review of the activities and services provided by the Department from January 1, 2014 to December 31, 2014. I am hopeful that you find this to be an informative and useful guide to the programs, staff and services offered to Green County residents over the past year. Included in the report is an organizational chart to help you understand the structure of the Department and the staff involved with the many important services we provide. There is also fiscal information showing a general breakdown of departmental expenditures. The narrative sections throughout the report present a picture of the services provided by staff and contracted agencies, as well as the scope of care provided by the Department.

While you will see that we accomplished a lot in 2014, I must draw your attention to a few major initiatives that were begun in 2014 and will carry over into 2015 and beyond: The Department, as part of a five county consortium, contracted with a national software company to migrate all of our behavioral health record needs to an electronic format; our local Comprehensive Community Services program developed, with Lafayette County, a regional CCS program, allowing us the opportunity to serve more individuals and capture more Medicaid revenues; and, we were involved in a five county consortium that brought in a nationally recognized trainer in Trauma-Focused Cognitive Behavior Therapy to train clinicians, social workers and community partners on the impact and treatment of trauma in our children and families.

With ever-increasing community needs, it is ever apparent that we must continue to emphasize ongoing partnerships and collaborations with the many service providers in and around Green County, while building and utilizing new community connections and continuing to look at regional relationships and opportunities.

Appreciation is again expressed to our county colleagues, our many valuable volunteers, partner agencies, and most importantly our departmental staff persons who are the key in making it all work. Your input, questions and concerns are, as always, appreciated.

Respectively submitted,

Greg Holcomb

Director

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Green County Human Services Board

o Herb Hanson, Chair

o Jerry Guth, Vice-Chair

o Sandra Horn, Secretary (citizen member)

o Gayl Christensen (citizen member)

o Anita Huffman (citizen member)

o Mike Furgal

o Beth Luchsinger

o Kate Maresch

o Russ Torkelson

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Funding/Expenses by Target Population

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Aging & Disability Resource Center

In 2014 the following services/program activities were provided by the Aging & Disability Resource Center (ADRC):

A total of 2,571 contacts were made by the ADRC with Information & Assistance Specialists. Seventy-nine percent of all contacts were made by phone, 20% in-person, and 1% via e-mail, fax or letter. The Information & Assistance staff completed 253 home visits and had 190 walk-ins.

Forty-three percent of inquiries originated from Monroe, 14% Brodhead, 4% New Glarus, 3% Monticello, 6% Albany, 6% from other towns in Green County, 2% from outside of Green County, and 18% had an unknown location. There was an increase in contacts made in Belleville by 29% since 2013 and an increase in contacts made in the Brodhead area of 78%.

In 2014, 61% of contacts were for female consumers and 39% for male consumers. Seventy-three percent of the inquiries were for persons over the age of 60 and 27% for persons aged 18-59. Forty-five percent of incoming calls were from the consumers themselves, 45% from family members and 10% from other agencies.

The Disability Benefit Specialist served 203 consumers in Green County in 2014. A large number of the cases involved assisting residents with applying for SSI or SSDI or Medicare Part D. Eighty-eight percent of the consumers served were low-income and 40% of them were between the ages of 50-59. Thirty-seven percent of disability cases received a positive determination for disability benefits. Twenty-eight percent of the approvals were for people with a physical disability, 40% had physical disabilities and a mental health condition, 16 % had mental health issues only and 6% had a developmental disability. The rest of the cases had a mixture of disabilities. The DBS program brought in over $1,103,250 in 2014 in Federal and State benefits to consumers in Green County.

Participation in several collaborative projects with local service providers continued in 2014, including; Stateline Senior Networking (area providers of services for seniors), the printing of the annual Service Guide by the Monroe Clinic, the Alzheimer’s & Dementia Alliance, and the Caregiver Coalition (described more below). The ADRC participated in the planning and implementation of the Stateline Senior Fun Fest, along with various other agencies in Green County. The ADRC continued to participate in the Reducing Hospital Re-Admissions Committee at the Monroe Clinic and was able to collaborate on getting services to those who were at-risk or who have had re-admissions.

The ADRC applied for and received various small grants in 2014 to assist in helping residents in Green County. A grant was used from the Alice Acherman Memorial Fund to assist with snow removal for elderly and disabled, scholarships for

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Disability Benefit Specialist

the Adult Day Center, and the home delivered meal program. The ADRC also received funding from the United Way to assist with marketing and outreach activities and the provision of home delivered meals.

The ADRC continues, each year, to put special efforts in reaching caregivers and providing them with support. In 2014, the ADRC collaborated with the Alzheimer’s and Dementia Alliance and Monroe Clinic to host an event for caregivers to learn more about dementia and the available resources to assist. We partnered in the annual regional Caregiver Renewal event and 25 caregivers participated and received a day of education and pampering treatments. A caregiver listserv continued to be able to do some targeted outreach to caregivers who have specific interests in areas when events and training opportunities arise. A caregiver newsletter was published twice in 2014 and sent to the listserv to inform about upcoming events and also educate on different issues related to caregiving.

The Caregiver Coalition continued to meet regularly. Many different organizations have a member on the coalition including the Monroe Clinic, Pleasant View Nursing Home, Monroe Manor Nursing Home, Public Health, Alzheimer’s & Dementia Alliance, the ADRC, Southwest Behavioral Healthcare Center, Behring Senior Center, and others. The group meets monthly and is aimed at collaborating on resources, training and support for caregivers.

Marketing efforts were also looked at to explore different ways to reach the target populations and their families and other loved ones. Regionally, billboard space was purchased throughout the 4 county areas around the holiday season. An ADRC flyer was developed and inserted into the Shopping News and reached 11,000 households that educated viewers on the various services the ADRC has to offer. The State of Wisconsin purchased television ads for all of the large Wisconsin markets and local radio ads also ran throughout the holiday season.

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Information & Assistance Specialists

The Information & Assistance Specialists also identify and enroll eligible consumers in a few smaller funded programs that the ADRC has available to provide in-home support or support in the community. Consumers placed on these programs are generally not eligible for publically funded long-term care programs. These funding sources help provide assistance to prolong the need for long-term care programs. The programs also provide support and respite to family caregivers so they can continue to provide support for their loved ones. These programs and number of participants are detailed below:

National Family Caregiver Support Program (NFCSP): provides support services for the family caregivers of older individuals, as well as grandparents raising children. These funds are limited and can be provided on a short-term basis only. In 2014, 29 consumers and their caregivers received assistance from this fund.

Alzheimer’s Family Caregiver Support Program (AFCSP): provides support services for an individual living with Alzheimer’s or dementia. This program has limited funds, but provides ongoing support each year. In 2014, 3 people were served with this fund.

Supportive Home Care: provides up to 15 hours a month of in-home services to people that are low-income and are elderly or living with a disability. In 2014, this program served 18 consumers.

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Information & Assistance Specialists

Wellness & Prevention Activities

Evidence Based Programs Living Well – held 2 workshops with a total of 11 participants. Two workshops were

cancelled due to low registration. Goal for 2015 – 2 workshops. Stepping On – held 4 workshops with a total of 51 participants. Existing partners:

Pleasant View Nursing Home & Rehab, Monroe Clinic Homecare/Hospice, Monroe Clinic Hospital Pharmacy, Wisconsin Council of Blind & Visually Impaired, and the Monroe Police Dept. New partners included a trained leader from the Green County Health Department and guest experts from Mercy Clinic and the New Glarus & Brodhead police departments. Also added one volunteer peer leader. Goal for 2015 – 4 workshops and additional leader support.

CAARN (Community Academic Aging Research Network) Project -- BeST Communication Research Study was funded and developed in 2014. Held 3 workshops for family caregivers in Monroe with 16 participants. UW and CAARN staff is currently seeking funding to expand project in 2015 to two additional counties.

Healthy Eating for Successful Living – a new evidence-based program focused on nutrition and how lifestyle changes can promote better health. Leaders were trained in 2014. First class is set to start in Feb 2015, with later classes in Albany and Brodhead.

Healthy Living with Diabetes – new evidence-based program focused on helping those with diabetes confidently manage their condition. Two Living Well Leaders to be trained in 2015. The goal is to hold 2 sessions in 2015 and seek additional leader support.

Community Events NCOA (National Council On Aging) Money Smart – Scam Prevention – held 2 one

hour sessions in Brooklyn and Albany with a total of 15 participants. Partnership among Adult Protective Service, Prevention, and Town Bank in Albany. Goal for 2015 – 1 session in Brodhead.

POA (Power Of Attorney) Event – held 1 one hour session in Monroe with a total of 26 participants. Partnership among APS, Prevention, I-team and Monroe Clinic. Goal for 2015 – sessions in New Glarus and Brooklyn.

We Need to Talk – developed by AARP to help family members start the conversation with older adults about their driving capabilities. One session held at Monroe Senior Center in December 2014 – 2 attendees. Goal for 2015 – 2 more sessions in Albany and Brodhead.

STEADI (Stopping Elderly Accidents, Deaths & Injuries) Toolkit – In 2014, approximately 92 four-stage balance tests were administered in various settings in the county.

AARP CarFit – offered in conjunction with Senior Fun Fest, 10 older adults were “fit” to their vehicles. The 3rd Friday of every month appointments are made available for personalized Carfits. Goal in 2015 – expand offerings and marketing of this program.

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Aging Programs Highlights

Nutrition: The most notable change in 2014 for the Green County Nutrition Program was the preparation to ready the ‘Blends & Friends Café’ for breakfast on Mondays, Wednesdays, and Fridays at the Behring Senior Center as part of the State Revitalization Project. A tremendous amount of work by both the Aging Programs Coordinator and ADRC Supervisor went into the preparation for the Café. A strong working relationship developed between the ADRC, the Behring Senior Center and Pleasant View Nursing Home as we worked together to transform the Monroe dining center into a Parisian Café. The Café opened on January 12, 2015. Following national & state trends, the congregate program showed a decline of 9% in 2014. The home delivered meal program saw its first year of decline across all dining centers with about 19% fewer participants. The hardest hit area was Monroe, with about one-third less HDM participants – most of who were funded by Family Care.

Adult Day Care: Hand in Hand remains vibrant with its participants ever-changing due to the fragility of the population, out of county moves, etc. A total of ten new participants tried the program with four of those remaining as of 12/31/14. The average number of participants for the entire year was 10.9, which is an overall decrease of 20% from 2013.

Transportation: A once per month shuttle to Freeport was initiated in June 2014. Driver Escort trips increased by 20% from 2013, with most of this gain occurring as a result of nutrition cab rides. Medical trips showed a substantial increase, almost doubling from 2013. Social/recreation trips showed a slight increase of 4%, probably as a result of special trips. Shopping/personal trips showed some decline.

Volunteers: Volunteers continue to be indispensable for our programs. In 2014, a total of 110 volunteers (a decrease of 13% over 2013) contributed 5,251 hours of service (a decrease of 25% over 2013), saving taxpayers at least $60,176.46.

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Aging Programs Coordinator

Elder Benefit SpecialistServing ages 60 and over

The Elder Benefit Specialist recorded services for 588 persons in 2014, reflecting numbers consistent with 2013.

Elder Benefit Specialist services captured $2,190,690 in state and federal dollars for Green County seniors.

77 site visits are scheduled each year for all communities within Green County. At each site the EBS is available to answer questions and assist consumers with applications or other concerns they may have. Additionally, group presentations were done for other agencies and community organizations.

Medicare 101/Welcome to Medicare is a program held in the community for people turning 65. It was held 5 times in 2014 and was attended by 72 people.

Medicare Part D clinics were held in 4 communities. These clinics allowed people to have their prescription drug plans reviewed locally. New this year was a computer class to teach consumers how to self-navigate the Medicare.gov Part D Planfinder.

Senior Care & Medicare Part D assistances are the 2 most prominent types of assistance provided. 208 Senior Care and 278 Medicare Part D applications were completed.

Summary of Benefits Obtained for Consumers

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Elder Benefit Specialist

Benefit Number of PeopleSenior Care 208

Medicare Part D 278Medicare Part D Low Income Subsidy 24Welcome to Medicare (office visits) 31

Medicare Savings Programs (QMB-SLMB/SLMB+) 20Social Security Retirement 23Social Security Disability 5

Foodshare 16WI Home Energy Assistance 25

NUTRITION PROGRAM

AREA# OF PARTICIPANTS

Congregate Dining Center Home Delivered Meals*2012 2013 2014 2012 2013 2014

ADC 30 24 21 NA NA NAAlbany 44 39 42 12 22 12Argyle/Browntown NA NA NA 6 2 3Brodhead 46 42 39 30 34 27Brooklyn NA NA NA 4 5 4Belleville 3 (est.) 3 (est.) 3 (est.) 5 (est.) 5 (est.) 10Clarno NA NA NA 2 2 0Juda NA NA NA 1 0 2Monroe 114 94 90 110 139 92Monticello 16 18 13 12 12 10New Glarus 36 45 48 20 20 17

TOTAL 289 265 256 202 241 194

*Disabled individuals under age 60: 2011: 4; 2012: 7; 2013: 7; 2014: - 3

Cong HDM0

5,000

10,000

15,000

20,000

25,000

30,000

Number of Meals Served - 2012 - 2013 - 2014

Num

ber o

f Mea

ls

# OF VOLUNTEERS HOURS OF SERVICE $ SAVED BY COUNTY/TAXPAYERS @$11.46/HR.98 4157 $47,639.22

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TRANSPORTATION PROGRAM

Personal Driver Escort One-Way Trips by Purpose# of One-Way Trips

Purpose 2012 2013 2014Medical 488 448 515Nutrition 458 12 1

Nutrition Cab rides 1,031 1,434Shopping/Personal 77 59 66Social/Recreational 342 238 152

Total Trips 1,365 1,788 2,168

Agency Vehicle One-Way Trips by Purpose# of One-Way Trips

Purpose 2012 2013 2014Medical 52 41 119Nutrition 303 325 345

Shopping/Personal 713 721 690Social/Recreational 2,024 2,084 2,161

Total Trips 3,092 3,171 3,315

Driver Escort Vehicles0

20

40

60

80

100

120

140

Number of Riders (undulplicate count)

Axis Title

DRIVER ESCORT PROGRAM# OF VOLUNTEERS HOURS OF SERVICE $ SAVED BY COUNTY/TAXPAYERS @$11.46/HR.

12 1094 $12,537.24

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Guardianship/Protective Placement/Elder Abuse Services

38 protectively placed wards located throughout the state were provided court-required monitoring and annual assessments in 2014. This was a 12% increase over 2013.

Legal interventions for 2014 included 4 temporary Guardianships, 11 final Guardianships, 3 Protective Placements, 1 Emergency Protective Placement, 6 Successor Guardianships, and 4 restraining orders.

128 Elder Abuse and Adult-at-Risk investigations were completed in 2014. This remained stable at the 2012 and 2013 levels.

Budget Counseling/Representative Payee Services

62 individuals referred by self-referral, the Social Security Administration and other Green County Human Services Units received representative payee services and 3 individuals received budget counseling services in 2014. 17% of this total was new referrals. The number of consumers remained consistent with 2013 statistics.

Securing affordable housing for clients with limited income and poor rental history continues to be a challenge for this program. The program’s staff person has become a member of the Green County Council on Housing and Homeless Prevention to advocate and explore solutions to housing issues in Green County.

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Adult Protective Services

Representative Payee Representative Payee

Alcohol and Other Drug Abuse

The Alcohol and Other Drug Abuse (AODA) Unit provides services to help individuals with alcohol and other drug abuse issues come to grips with those issues and continue with or return to a healthy life. Referrals come predominately from Intoxicated Driver arrests - 69%, Probation and Parole - 10%, other court - 9% and self-referral - 6%.

The AODA Unit provides screening and referral, assessment, diagnosis, treatment planning, counseling, education and therapeutic services. Prevention programing is done in conjunction with the Health Department, area schools, the Monroe Clinic, UW Extension and law enforcement through participation in the Community Health Improvement Process, Green County United Prevention Professionals for Youth, the Child Death Review Panel, and the Green County Heroin Workgroup,

In 2014, 165 individuals were discharged from treatment services. 68% of those completed treatment, an increase from 53% in 2013. Of those who completed, 96% completed with improvement compared to 81% in 2013. Of those who did not complete, we saw a decrease in those who withdrew against staff advice from 26% in 2013 to 15% in 2014. In 2014, as has historically been the case, alcohol was the most commonly abused substance affecting 87% of our clients. Marijuana remained the second most used substance at 41%. Opiate use, including heroin, continues to increase, almost doubling between 2013 and 2014. Opiate abuse most often starts with the legitimate use of prescription pain medication with research showing that 70% of abused prescriptions are taken from family and friends. To address this, the Heroin Workgroup, which was started in the fall of 2013, has joined with the Monroe Clinic and Hospital Foundation and the Green County Leaders to place and promote medication drop boxes for unused medications in police stations around the county. The first box, at the Sheriff’s Department, was emptied in September 2013 after 4-5 months of use and yielded 200 pounds of medications. This was done in conjunction with the annual Prescription Drug Roundup hosted by the Health Department which yielded another 250 pounds of medications.

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Our mission is to help individuals break the bond of chemical dependency so that they may reach their

greatest potential by creating an environment of trust, focusing on individual strengths, providing education to

strengthen life skills, and encouraging independence and self-awareness.

2013 20140

10

20

30

40

50

60

70

Treatment Completion

% Completed

% Did not complete

% Completed w/ Improvement % Left Against Staff Advice0

102030405060708090

100

Treatment Outcomes

20132014

0102030405060708090

Types of Drugs Used

Types of Drugs Used

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Birth to Three/Children’s Long-Term Support/Family Support Programs

Children’s disability related programming is provided to Green County residents through a contract with Lutheran Social Services. Human Services provides office space and support while LSS provides qualified staff for each service.

The Birth to Three Program (B-3) provides early intervention services to children from birth to age 3 who are determined to have a diagnosed physical or mental condition with a high probability of a resultant developmental delay, or with a cognitive, physical (including vision and hearing), communicative, social or emotional condition. The services, which include therapy and service coordination, are provided in the child’s natural environment (e.g. home, daycare, etc.). Parents should be involved and present, to the greatest extent possible, when and where the child receives services. Early intervention services are coordinated with the child’s primary health care provider. In 2014, the program served 97 children, a 7% decrease over 2013.

The Children’s Long-Term Support Program (CLTS Waiver) coordinates and manages an array of comprehensive services for eligible children from birth to age 18 with a severe developmental, physical or emotional disability, or autism.  Services are individually designed to help support the child and family and to promote health, safety, participation, and independence in the home and community. Respite is the predominate service provided, with 77% of the families receiving this service. In 2014, the program served a total of 43 children, 13 with autism, 21 developmentally disabled, 4 physically disabled and 5 severely emotionally disturbed children.

The Family Support Program (FSP) provides funding for children and families and is often used as a financial match to the CLTS Waiver for children in locally matched slots. FSP funds are also granted to children and their families to assist with one-time costs such as memberships in parent education programs as well as community recreational programs including, pool passes, swim lessons and camp fees. In 2014, the program served 19 families, 6 as local match to the federal CLTS waiver and 13 for one-time costs.

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Children, Youth and Families

The Children, Youth and Families (CYF) Unit is responsible for the investigation of all allegations of child abuse and neglect, recruiting and licensing foster homes for children, custody studies and step-parent adoption screens, dispositional reports for the court, arranging and supervising alternate living placements for juveniles, and providing Juvenile Intake and supervision and support services to all youth under court jurisdiction in Green County.

The number of child abuse and neglect investigations was up slightly from the previous year, with the CYF Unit investigating 266 cases in 2014. Overall, the number of abuse and neglect investigations has remained relatively consistent over the past decade. Children in Need of Protection and Services cases (CHIPS) have continued to drop since 2010 however are up from the previous years. The overall drop is likely due to the CYF Unit providing Juvenile Intake services for children and providing more services on a voluntary or informal basis as opposed to filing for court jurisdiction. The increase appears related to the severity of cases coming into the unit requiring more significant, long term intervention.

The Green County Child Advocacy Center (CAC) continued to be fully operational. Forty-nine forensic interviews were conducted at the CAC in 2014. This is a significant increase from 22 interviews in 2013. We continue to be a member of the National Children’s Alliance and are recognized as one of only 14 Child Advocacy Centers in the state. The CAC moved in April, 2014 to its new location nicknamed the “Brick House” located in a building formerly used by the Green County Highway Department. The “Brick House” renovation was a community project made possible primarily from donations and donated labor. We rent space to Sexual Assault Recovery Program (SARP) to offset operational expenses and they are an excellent partner in the mission to support children and families who have experienced abuse and/or neglect. The CAC continues to work toward full national accreditation and plans to be fully accredited in 2016.

The Juvenile Intake function moved from the circuit court to the CYF Unit on January 1, 2009, adding to the responsibilities and functions of the unit. One hundred-fifty-seven intakes were received in 2014 with 60 cases resulting in court action. This is consistent with previous years with an increase in court cases. The program transition from court to Human Services continues to be successful resulting in significant cost savings for Green County as well as more efficient work flow.

The CYF Unit continued two wrap-around initiatives in 2014. The unit received funding in 2009 to start a Coordinated Systems Team (CST) in Green County which is now titled Wrap-Around of Green County. CYF brought the program in-house in 2012. The program served 9 families in 2014. There has been very good participation in the program from the community and school systems in Green County helping to support families and keep children in the home. CST grant

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Green C ounty Child A dvocacy Center

funding remained consistent in 2014 with a slight increase to enable counties to provide parent peer support. Green County contracted with Family Ties in order to provide that support to CST families. Additionally, we continued to contract with Lutheran Social Services to provide Family Partnerships Initiative (FPI) which is another wrap-around program designed to prevent children from being placed in costly residential facilities. FPI served 4 families (5 children) in 2014.

The CYF Unit continued two initiatives in 2014: Permanency Roundtables (PRT) and In-Home Safety Services. PRT’s are designed to be a structured case consultation process that includes a trained facilitator and at least two other participants from outside Green County to expedite permanency (reunification, adoption or guardianship) for children placed in out-of-home care. Eleven PRT’s involving 14 children were held in 2014 and 10 children reached permanency (as of 5/31/15). PRT’s have been very successful in achieving permanency and reducing the number of children in out-of-home care. This can be seen in the reduction of children in out-of-home placement at the end of 2014. The CYF Unit started another initiative in January 2012 involving funding for In-Home Safety Services to prevent the removal of children from the home. This is a two year project working in a consortium with Rock and Jefferson Counties. All three counties contracted with Orion Family Services to provide specific services to control safety in the home and prevent the need to remove children. Green County served 9 families and 17 children in 2014 and prevented removal in 7 out of 9 families (13 children). Due to the success of the program, the State is continuing the funding in 2015. Green County also started another grant funded initiative in 2014 called Post-Reunification Support (P.S. Program). The P.S. program is designed to expedite reunification and prevent re-entry into alternate care. Each family eligible for support can receive up to $1100 per month per child to support successful reunification. Due to eligibility issues in 2014, the program had a slow start serving only 6 children. However, funding has been expanded and will continue in 2015 and it is anticipated to prove successful.

The CYF Unit took the lead in an agency-wide initiative to bring trauma-informed care to Green County. This was a grant project involving a five county consortium including Grant, Lafayette, Iowa, Crawford and Green County. The grant was awarded in 2013 to begin the project in 2014. It is a three tier project involving training area clinicians in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), training care providers, including parents, foster parents and agency case workers in trauma-informed behavioral interventions and educating community stakeholders about the impact of trauma on children and families. The project was successful enabling 2 agency clinicians to be fully trained in the model as well as several Orion Family Services clinicians that serve Green County via contract and private insurance. Five workshops were also held serving Green County parents and foster parents and one training was offered in our region. Additionally, one CYF staff person and a Green County foster parent were trained to facilitate the workshops in 2015 and beyond. Tier 3 was initiated involving the Monroe School District with plans to continue in 2015 working cooperatively around serving children who have experienced trauma.

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One of the biggest challenges that the CYF Unit has continued to face over the last several years is the placement and service needs of children with severe emotional, cognitive and physical disabilities. We have also experienced more and more children who have been adopted via the state run Special Needs Adoption Program and/or international adoptions that have significant disabilities as well as other concerns including trauma and attachment issues. These children often require significant supports, respite and therapies that are often well beyond the abilities of their parents or even foster or treatment foster home placements. Residential placements have been extremely costly and, regrettably, not very effective for children with lifelong challenging disabilities. Placing them outside their home is most often not beneficial and yields few if any lasting results. The unit has been challenged to find effective options for these children. We continue to partner with the Children’s Long Term Support Program and the school system as well as utilizing wrap-around programming to develop successful services to assist these children in remaining at home or at least in less restrictive placements. Despite these efforts and a decrease in out of home placements overall, residential placements increased in 2014. We are constantly working to develop new and innovative programming to work with and maintain these children in the community however; it remains a significant and costly challenge.

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

50

100

150

200

250

300

350

400

Abuse/Neglect Investigations2004 - 2014

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32%

4%

39%

14%1% 11%

2014

ABUSE

ABUSE/NEGLECT

NEGLECT

SEXUAL ABUSE

EMOTIONAL ABUSE

UNBORN CHILD ABUSE

CHILD WELFARE

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

5

10

15

20

25

30

35

40

45

50CYF Court Cases by Year

JIPSDELINQUENCYCHIPSTPRGUARDIANSHIP

CASE YEAR

Numb

er of

Case

s

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11%

89%

Investigation Outcomes2014

SUBSTANTIATEDUNSUBSTANTIATED

2009

2010

2011

2012

2013

2014

0 20 40 60 80 100 120 140 160 180

Juvenile Intake/Delinquency Referrals2014

PETITIONSREFERRALS

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27%

33%7%

13%

13% 7%

Children in Out-of-Home Care2014

GROUPFOSTERRCCCORRECTIONTFCRELATIVE (CT ORDERED)RELATIVE FC

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

5

10

15

20

25

Alternative Care Placements by Year2004 - 2014

GROUPFOSTERRCCCORRECTIONTFCRELATIVE FCRELATIVE CO

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Community Support Program

Green County’s Community Support Program (CSP) serves clients with serious and persistent mental illnesses. The most common diagnoses amongst clients in the program are Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder. Some examples of symptoms the clients in this program experience are: auditory hallucinations, delusions (persecutory, religious), disorganized speech, poor eye contact, impaired grooming and/or hygiene, lack of persistence at work or school, few if any relationships with friends/peers, inflated self-esteem or grandiosity, decreased need for sleep, distractibility, low energy or fatigue, low self-esteem, and hypersomnia. These symptoms impair their ability to hold jobs and affect their social interactions, their judgment, and their ability to complete simple tasks such as cleaning, doing laundry, and bathing.

The CSP program follows the guidelines of the PACT/ACT model. “A Manual for ACT Start-Up” published by NAMI states ACT is “a team which has a multidisciplinary mental health staff organized as an accountable, mobile mental health agency or group of treaters who function interchangeably to provide the treatment, rehabilitation, and support services that persons with severe mental illness need to live successfully in the community.” This manual also indicates that the goals of the ACT treatment team are to help lessen or eliminate symptoms of mental illness for the enrolled clients as well as to prevent acute recurrent episodes of their illness. Other goals include enhancing the quality of life of clients, meeting basic needs of clients, improving functioning in social and employment activities, and to lessening the burdens on families providing care for clients.

Green County’s CSP team is made up of nine case managers, a nurse, a psychiatrist, an administrative assistant, and a clinical coordinator. CSP strives to follow the guidelines of the ACT model and achieve the goals of this model. CSP staff deliver and observe clients taking their medications, monitor symptoms, help them set up and attend medical and psychiatric appointments, help clients apply for jobs, provide job coaching, prompt clients to clean their apartments, prompt clients to do their laundry, etc. The level of care provided to clients varies based on their needs. Some clients are seen twice a day, 7 days a week. Some clients are seen twice a week and some, who have maintained extended stability, are seen once a month. CSP offers services 365 days per year. CSP hours of operation are 8am-8pm weekdays, weekends 10am-7pm, holiday hours 8am-6pm, as well as 24 hour on call crisis services through Northwest Connections.

During 2014, CSP served a total of sixty eight clients, 63% male, and 37% female. The age range was 17-82. We enrolled 5 clients during that year. Three referrals originated in the outpatient mental health program, one came from CCS, and we had one self-referred. There was only one discharge from CSP due to the client having to relocate. 100% of our clients were

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Caucasian, 98% lived on their own and only 2% in group homes or adult family homes. 38% of our clients work part time or volunteer for at least 1 hour per week. We had 3 psychiatric hospitalizations in 2014. Most of the clients in CSP reside in Monroe, but we also serve clients residing in New Glarus, Brodhead, Albany, Monticello, Juda, and Belleville.

We had a small garden again in 2014. Clients participated by planting, weeding, watering, and harvesting vegetables. This usually happened during regular contacts with staff. 20% of the clients participated in gardening versus 3% the previous year. The produce was then shared with the clients in the program.

Because of the generosity of donors, we were able to have three events during the year, a picnic, a Halloween party, and a Christmas party, to help clients find opportunities for socialization. All three events were well attended, and clients look forward to them again in 2015.

In 2015 we hope to increase client involvement in social and physical activities in order to reduce isolation and decrease symptoms of their mental illnesses. We also hope to increase the number of clients enrolled in CSP.

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Economic Support

The implementation of the Affordable Care Act (ACA/Obama Care) was to be begin January 1, 2014, however it was delayed in the state of Wisconsin by directive of the Governor and subsequently pushed back to March 2014. Green County Economic Support, as well as the other counties in the Southern Consortium (Green, Grant, Iowa, Lafayette, Jefferson, Crawford and Rock) spent considerable time processing applications that were submitted on the Federal Market Place website but referred on to the counties as possibly being eligible for one of the Wisconsin Medical Assistance programs. In Green County, the Monroe Clinic, provided assistance to those wishing to apply for medical insurance under the Affordable Care Act/Federal Market Place and still provides that service during open enrolments and for those who can enrol due to a significant life change such as losing employer-provided health insurance. In addition the BadgerCare program began to cover adults without dependents; however, income guidelines are such that even moderately employed individuals may exceed the income limit which is 100% of the Federal Poverty Limit or $980.83 per month for an individual. The roll out of ACA did cause a drop in the total number of individuals receiving Wisconsin Medical Assistance in Green County; however, approximately 22% of county residents do receive Wisconsin Medical Assistance in some form or another (see chart).

1 2 3 40

1000

2000

3000

4000

5000

6000

7000

5167

6764 6781 6616

Medical Assistance Recipients 2009, 2012, 2013, 2014

Additional adjustments were made to the Emergency Temporary Assistance Program (Housing Assistance) to ensure only the very needy and those truly at risk receive assistance. A “light touch approach” in issuing only the amount that is needed to address the crisis situation was applied and as a result the program costs decreased substantially in 2014 while still serving those truly in need and at risk (see chart).

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1 2 30

50000

100000

150000

200000

250000

233971 219430

112567

ETA/Housing Expenditures 2012, 2013, 2014

In the second half of 2014, the staff put a greater focus on conducting benefit recovery activities. Benefit Recovery occurs when customers fail to report required changes and, as a result, are over- issued benefits. The agency is then required to seek repayment from those individuals. In addition the agency may initiate an Intentional Program Violation, which disbars an individual from receiving FoodShare for a twelve month period if he or she intentionally makes a false or misleading statement or misrepresents, conceals or withholds facts, including their identity or place of residence, or commits any act that constitutes a violation of the Food Stamp Act, the Food Stamp Program Regulations, or any Wisconsin statute for the purpose of using, presenting, transferring, acquiring, receiving, possessing or trafficking of FoodShare benefits. Due to the hard work put in by the Economic Support staff, application processing timeliness rates improved by 10.30% over 2012 (75.41%) and 21.30% over 2013 (86.41%). 2014 was 96.71% (see chart).

1 2 30

102030405060708090

100

75.41%86.41%

96.71%

Application Processing Average Monthly Timeliness Rate 2012, 2013, 2014

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1 2 3 40

200

400

600

800

1000

1200

1400

1600

1800

12891535 1619

1435

Energy Applications Processed 2009, 2012, 2013, 2014

Crawford 1,9304.41% Grant 4,946

11.29%Green 3,6898.42%

Iowa ,21684.95%

Jefferson ,7898

18.03%Lafayette 1,6303.72%

Rock 21,54549.18%

Southern Consortium Cases Per County

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Mental Health

The Mental Health Unit provides psychiatric counseling for residents of Green County. The program is certified to provide outpatient counseling and crisis intervention services that are accessible 24 hours a day. The unit is staffed by a secretary, three full time counselors and the supervisor. All counselors and the supervisor have Master’s Degrees in Counseling or Social Work and are state licensed/certified. The Mental Health Unit contracts with The Monroe Clinic and another private physician for 16 hours of psychiatric support per week. The Mental Health Unit and personnel from the AODA Unit form our Mobile Crisis Intervention Service. This program is also state certified and, in conjunction with newly contracted services provided by Northwest Connections, serves to provide the county with 24 hour emergency mental health services.

The after-hours crisis intervention service responded to 410 crisis calls in 2014. Many of those calls were in support of law enforcement in assisting persons in crisis and in making determinations about whether or not a person needed to be placed on an involuntary emergency detention.

There were 78 emergency detentions in 2014. Fifty-nine were adults and 19 were minors. These numbers continue to reflect a common annual total for the past decade. The profile of clients served by outpatient mental health is one of ever-increasing seriousness in terms of clinical condition and economic need. A waiting list has been in place and the most serious cases are triaged in for more immediate services. Most of our clients have inadequate insurance coverage for mental health care, or no insurance at all. Yet, these people remain the most in need of assistance.

349 people were seen for psychiatric counseling in the Mental Health Unit in 2014. These numbers are unduplicated and the demographic breakdown is as follows:

Under 18 years = 41 Caucasian = 338 Male = 14219-44 = 156 African American = 6 Female = 20745-64 = 130 Hispanic = 365 and over = 22 Native American = 1

Pacific Islander =1

The trend for us in mental health care in Green County continues to be more toward providing crisis intervention and follow-up type services. This is again based upon the fact that there are so many people in need of mental health services coupled with our inability to accommodate these numbers in terms of access to a psychiatrist. Nevertheless, Green County relies upon the

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dedication of its staff and their ability to creatively manage difficult circumstances in order to effectively manage the needs of an increasingly more challenging population.

12%

45%

37%

6%

Ages

Under 1819-4445-6465 and over

Male Female0

50

100

150

200

250

Gender

Ethnicity

CaucasianAfrican AmericanHispanicNative AmericanPacific Islander

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GREENLAFAYETTE

Comprehensive Community Services

The Comprehensive Community Services (CCS) Program is a state-certified, community-based mental health and substance use psychosocial-rehabilitation program that provides services for eligible consumers in Green County. The CCS Program is Medicaid funded and participants must be eligible for Medical Assistance, BadgerCare or another Medicaid program. The Green County CCS Program began in January 2009 and currently serves thirty seven consumers.

A primary goal of the CCS Program is to provide services through a single coordinated system of care and support. Consumers participate as equal partners in the process with a shared set of core values based on the client-centered recovery model. The CCS Program works with the consumer on their recovery journey along with their natural support systems in the community.

In 2015, the CCS Program will be expanding under a state certified regional model to include consumers in Lafayette County. This partnership will provide services to consumers in need of case management that cannot be provided by traditional outpatient mental health professionals and who do not need the level of treatment that is provided by our Community Support Program.

CCS 2015 REGIONAL MODEL

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Regional Aging & Disability Resource CenterServing Grant, Green, Iowa and Lafayette Counties

The Regional Aging and Disability Resource Center works with the local ADRC offices in Grant, Green, Iowa and Lafayette Counties. The regional office is responsible for overseeing the contract with the Wisconsin Department of Health Services, Division of Long Term Care, for managing the ADRC budget and working with local offices in providing outreach, information and assistance and connection to resources pertaining to aging and disabilities.

2014 was a very busy year for the regional and local Aging and Disability Resource Center offices. The local ADRC offices had many contacts with a variety of people wanting information and assistance on caregiving, in-home services, long-term care, public benefits, transportation, nutrition and many other topics. The Disability Benefits Specialists in the local ADRC offices worked diligently to assist people in obtaining needed benefits through Social Security and other sources.

Highlights of 2014:

Information and Assistance: Contacts: 7,535 people contacted their local ADRC office in the region which is an

increase of 438 from 2013. Age Group of the customers: 72% were 60 plus years of age and 28% were between 18

and 59.

Caller Type: 38% were calling for themselves, 26% were contacts made by the ADRC staff to customers (staff will follow up with customers to see if further assistance is needed), 28% were contacts made by relatives/family members/friends, and 8% were contacts made by agencies/physicians/caregivers/others.

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Reason for contacting the ADRC: 40% contacted the ADRC for information and assistance about public benefits compared to 43% in 2013. 60% contacted the ADRC for information and assistance on a variety of topics such as in-home services, legal services, housing, transportation, long-term care services, assisted living, etc. compared to 57% in 2013.

Public Benefits Other0

1000

2000

3000

4000

5000

6000

7000

Reason for Calling

Disability Benefits Specialist Program: The Disability Benefits Specialist Program assists people aged 18-59 with obtaining needed benefits. The monetary impact for the program in our

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area was $4,636,849 which is an increase of $808,551 from 2013. Federal funds made up 89% of the total monetary impact while state funds made up 9% and other funds 2%.

Regional Dementia Care Specialist: In April of 2014 the ADRC of Southwest Wisconsin applied for and received a grant for a regional Dementia Care Specialist Program. The grant is for two years with the possibility of continued funding in the Governor’s 2015-2017 Biennium Budget. The Dementia Care Specialist has been focusing on three main goals: Create a “Dementia Capable” ADRC; Collaborate with community partners to create dementia friendly communities; and, Provide opportunities for people with dementia to remain in their homes.

1. Create a Dementia Capable ADRC. The regional Dementia Care Specialist had all ADRC staff complete a survey that pertains to their knowledge of dementia. The Dementia Care Specialist has developed monthly training criteria that staff are to complete. At the end of six months staff will retake the survey to see if their knowledge related to dementia and what steps to take in assisting someone with dementia has improved. She has trained and/or retrained Information and Assistance Specialists on completing Memory Screens and is developing a process for assisting people with discussing the screens findings with their physician.

2. Collaborate with Community Partners to create Dementia Friendly Communities. The Dementia Care Specialist has been working with groups in Monroe, Mineral Point, Lancaster and Darlington. The first step in creating dementia friendly communities is to train business owners and their staff on what dementia is and how they might identify when someone with dementia may need extra time and/or patience when they are in their establishment.

3. Provide Opportunities for People with Dementia to Remain in Their Homes. The Dementia Care Specialists continues to offer the LEEPS (Language Enriched Exercise Plus Socialization) Program which pairs someone with dementia with a volunteer that comes to their home twice per week. During these visits the person with dementia will complete series of exercises. One time per month the volunteer and participant go out in the community to enjoy an activity or do volunteer work. The Dementia Care Specialist also offers a new program called Memory Care Connections. This program is designed to educate family and friends, who have a loved one with dementia, about the disease and how to support the person to remain in their own home.

Looking forward, the regional and local ADRC offices will continue to do outreach so that the residents in our region are aware that there is a place for them to contact for any type of question or service related to aging and/or disabilities.

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Staff ListingAs of December 31, 2014

NAME/UNIT JOB TITLE/JOB DESCRIPTION STATUS/HOURS START DATE

ADMINISTRATIONGreg Holcomb Director FT - 40 hrs./wk. 02/06/1989Julie Sachs Fiscal Services Supervisor FT - 40 hrs./wk. 03/18/1998Lori VanRyswyk Business Manager FT - 40 hrs./wk. 08/13/1997Mary Miller Fiscal Coordinator FT - 40 hrs./wk. 06/11/2001Lisa Bergum Fiscal Clerk FT - 40 hrs./wk. 07/30/1999Mary Ubert Receptionist FT - 40 hrs./wk. 04/21/1997Larry Young File Clerk PT - 20 hrs./wk. 10/29/2009

AGING & DISABILITY RESOURCE CTR.Linda Boll Supervisor FT - 40 hrs./wk. 07/12/1990Katie Gilbertson Secretary FT - 40 hrs./wk. 08/20/2012Amber Russell Resource Center Coordinator FT - 40 hrs./wk. 05/15/2006Lou Dalton Aging Programs Coordinator FT - 40 hrs./wk. 03/01/1995Linnea Guse I&A Specialist II PT - 25 hrs./wk. 05/22/2006L.A. Klug-Lasiewicz I&A Specialist II FT - 40 hrs./wk. 04/25/2007Mandy Johnsen I&A Specialist I FT - 40 hrs./wk. 11/01/2011Maria Johnson Case Manager II FT - 40 hrs./wk. 08/01/2002Stephanie Hafez Wellness & Prevention Specialist FT - 40 hrs./wk. 10/31/2012Brenda Ringhand Human Services Assistant II FT - 40 hrs./wk. 02/24/2009Julie Ames Disability Benefit Specialist FT - 40 hrs./wk. 04/09/2001Linda Gallagher Elderly Benefit Specialist FT - 40 hrs./wk. 03/19/2002Vicki Krattiger Volunteer & Transportation Coordinator PT - 25 hrs./wk. 06/25/2003Emily Jeremiason Adult Day Center Assistant PT - 19 hrs./wk. 02/11/2014Kristi Bessert Nutrition Site Manager - Monroe PT - 16.5 hrs./wk. 02/04/2014Linda Johnson Nutrition Site Manager - Brodhead PT - 15 hrs./wk. 04/09/2014Jan Lien Driver PT - 15 hrs./wk. 03/21/2000Dean Braund Driver PT - 9 hrs./wk. 10/04/2002Henry Tschanz Driver PT - 3 hrs./wk. 12/03/2005Dick Atkinson Driver PT - 5 hrs./wk. 09/03/2010

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NAME/UNIT JOB TITLE/JOB DESCRIPTION STATUS/HOURS START DATE

ALCOHOL & OTHER DRUG ABUSEBob Gibson Supervisor FT - 40 hrs./wk. 08/20/2012Marlene Bergemann Secretary FT - 40 hrs./wk. 02/10/1999Anita Stein AODA Counselor III FT - 40 hrs./wk. 02/24/1997Barb Alexander AODA Counselor III FT - 40 hrs./wk. 04/28/1997Eric Gebhart AODA Counselor III FT - 40 hrs./wk. 01/02/2004Nancy Richardson AODA Counselor III FT - 40 hrs./wk. 09/29/2014

CHILDREN, YOUTH & FAMILIESDee Jaye Miles Supervisor FT - 40 hrs./wk. 06/19/1989Cheryl Kraus Secretary FT - 40 hrs./wk. 02/16/1998Jaime Proctor Human Services Assistant I FT - 40 hrs./wk. 01/22/2014Jennifer Amacher CYF Coordinator FT - 40 hrs./wk. 11/20/2002Angie Wardlow Case Worker II FT - 40 hrs./wk. 06/07/2004Penny Dunlavey Case Worker II FT - 40 hrs./wk. 12/31/2009Stephanie King Case Worker II FT - 40 hrs./wk. 01/05/2010Tracey Reich Case Worker I FT - 40 hrs./wk. 02/06/2012Katlyn Graebner Case Worker I FT - 40 hrs./wk. 07/09/2012Kayla Brick Case Worker I FT - 40 hrs./wk. 02/15/2013Christina Novosad Case Worker I FT - 40 hrs./wk. 03/31/2014Danielle Gallagher Social Worker II FT - 40 hrs./wk. 07/31/2006Kimber Blum Social Worker II FT - 40 hrs./wk. 12/17/2007Kelly Blanke Social Worker II FT - 40 hrs./wk. 05/04/2010

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NAME/UNIT JOB TITLE/JOB DESCRIPTION STATUS/HOURS START DATECOMMUNITY SUPPORT PROGRAMPamela Geisser Supervisor FT - 40 hrs./wk. 08/01/2014Traci Strauch Secretary FT - 40 hrs./wk. 01/12/2010Debbie Champeny Community Support Specialist II FT - 40 hrs./wk. 02/'03/2014Cheryl Hanson-Liu Community Support Specialist II FT - 40 hrs./wk. 11/16/2009Sara Cadmus Community Support Specialist II FT - 40 hrs./wk. 08/02/2004Angie Zimmerman Community Support Specialist I FT - 40 hrs./wk. 09/15/1993Sarah Ragan Community Support Specialist I FT - 40 hrs./wk. 10/01/2014Julia Swanson CSP Nurse FT - 40 hrs./wk. 09/20/2006Kevin Cox Community Support Professional FT - 40 hrs./wk. 03/15/2004Heather Biggin Community Support Professional FT - 40 hrs./wk. 05/01/2006Mickey Rockey Mental Health Technician FT - 40 hrs./wk. 05/03/2004Alan Meana Mental Health Technician FT - 40 hrs./wk. 06/16/2014

ECONOMIC SUPPORTMark Nelson Supervisor FT - 40 hrs./wk. 05/31/2013Jenny Lingle Secretary FT - 40 hrs./wk. 09/25/2013Tammy Haring Economic Support Specialist II FT - 40 hrs./wk. 03/25/1982Kathy Gempeler Economic Support Specialist II FT - 40 hrs./wk. 01/01/1984Kathy Grossen Economic Support Specialist II FT - 40 hrs./wk. 09/02/1997Tabbie Kupersmith Economic Support Specialist II FT - 40 hrs./wk. 01/02/2009Tami Padulla Economic Support Specialist II FT - 40 hrs./wk. 10/24/2011Kristi Baker Economic Support Specialist II FT - 40 hrs./wk. 07/23/2012Amie Ballard Economic Support Specialist I FT - 40 hrs./wk. 07/23/2012Jodi Furniss Economic Support Specialist I FT - 40 hrs./wk. 08/12/2013Katie Gempeler Economic Support Specialist I FT - 40 hrs./wk. 10/08/2013

MENTAL HEALTHRob Miles Supervisor FT - 40 hrs./wk. 02/26/1990Kelli Bauman Secretary FT - 40 hrs./wk. 11/01/2011Karen Stites Psychiatric Social Worker II FT - 40 hrs./wk. 07/06/1999Tracey Atkinson Psychiatric Social Worker II FT - 40 hrs./wk. 05/12/2008Megan Schilt Psychiatric Social Worker I FT - 40 hrs./wk. 03/18/2014

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NAME/UNIT JOB TITLE/JOB DESCRIPTION STATUS/HOURS START DATE

COMPREHENSIVE COMMUNITY SERVICESSharon Farrey Supervisor FT - 40 hrs./wk. 01/26/1998Anna Frontz CCS Case Manager II FT - 40 hrs./wk. 08/01/1995Holly Best CCS Case Manager III FT - 40 hrs./wk. 03/17/2003

REGIONAL ADRCMary Mezera Manager FT - 40 hrs./wk. 09/15/2008Danica Hay-Skattum Human Services Assistant II FT - 40 hrs./wk. 08/26/2013

CONTRACTED STAFFPatricia Jens, MD Psychiatrist PT - 8 hrs./wk.Monroe Clinic Doctors Psychiatrist (2) PT - 8 hrs./wk.David Pierce, MD Psychiatrist PT - 8 hrs./wk.Kenneth Clark, PhD Psychologist PT - 16 hrs./wk.Stacey Palermo LSS CLTS Case Manager FT - 40 hrs./wk.Tricia Miller LSS B-3 Case Manager PT - 40 hrs./wk.

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Organization Chart

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B-3/CLTS/FSLSS Contract

REGIONAL ADRCSTAFF

REGIONAL ADRCMANAGER

ADRCSTAFF

12/31/14

GREEN COUNTY HUMAN SERVICES ORGANIZATIONAL CHART

AGING STAFF

AGING PROGRAMS

COORDINATOR

CYFSTAFF

ESSTAFF

ADRC COORDINATOR

ADRC SUPERVISOR

CYFSUPERVISOR

ESSUPERVISOR

AGING & DISABILITY ADVISORY

COMMITTEE

CSP STAFF

MHSTAFF

AODASTAFF

CSPSUPERVISOR

MHSUPERVISOR

AODASUPERVISOR

CONSULTING DOCTORS

ADMINISTRATIVESTAFF

FISCAL SUPERVISOR

DIRECTOR

HUMAN SERVICES

BOARD

COUNTYBOARD

CCSSUPERVISOR

CCSSTAFF