WASHINGTON COUNTY 1

HUMAN SERVICES BOARD 2

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Public Agency Center, Room 1023 February 10, 2016 4

West Bend, WI 8:00 a.m. 5

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Members Present: Michael Bassill, Kristine Deiss, Dawn Eyre, Robert Hartwig, Dennis Myers 7

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Members Excused: Leslie Borman, Sarah Follett, Paul Ustruck 9

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Members Absent: Timothy Michalak, Patricia Strachota 11

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HSD Staff Present: Aaron Daul, Eric Diamond, Mary Knoeck, Jaclyn Moglowsky, Anita Olson, 13

Leigh Sanderson 14

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Guests Present: Ralph Chapoco, West Bend Daily News, Don Kriefall, County Board 16

Supervisor, Joshua Schoemann, County Administrator 17

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Chairperson K. Deiss called the meeting to order at 8:01 a.m. 19

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MINUTES 21

Motion by D. Eyre, seconded by D. Myers to approve the Human Services Board minutes from 22

the January 13, 2016 meeting as distributed. M. Bassill abstained due to absence from said 23

meeting. Motion carried. 24

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R. Chapoco arrived at 8:08 a.m. 26

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REVIEW OF LOST REVENUE AND APPROVAL TO WRITE OFF UNBILLABLE 28

CLAIMS: 29

E. Diamond and A. Olson presented. Human Services requests write off of $120,588.05 in 30

unbillable, uncollectible revenue from the 2014 and 2015 service years. Questions and answers 31

followed from D. Kriefall and various Human Services Board Supervisors. D. Eyre requested a 32

quarterly review of this revenue going forward. M. Bassill requested that a report of this revenue 33

also be included in the Human Services Annual Report. Motion by M. Bassill, seconded by D. 34

Eyre to approve the write off of $120,588.05 in unbillable, uncollectible revenue from the 2014 35

and 2015 service years. Motion carried. 36

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J. Schoemann arrived at 8:30 a.m. 38

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NON-LAPSE OF 2016 HUMAN SERVICES FUNDS: 40

E. Diamond and M. Knoeck presented. Eric provided an overview of the amounts in the 2015 41

Human Services budget for consideration of non-lapsing to 2016. HSD requests to non-lapse 42

$97,337.92 in revenue and $15,315.47 in expenses to the 2016 Budget. Approval of this request 43

will create a net increase in the Human Services budget by a total of $82,022.45. Motion by D. 44

Myers, seconded by R. Hartwig to approve non-lapsing the balances in the Administration 45

County-Other Revenue account, Administration County – Other Purchased Software account, 46

Human Services Board February 10, 2016 Page 2 of 2

Administration-Family Court Conferences account, Administration-Memorials account, and the 1

Memorials-Behavioral Health account from 2015 to 2016. Motion carried 2

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PRELIMINARY 2015 FINANCIAL REVIEW: 4

M. Knoeck provided a financial summary report for the 12 months ending December 31, 2015. 5

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INCOME MAINTENANCE OPERATIONAL ANALYSIS: 7

This discussion was inadvertently omitted from this agenda and will be presented at the next 8

Human Services Board meeting on March 9, 2016. 9

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HUMAN SERVICES MANAGEMENT REPORT: 11

E. Diamond presented. K. Deiss requested a presentation of HSD program dashboards once 12

completed. 13

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NEXT TENTATIVE MEETING DATE 15

The next Human Services Board meeting is tentatively scheduled for Wednesday, March 9, 16

2016, at 8:00 a.m. in Room 1023 of the Public Agency Center. 17

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ADJOURNMENT: 19

Meeting adjourned at 8:55 a.m. 20

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HUMAN SERVICES CLINIC PHARMACY TOUR: 22

J. Moglowsky led a tour of the new HSD Clinic Pharmacy. 23

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Leigh Sanderson, Recording Secretary 27

COMMITTEE REPORT

To: Human Services Board

From: Sandra Hoefert, Children and Families Manager

Date: March 9, 2016

Re: Family Court Custody Study Hourly Fee

POLICY QUESTION: Should the Human Services Board approve a reduction in the hourly fee

charged to write a Family Court Custody Report and subsequent Court Appearances from $61.55

per hour to $58.00 per hour?

DISCUSSION: On August 26th, 2015 the Human Services Board voted to approve a Family

Court Custody Study hourly fee of $61.55 per hour to cover the cost of writing a Family Court

Custody Report and any subsequent Court Appearances. The hourly fee was set based on the

Senior Social Worker rate calculated by the Human Services Accounting Division. However,

based on current calculations, the Senior Social Worker rate for 2016 is actually $58.00. This

recalculation and subsequent reduction is due to employee turnover in the division the second

half of 2015.

FISCAL EFFECT: There will be no major fiscal effect on the Department. All Family Court

studies and fees are ordered by the Court. Revenue from these studies are based on number of

studies ordered as well as the amount of fees ordered or waived by the Court.

ATTACHMENTS:

None

RECOMMENDATION: The Children and Families Division respectfully requests approval for

the amended 2016 Senior Social Worker rate of $58.00 per hour for the drafting of Family Court

Custody Reports and all subsequent Court Appearances.

COMMITTEE REPORT

To: Human Services Board

From: Eric Diamond, Human Services Administrator

Date: March 9, 2016

Re: Treatment, Alternatives and Diversion 2016 Approval

POLICY QUESTION: Should the Human Services Department (HSD) continue providing

TAD Programming for 2016?

DISCUSSION: The Washington County TAD Program offers individuals charged with 2nd, 3rd

and misdemeanor 4th Operating While Intoxicated (OWI) offenses a structured and supervised

treatment program in lieu of jail time.

TAD programming improves public safety by addressing with each participant the root cause of

the OWI offense: his/her substance use disorder. When successfully addressed, TAD

participants address their addiction, adhere to all requirements, and successfully complete the

program. Over time, high performing programs reduce participants' OWI recidivism rate. In the

immediate, Washington County saves money (measured in jail bed days) by diverting

participants from jail.

Our program vendor is Elevate, Inc., who serves between 20-30 participants at any given time,

and approximately 55 per year. Elevate has on staff a TAD Coordinator, a part time Case

Manager, and together these staff complete assessments, develop service plans, refer and assure

participant adherence to treatment, and complete structured and frequent contacts, as well as

frequent and random drug testing for the duration of the program.

FISCAL EFFECT: he TAD Program is accounted for in the 2016 HSD Budget. Total Program

Cost is $ 123,513. The State Department of Justice provides $92,635 and the County must

match 25%, or $30,878.

ATTACHMENTS: TAD Program 2015 Final Report

RECOMMENDATION: The Human Services Department respectfully requests approval to

continue providing TAD Programming for 2016.

Page 1 of 2

WASHINGTON COUNTY, WISCONSIN 1

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Date of enactment: __________ 3

Date of publication: __________ 4

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2015 RESOLUTION ___ 6

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Grant Application – Treatment Alternatives and Diversion (TAD) Program for 2016 8

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WHEREAS, Washington County Code Section 4.27 requires that all county grant 10

programs or applications for funds receive prior approval by the County Board of Supervisors or 11

subsequent review and ratification; and 12

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WHEREAS, in order to timely apply, an application for 2016 TAD grant funding was 14

submitted in January 2016, and approval is needed to accept the grant award; and 15

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WHEREAS, the TAD program is intended to reduce recidivism, increase public safety 17

and reduce the jail population; and 18

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WHEREAS, between 2007 and 2014, 73% of the clients successfully completed the 20

program averting 18,208 total days of combined jail and prison time; for 2015, 52% of the clients 21

successfully completed the program, averting 1,485 total days of combined jail and prison time; 22

and 23

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WHEREAS, the TAD program had been administered through the Washington County 25

Sheriff’s Department since 2007; however it was determined that the Sheriff’s Department would 26

not seek renewal of the TAD grant for 2015; and 27

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WHEREAS, 2014 Resolution 56 authorized the Human Services Department to pursue 29

2015 TAD funding for continuation of County programming by contracting with Elevate, Inc.; and 30

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WHEREAS, the Human Services Department plans to continue the TAD program in 2016 32

for Washington County; and 33

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WHEREAS, the TAD program will continue to provide diversion of 2nd, 3rd, and 35

misdemeanor 4th OWI offenders to a structured treatment program; and 36

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WHEREAS, in 2015, TAD grant funding was offered to Washington County in the 38

amount of $92,635 with a 25% match requirement or $30,878 and the Human Services Department 39

anticipates the grant funding amount to be the same for 2016; and 40

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WHEREAS, the State has indicated that Intoxicated Driver Program funds may be used 42

as the match for the TAD grant and $30,878 has been budgeted for the match using a portion of 43

this program’s client co-pays in the Human Services Department’s 2016 proposed budget; and 44

45

WHEREAS, the Human Services Board approved the Human Services Department’s 46

proposed budget and authorized the application for 2016 grant funds; 47

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Page 2 of 2

NOW, THERFORE, BE IT RESOLVED by the Washington County Board of 1

Supervisors that the Washington County Human Services Department’s application for the grant 2

funding described herein is ratified and the continuation of the TAD program for Washington 3

County is endorsed. 4

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BE IT FURTHER RESOLVED that the Human Services Department is hereby 6

authorized to accept the above noted grant funds to continue the Treatment Alternatives and 7

Diversion programming. 8

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BE IT FURTHER RESOLVED that upon receipt of grant funds, the use of same will be 10

within the parameters set forth in the grant program. 11

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BE IT FURTHER RESOLVED that the County Board Chairman and County Clerk are 13

authorized to execute the necessary application or other documents in order to obtain grant funding 14

described herein, subject to review and approval of the County Attorney’s Office. 15

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_________________________ 17

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VOTE REQUIREMENT FOR PASSAGE: Majority 19

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RESOLUTION SUMMARY: Authorization to apply for grant funding for the continuation of the 21

Treatment Alternatives and Diversion (TAD) Program through the Human Services Department 22

for 2016. 23

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APPROVED: Introduced by members of the HUMAN SERVICES 25

______________________________ BOARD and the FINANCE COMMITTEE 26

Kimberly A. Nass, County Attorney as filed with the County Clerk. 27

Dated_________________________ ________________________________ 28

Kristine M. Deiss, Chairperson 29

Considered_____________________ Human Services Board 30

Adopted_______________________ ________________________________ 31

Ayes_____ Noes_____ Absent_____ Raymond W. Heidtke, Chairperson 32

Voice Vote_____________________ Finance Committee 33

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(The County’s match for this grant is $30,878. This match is included in the 2016 budget.) 35

COMMITTEE REPORT

To: Human Services Board

From: Sandy Potter, Economic Support Division Manager

Date: March 9, 2016

Re: Income Maintenance Operational Analysis

POLICY QUESTION: None. Review with the Board the Income Maintenance Operational

Analysis (IMOA), its findings and potential next steps.

DISCUSSION: In 2015, The Department of Health Services (DHS) contracted with Deloitte

Consulting to perform an analysis of the Income Maintenance Consortium operations. The

purpose of the initiative was to assess and compare current organizational models, operational

models, processes and performance in the hopes of finding opportunities for improvement. For

the IMOA report, Deloitte used data and operational processes that were in place at the end of

2014 which is not necessarily reflective of the operating models today. In addition, the

comparison is not one of apples to apples as each consortium share both similarities and

differences in their operational approach. There was however a number of characteristics shared

by the top performing consortia. The specific characteristics that stand out among the leading

performers include:

A primary organizational structure that is consortium based

Case management performed consortium wide by teams assigned certain tasks

Standard operating procedures (SOPS) at the consortium level

Communications are centralized and a common location for reference and training

materials

Data driven reporting to monitor performance

Monitoring staff performance via a standardized tool

Operate a call center offering an array of services and a one touch approach

Processing documents in the call center and by an assigned team of workers

Standardized structured IM agency-level training

Other areas identified as needing improvement:

Increase use of the Centralized Document Processing Unit (CDPU), Call Center

Anywhere and telephonic signature

Establish a common consortium approach to Second Party Review findings

The highlighted areas above are already a part of the operational process for Moraine Lakes and

the rest will become part of our consortium improvement plan. There is no deadline to

implement the suggested processes; we only need to be consistently and continually moving

toward efficiencies. As you move to the next page of this report you will find that although we

have already met most of the suggested improvements, we have identified some starting points

for further improvement. As each area enhancement is incorporated into our model we will

continue to develop additional enhancements.

Moraine Lakes Draft plan for improvement:

1. Use of team and task based processing:

Expand case processing tasks across the consortium to include applications received

through Access add a program, automated case processing, alerts, discrepancies and other

dashboard tasks. Timeline-transition over the next 18 months

2. Create/Use Standardized Operating Procedures (SOPs):

While we currently use SOPs, our goal is to incorporate them into an easily accessible

manual to ensure uniformity. Timeline- January 1, 2017

3. Utilize Call Centers to Support One-Touch Processing:

Further reduce number of case actions processed outside call center by increased usage of

“one touch” to 80% of non-Long Term Care cases. Timeline-September 2016

4. Enhance Use of CDPU:

Electronically send all in house scanned documents to the CDPU for validation.

Timeline-immediate

5. Adopt a Centralized Quality Control process:

Quality control reviews reported to a central contact who will disseminate the

information to each county and track the findings and case resolutions. Timeline-

Immediate

6. Future considerations:

Shared supervision of team tasks

Lead line in CCA for escalated calls

Shared training resources

Add Child Care case processing to the consortium model. Requires a waiver from the

Department of Children and Families. Currently child care eligibility and authorizations

must be completed in the county of residence. Timeline-January 2017

FISCAL EFFECT: The adoption of the above improvements will be measured to determine

their fiscal effect.

ATTACHMENTS:

None

RECOMMENDATION:

None

Financial Statements for 12 Months Ended Dec. 31, 2015

APPROVED 2015 BUDGET

Total

1. Total Expenses 20,739,469

2. State Aid 7,985,777

3. Other Revenue 2,976,942

4. County Funding 9,776,750

YEAR TO DATE TOTALS

5. Total Expenses 21,461,562

6. State Aid 8,155,850

7. Other Revenue 3,239,329

8. County Funding 10,066,383

County Funding

(line 4) Approved County Funding 9,776,750

(line 8) Current County Funding 10,066,383

Balance (289,633)

Total Approved County Funding 9,776,750

County Funding as of 12/31/15 10,066,383

Balance (289,633)

% Remaining -2.96%

Estimated Lytec revenue not recognized in 2015 250,000.00

Balance had A/R been recognized (39,632.73)

● Accounting rule - Revenue recognition period 60 days

● Adm - Cost savings

● BH - Inpatient stays

● CF - on target

● ES - on target

Prepared for the 3/09/16 HSD Board Mtg with information available on 2/25/16

2015 TAD Annual Summary 1

Washington County TAD Program 2015 Annual Summary

I. Referrals, Admissions, and Discharges A. Referrals Total Referrals: 100 (from DA’s office in 2015) Active from 2014: 15 (not included in total referral number) Admitted: 71 No contact: 14 Not appropriate: 8 Appropriate, did not engage: 3 Assessment scheduled Q1 2016: 3 Out of county: 1 Total Active 2016: 86 (15 @ start of 2015, 71 admissions in 2015) B. Admissions and Discharges Total Admissions: 71 2nd OWI: 56 3rd & 4th OWI: 14 Other: 1 (DPA) Just Elevate With GBS Clients Total Discharges: 37 52 Successful: 25 (52%) 38 (73%) Unsuccessful: 12 (48%) 14 (27%) Reasons for unsuccessful discharges:

571 (GBS) – Failure to comply with program expectations (treatment and sobriety) 615 (GBS) – Continued substance use (THC) 631 – Substance use, missed appointments, missed contacts following 2 extensions 635 – Continued substance use, lying about use, was offered IOP and Res. TX 636 – Substance use, bail jumping, failed to follow up with case manager 644 – Re-offended 3rd OWI 645 – Decided not to continue with the program (later re-offended, opiate problem) 646 – Continued substance use, serious mental health and cognitive problems 654 – Continued substance use 661 – Continued substance use following detoxification and leaving residential TX 664 – Continued substance use, failure to engage in treatment 666 – Continued substance use, failure to engage in treatment 672 – Substance use while on EM Program, probation revoked 677 – Decided not to continue with the program Total Days Diverted: 1485

2015 TAD Annual Summary 2

II. Services Provided A. AODA OWI Education: 14 AODA Outpatient Treatment: 50 AODA Intensive Outpatient Treatment: 8 AODA Detoxification Services & Follow Up: 2 AODA Residential Treatment Services: 1 (also received detoxification services) No Engagement in Treatment: 12 Reasons No Engagement in Treatment:

3 participants had yet to engage in treatment by the end of 2015, 2 due to starting at the very end of the year and not yet finding a provider and 1 due to being incarcerated and unable to start. 2 participants chose to drop out of the program within 1-2 weeks of starting and as a result did not engage in treatment during their participation 3 participants completed their treatment prior to engaging in the TAD program and did not demonstrate a need for re-engagement during their involvement in the program 4 delayed their engagement in treatment and continued to use substances and as a result were terminated from the program

B. Mental Health Mental Health Outpatient Treatment Only: 2 Medication Management Only: 13 Mental Health Outpatient and Medication Management: 14 Inpatient Mental Health Treatment: 2 Diagnosed with Mental Health Disorder at Admission: 26 Depressive Disorder: 11 Anxiety Disorder: 13 ADHD: 7 Bipolar Disorder: 1 Mood Disorder NOS: 1 PTSD: 1 Anorexia: 1 More than one mental health diagnosis: 7 C. Urine Drug Screens and Preliminary Breath Tests UDS Total: 340 Negative: 291 Positive: 49 Positive RX: 14 PBT Total: 366 Negative: 356 Positive: 10

2015 TAD Annual Summary 3

III. Review of Goals for 2015 1. 80% of the OWI TAD participants will not reoffend within one year of satisfactory completion of the program - We cannot currently track annual recidivism. The current way of tracking annual recidivism in 2016 will be to look at Wisconsin Circuit Court Records for participants who were discharged per quarter in 2015. Participants who recidivate within the 1 year period after their discharge will be listed in each quarterly report of 2016. - In 2016 continue to work on developing an effective method for which to study recidivism rates of program participants for future study. - Determine what we will count as recidivism (all new offenses, all new criminal offenses, offenses vs. convictions, only OWI arrests/convictions, etc.) - In 2015 a total of 6 participants that were discharged from the program obtained new criminal charges and/or convictions:

One participant who was unsuccessfully discharged from the program was convicted of Operating While Revoked (Rev due to alc/contr subst/refusal), and Operating a motor vehicle w/o insurance

One participant who successfully completed the program was convicted of Disorderly Conduct – County/Municipality

One participant who was unsuccessfully discharged from the program was charged with Bail Jumping – Misdemeanor while engaged in the program and convicted after he was discharged.

One participant who was unsuccessfully discharged from the program was charged with OWI (3rd), Bail Jumping – Misdemeanor, and Operating w/ PAC (3rd) while he was engaged in the program and the cases remain open. This participant was also convicted of 2 speeding violations after discharge from the program.

One participant was received a charge of Bail Jumping – Misdemeanor, while engaged in the program and was convicted after he was discharged (TAD15060664)

One participant who was unsuccessfully discharged from the program in the 3rd quarter of 2015 was convicted of 1 count of Theft-Movable Property <=$2500 and 2 counts of Credit Card-Fraudulent Use (<=$2500) (TAD15060635). However, the offense date for this crime was prior to the participant engaging in the TAD Program.

2. 90% of the OWI clients will satisfactorily comply with the requirements of the program and receive reduced jail time thereby reducing the jail population. Just Elevate With GBS Clients Total Discharges: 37 52 Successful: 25 (52%) 38 (73%) Unsuccessful: 12 (48%) 14 (27%) - This year, even with counting the 15 clients transferred from Genesis at the start of the year that were considered very low risk, the completion rate for the year is 73%, and 52% considering only clients admitted through Elevate in 2015. - Review the reasons for discharge above and discuss possible areas for improvement 3. Clients served: anticipate 20 clients at any one time, with a minimum of 80 clients served in 2015 - We typically have had between 20 – 35 clients at any one time - Counting clients transferred at the start of the year we have served 86 clients in 2016

HSD Management Team Report March 9, 2016 1

DATE: March 9, 2016

TO: Washington County Human Services Board

FROM: Eric Diamond, HSD Administrator

RE: Human Services Department – Management Team Report

1. Administration:

a. HSD Supervisor Training: Supervisor and Manager training on HSD’s new

Competency-based Supervision Policy and Procedure continues and will be completed by

March 3, 2016.

b. Program Dashboards: The Management Team is continuing its work with the Finance

Department to develop Dashboards that bring together financial, output and quality data

for each of its programs. We have held meetings with a number of program staff,

introduced the idea and have worked with them to complete a final draft list of data

points. A Program Management Policy and Procedure has been developed to support the

development of a culture of continuous process improvement.

2. Behavioral Health Division: a. Lytec MD Implementation Update: The Billing Project has been completed, and Health

Care Data Systems is now refocusing its attention on State Reporting. We expect State

Reporting to be completed by April 1, 2016. We have been granted approval from the

State of WI to begin reporting following this date.

b. Clinic Pharmacy Update: A Pharmacy Manager has been hired and will hire additional

staff. Expected open date is March 14, 2016.

c. Motivational Interviewing: The Comprehensive Community Services (CCS) Regional

Group is developing its implementation plan to further embed Motivational Interviewing

Practice across HSD and our CCS Region. Awarded a MI Grant, BH staff will learn how

to better use the practice with clients with Substance Use Disorders.

d. Treatment, Alternatives and Diversion (TAD) Study Planned: Our TAD Coordinating

Committee is partnering with Sociologist Professor Scholz at the UWWC to study the

outputs and outcomes of our TAD Program. We are interested in better understanding

the effect of not only the program as a whole, but also the value of the various evidence

based practices of which it is comprised to chart direction for the program.

e. Winnebago Mental Health Institute (WMHI) Improvement Project: We will be partnering

with WMHI leadership, Jefferson County, a UW-Madison NiaTx Coach, and DHS

leaders to complete an improvement project related to decreasing length of stays,

improving client transitions to the community, and reducing readmissions.

f. Homeless Coalition: Washington County HSD has reengaged with the Homeless

Coalition, a loose group of area non-profits working to improve supports for WA

County’s homeless. The HSD Administrator has recently attended meetings with Youth

and Family Project, Family Promise, the United Way, and St. Vincent de Paul’s, and will

be working with the Coalition to develop a comprehensive plan for improving our

Emergency Shelter program for single men.

g. Comprehensive Community Services (CCS) Audit: Washington County’s CCS Program

recently received high acclaim and a two-year certification for its CCS Program

following a site audit from the Department of Quality Assurance.

HSD Management Team Report March 9, 2016 2

3. Children and Families Division: a. Child Protective Services (CPS): The CPS Access and Initial Assessment Unit has

struggled with turnover and in its efforts to hire new staff over the last few months. The

difficulty is related in part to the fact that we require Master of Social Work degrees for

the position. Many counties use Bachelor level staff in this same position. Our CPS unit

will be piloting the use of Bachelor level staff and has reposted the remaining open

positions as “Master of Social Work preferred”.

b. Juvenile Justice (JJ) Team Planning: Work continues on implementing the JJ Dashboard

and moving the team’s focus to a standard approach and monitoring of evidence based

practices.

c. Children’s Long Term Care (CLTS) Program Reboot: Work continues on the

development of new Policy and Procedure based on our recent internal program

discussions and contact with the state.

4. Economic Support Division:

a. Open enrollment for insurance through the Federal Marketplace began November 1, 2015

and ended January 31, 2016. BadgerCare applications, received as referrals from the

Marketplace and processed by Moraine Lakes Consortium staff, totaled 4,221. This is

25% of the total applications received (15,282) during open enrollment and is up 13%

from the same period last year. By comparison, process an average 3,800 applications per

month outside of open enrollment. Because of this ongoing workload associated with the

Affordable Care Act, consortium will continue to work with the Department of Health

Services in an effort to maintain ACA funding in future budgets.