Loading...
HomeMy WebLinkAboutAgenda - 03-05-2009 - Attachment 2 Attachment 2 Community Service Departments FY 2009-10 Departmental Budget Summaries And Reduction Impact Statements FY 2009-10 Departmental Budget Summary Department Social Services 2008-2009 Performance Highlights (January 2009 Numbers) • Provided Food and Nutrition Services to 3,497 families. (12% increase since July 2008) • Provided Medical insurance for 6,082 families through Medicaid and Health Choice. (4% increase since July 2008) • Issued 764 emergency assistance payments for rent, utilities and other basic needs. (500 more than this time last year) • Provided services to 257 children through child welfare services, in addition to 145 foster children. • Provided services to 246 disabled or elderly adults, in addition to 17 legally appointed wards. O Exceeded performance criteria for Work First demonstration grant, which may qualify the county for additional funding in FY2009-10. 0 • Provided child care subsidy to 758 children, but have a waiting list of 283. O Provided preventive services to 1,198 children through adolescent parenting, school social work and related programs. 2009-2010 Budget Impacts * Reduced costs for planned automation projects, eliminated purchase of cars for social workers, and reduced administrative costs for all programs. O Reduced contract for job services with Orange Enterprises by $10,000. • Reduced contract for job services with Center for Employment Training by $5,000. • Eliminated financial counseling contracts with a private contractor and the Women's Center. O Eliminated funding to the Department of Aging for management of the Wheels to Work program. This program will likely be suspended. • • Reduced contract for Fatherhood Program with a private contractor by $10,000, eliminating the one-on-one client sessions. O Reduced cost of OPC contract to assist with locating mental health services for DSS clients. O Reduced in-home aide services by $46,000, resulting in fewer hours of service to each client and fewer clients receiving in-home aide services. O Funds for administrative costs at Skills Development Center will be reduced requiring partners who use the facility to pay their own expenses. O Justice Partnership funds were reduced resulting in the coordinator being assigned additional duties. This will reduce time spent on monitoring functions with contractors. 1 • Additional revenue is budgeted in economic services for Justice Partnership Coordinator and Veterans' Services Officer. This will require each of these staff members to assume additional responsibilities resulting in them having less time committed solely to Justice and Veterans activities. • County funds in the amount of $50,000 for child care subsidy, previously committed by the Commissioners, have been eliminated resulting in 33 fewer children having the ability to utilize this funding to receive child care. Positions with Funding at Risk • School Social Workers — 8 Positions. These are 50% funded by Medicaid and 50% funded by the Orange County Schools system. Medicaid funding for this program is at risk. A moratorium is currently in place that allows this funding to continue until June 30, 2009. • Hospital Staff — 1 Full-time, 1 Part-time Position. UNC Hospital pays 100% of the non-federal share via a contract. • Justice Partnership — 1 Position. This position is funded through a combination of funds from Orange County, Chatham County, and a state grant. • Work First Demonstration Grant — 3 Positions. These are time-limited positions tied to a Work First grant. Some amount of grant funding is • expected to continue through FY2009-10. C C 2 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. • Department Social Services —4050 Subsidy 10405020 761000 Program Payments S-1 Proposal (Provide a brief description of the service change) The amount of funding for program payments will be reduced by 1.0% per budget directives. This funding is used for continued recruitment efforts for the Foster Care program. Services include providing Hepatitis B vaccines and CPR training for foster parents. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($600) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, the agency will be unable to provide required vaccinations. and trainings for 12 potential foster parents at a time when there is an increased need for foster parents to care for children in DSS custody. Department Social Services —4050 Subsidy 10405020 764000 Child Day Care S-1 Proposal (Provide a brief description of the service change) The amount of funding for child day care will increase based on state estimates. This is funding to pay for subsidized care for children whose parents are working and cannot otherwise afford the costs of licensed child care. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 3 $187,545 (This money is 100% federal) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the agency to continue the current rate of service for children receiving child care subsidy. The additional amount will not be sufficient to remove children from the waiting list. The current waiting list (February 1, 2009) is 283 children and the current wait time is approximately 6 months. Department Social Services —4050 Subsidy 10405020 764100 Adult Day Care S-1 Proposal (Provide a brief description of the service change) The amount of funding for adult day care will increase based on state estimates. This funding helps to provide adult day care to aged and/or disabled adults in Orange County that could not otherwise afford the costs. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $2,612 (This money is 100% federal) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the agency to continue to provide adult day care services to clients in need and matches the revised budget numbers for FY2008-09. Department Social Services —4050 Subsidy 10405020 764200 County Day Care S-1 Proposal (Provide a brief description of the service change) The amount of funding for county day care will be eliminated to meet the required overall budget cuts. This is match funding to encourage businesses, churches and other community groups to sponsor a child, paying 50% of the child's cost of care for 6 months so that the child can receive services and move off the waiting list. This funding was one of the county's responses to the long wait lists for child care subsidy and helps parents maintain their employment. S-1 Fiscal Impact (This number should correspond to the amount included 4 on the department's budget request excel spreadsheet) ($50,000) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This elimination of funding will mean that approximately 33 fewer children can participate in the sponsorship program causing the wait list to lengthen and wait times for subsidy to increase. The current waiting list (February 1, 2009) is 283 children and the current wait time is approximately 6 months. Department Social Services —4050 Subsidy 10405020 765000 General Assistance Utility Deposits S-1 Proposal (Provide a brief description of the service change) The amount of funding for general assistance utility deposits will be reduced per budget directives and current need. These funds allow to agency to provide a promissory note to local utility companies to turn service on for clients previously disconnected for failure to pay or without sufficient credit history to waive the deposit. Funds are used only when the client defaults. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($1,500) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, 5 fewer promissory notes will be able to be issued if needed. Department Social Services — 4050 Subsidy 10405020 766001 Foster Care Board S-1 Proposal (Provide a brief description of the service change) The amount of funding for foster care board payments will be increased based on a rate increase and the number of children in care. The foster care board rate is the amount of money paid monthly to foster families and other institutions to provide care, clothing, food and other items for Orange County foster children. S-1 Fiscal Impact (This number should correspond to the amount included 5 on the department's budget request excel spreadsheet) $12,536 (At least 50% of the board cost is reimbursed) SA Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the agency to continue to provide placements and foster care payments for all of the children currently in custody. The number is currently 145. Department Social Services —4050 Subsidy 10405020 767000 Adoption S-1 Proposal (Provide a brief description of the service change) The amount of funding for adoption will be increased based on the increased number of children in adoptive placements and based on a state increase in the monthly rate to parents. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $25,000 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the agency to continue to complete adoptions for children who are in DSS custody and freed for adoption. This would impact achieving permanence for more than 20 children. This line item is for the county share of the costs which are also supported by state and federal funds. Department Social Services —4050 Subsidy 10405020 767001 Adoption Vendor Payments S-1 Proposal (Provide a brief description of the service change) The amount of funding for adoption vendor payments will be increased based on the number of children in care. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $10,000 (About 85% is paid for by the state.) 6 S-.1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the agency to continue to provide necessary services for DSS children who have been adopted. Department Social Services —4050 Subsidy 10405020 768000 Psychological S-1 Proposal (Provide a brief description of the service change) The amount of funding for psychological evaluations will be reduced by 10% per budget directives. Outside psychological evaluations for parents involved with Child Protective Services will be reduced. These are frequently court-ordered. A contract for clinical support will also be eliminated. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($3,600) ($43,000 of this line item is Smart Start funded.) S-1 Description -- Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, the county will be'able to provide fewer psychological evaluations for parents involved with CPS. This can be a barrier to: returning children to their families; confirming that reduced mental capacity or instability is an issue for a family potentially resulting in leaving vulnerable children in an unsafe environment; and confirming that reduced mental capacity or instability is so significant that children cannot be safely returned home. Department Social Services —4050 Subsidy 10405020 768100 County Social Services S-1 Proposal (Provide a brief description of the service change) The amount of funding for handling unclaimed bodies will be reduced by 10% per budget directives. When no other claimant can be found, bodies of deceased persons become the responsibility of the county. 7 S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($500) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. If demand exceeds available funding, funds will have to be moved from another line item to meet this mandate. 8 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Social Services —4001 DSS Central Administration 10400110 511000 Temporary Personnel S-1 Proposal (Provide a brief description of the service change) The amount of funding for temporary personnel will be reduced 10% per budget directives. These funds are used to provide temporary personnel when vacancies or emergencies occur in critical areas. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($390) (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This decrease will result in 24 fewer hours of temporary staff activity and could result in longer wait times and slower responses in public assistance. Department Social Services —4001 DSS Central Administration 10400120 530000 Travel, 530100 Training/Development, 540000 Telephone, 550000 Postage, 560900 Motor Pool, 571000 Equipment Repairs, 590000 Duplicating, 600000 Advertising, 611000 Subscriptions, 680000 Board Allowance, 740000 Capital Under$250 S-1 Proposal (Provide a brief description of the service change) The amount of funding for the administrative line items listed above has been decreased per budget directives. These include funds for travel and training, cell phones for field staff, postage, motor pool and personal mileage for staff making 9 home visits, equipment repairs, costs associated with duplicating and advertising, subscriptions, funds for the Social Services Board for training and travel, and Capital purchases under $250. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($24,696) (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The decreases in these line items will have significant impacts on agency staff and services. Field staff who require a cell phone for safety may have to do without. Due to the reductions in both motor pool and personal mileage, it may be difficult for staff to make required home visits. The agency will also be severely limited in the amount of training it can fund. Certain types of training are mandatory for new staff in Child Welfare. Department Social Services —4001 DSS Central Administration 10400120 580000 Building Rent S-1 Proposal (Provide a brief description of the service change) The amount of funding for the building rent will increase due to the lease being budgeted for a full twelve months. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $534,027 (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service,delivery impact of the proposed reduction/change. This increase is for the building rent for the full twelve months. Department Social Services —4001 DSS Central Administration 10400120 591000 Printing S-1 Proposal (Provide a brief description of the service change) The amount of funding for printing will be increased due to consolidation with Skills Development Center line item. 10 • S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $1,000 (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase consolidates this line item with the printing line item in Skills Development Center, and is a net decrease from FY2008-09. Department Social Services —4001 DSS Central Administration 10400120 620000 Departmental Supplies • S-1 Proposal (Provide a brief description of the service change) The amount of funding for departmental supplies will be increased in order to provide supplies for cleaning Hillsborough Commons. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $24,068 (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will provide supplies for cleaning Hillsborough Commons and is based on estimates from Public Works. Department Social Services —4001 DSS Central Administration 10400120 621000 Office Supplies S-'1 Proposal (Provide a brief description of the service change) The amount of funding for office supplies will be increased to absorb amounts moved from line items in Skills Development Center and Economic Services. ($1,000 and $2,000) SA Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $3,000 (State/federal reimbursement is 50%) 11 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The increase allows the consolidation of line items from Skills Development and Economic Services, and is a net decrease. Department Social Services —4001 DSS Central Administration 10400120 629000 Other Supplies S-1 Proposal (Provide a brief description of the service change) The amount of funding for other supplies will be increased to absorb amounts moved from line items in Skills Development Center and Economic Services. ($1,500 and $2,000) S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $3,500 (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The increase allows the consolidation of line items from Skills Development and Economic Services, and is a net decrease. Department Social Services —4001 DSS Central Administration 10400120 630000 Contract Services S-1 Proposal (Provide a brief description of the service change) The contract with Northwoods Consulting Partners will be decreased to reflect the replacement of professional services with maintenance agreements. • S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($200,000) (State/federal reimbursement is 50%) 12 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, no new IT licenses or software products may be purchased. If funding appropriated in the FY2008-09 budget cannot be used, this reduction may impact the ability of staff to share information efficiently regarding shared clients and could lead to duplication of effort. Department Social Services —4001 DSS Central Administration 10400120 630200 Verification Fees S-1 Proposal (Provide a brief description of the service change) The amount of funding for verification fees will be reduced by 10% per budget directives. These funds are used to verify reserve amounts for various public assistance programs. SA Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($250) (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, less money will be available to verify reserve amounts for various public assistance programs. This could result in inaccurate issuance of benefits. Department Social Services —4001 DSS Central Administration 10400120 630300 CommunityNolunteer Services • S-1 Proposal (Provide a brief description of the service change) The amount of funding for community and volunteer services has been reduced per budget directives. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($4,500) (State/federal reimbursement is 50%) 13 • S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This reduction will cause less money to be available for community outreach services. Department Social Services —4001 DSS Central Administration 10400120 650000 Electricity, 651000 Water, and 652000 Natural Gas S-1 Proposal (Provide a brief description of the service change) The amount of funding for utilities including electricity, water and natural gas will be increased due to the move to Hillsborough Commons. This estimate is based on information from Public Works. SA Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $150,094 (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will result in electricity being provided to all of Social Services' space at Hillsborough Commons. 14 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Social Services —4002 Children/Family Services 10400210 510100 Overtime S--1 Proposal (Provide a brief description of the service change) The amount of funding for overtime will be reduced by 10% per budget directives. This funding is used to allow staff in child welfare to provide on-call and after hours emergency services. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($5,000) (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, fewer staff will be able to work extended hours. This may result in the need for a county on-call policy. It may also result in children and families not being seen as needed or work not being completed as required. It could present an increased risk for abused and neglected children. Department Social Services —4002 Children/Family Services 10400220 630000 Contract Services S-1 Proposal (Provide a brief description of the service change) The amount of funding for contract services will be reduced by 10% per budget directives. The costs contained in this line item relate to the in-home aide program. This program provides in-home care to elderly and disabled adults in Orange County so that they can continue to live in their home without risk of placement. 15 S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($46,183) (A portion of these costs are paid by the state) S-1 Description — Describe, in detail, the service delivery impact of the •proposed reduction/change. Due to the reduction, the agency will be able to provide 3,207 fewer hours of in- home aide to clients. This will result in clients receiving fewer hours of in-home services and/or fewer clients receiving services. It could result in the formation of waiting lists for these services. Department Social Services —4002 Children/Family Services 10400220 630004 Emergency Care Contract S-1 Proposal (Provide a brief description of the service change) The amount of funding for the emergency care contract will be reduced by 10% per budget directives. This program provides a liaison between Orange County DSS and OPC to assure that children served by Social Services who need mental health services are immediately engaged in the mental health system. The county and Juvenile Justice each fund 50% of this position. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($3,200) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, Juvenile Justice and/or OPC will be asked to pick up the additional costs. If they are unable to do so, the hours of the liaison will have to be reduced or the program may have to be eliminated. Elimination of this program would mean that 128 children per year would have difficulty receiving needed mental health services. Additionally, 22 children would have trouble accessing rapid response mental health beds, 30 children would not have mental health assistance in their placements, and 20 parents involved with child welfare could have trouble accessing their own mental health services. 16 Department Social Services —4002 Children/Family Services 10400220 632010 Court Ordered Tests SA Proposal (Provide a brief description of the service change) The amount of;funding for court ordered tests will be reduced from $20,000 to $17,500 per budget directives. These funds pay for costs to cover drug testing for parents in certain Child Protective Service cases. SA Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) • ($2,500) • SA Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, staff will be able to pay for 34 fewer drug tests for parents involved with Child Protective Services. This can be a barrier to returning children to their families, and can also be a barrier to confirming that substance abuse is an issue for a family potentially resulting in leaving vulnerable children in an unsafe environment. Department Social Services —4002 Children/Family Services 10400220 680012 Child Welfare SA Proposal (Provide a brief description of the service change) The amount of funding for child welfare services will be reduced per budget directives and state allocations. This funding covers incidental needs for children involved with Child Protective Services and helps prevent removal of children from the home by providing items that might allow a child to remain safely at home or remain with relatives. It is also used to support permanency for children in DSS custody. SA Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($12,305) (The remaining money is 100% state funded). This cut reflects an anticipated reduction in the allocation for this service from the state. SA Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This reduction will limit the resources available to the agency to prevent the removal of children from the home in child protective services cases. 17 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Social Services —4030 Economic Services 10403010 510100 Overtime S-1 Proposal (Provide a brief description of the service change) The amount of funding for overtime will be reduced by 10% per budget directives. This funding is used to allow staff in the public assistance areas to work an occasional weekend to catch up on paperwork as their workloads have increased. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($250) (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, fewer staff will be able to take advantage of weekend hours to catch up on paperwork causing processing times in income maintenance programs to become slower. Department Social Services —4030 Economic Services 10403020 550000 Postage-E13T. S-1 Proposal (Provide a brief description of the service change) The amount of funding for EBT services will be reduced based on state estimates. This money covers the county costs.related to the Food and Nutrition Services call center and the issuance of EBT cards used by clients. • 18 S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($9,000) (State/federal reimbursement is 50%) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This reduction is based on state budget estimates and takes into account the number of Food and Nutrition Services clients and call center usage. If the call center is used at a higher rate than budgeted, costs to pay the county share will have to be taken from another line item. Department Social Services —4030 Economic Services 10403020 630000 Contract Services S-1 Proposal (Provide a brief description of the service change) The contract for the Center for Employment Training (CET) will be decreased from $30,000 to $20,000 based on current usage and,budget directives. This contract provides comprehensive vocational training for Work First Participants. This program is used primarily for hard to serve clients. S-1 Fiscal Impact This number should correspond to the amount included on the department's budget request excel spreadsheet) ($10,000) (The remaining funds are made up of 100% federal TANF money or • the required Maintenance of Effort to receive these funds.) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, fewer clients will be able to be referred to CET for vocational training. It is estimated that the number of clients that can be served by the program will decrease by 5. S-2 Proposal (Provide a brief description of the service change) The contract for Orange Enterprises (OE) will be decreased from $15,000 to $10,000 based on usage and budget directives. This contract provides intensive case management services to the hardest to serve Work First families. It provides services that enable individuals with employment barriers to maximize their vocational potential through employment. 19 S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($5,000) (The remaining funds are made up of 100% federal TANF money or the required Maintenance of Effort to receive these funds.) S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction, fewer clients will be able to be referred to OE for vocational training. It is estimated that the number of clients that can be served by the program will decrease by 2. S-3 Proposal (Provide a brief description of the service change) The two contracts for financial counseling, one with Harvey Reid and the other with the Women's Center, will be eliminated and those services will be brought in-house. These contracts provide financial education and counseling to families receiving emergency assistance and Work First. They also introduce families to methods of record keeping and assist families with developing solutions to financial crises. S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($25,675) S-3 Description — Describe, in detail, the service delivery, impact of the proposed reduction/change. Due to the elimination of these contracts, fewer financial counseling services will be available,to clients. Social Workers within the agency will provide some degree of financial counseling services but the agency will no longer have someone doing this full-time. This may result in the loss of financial counseling services for approximately 567 Orange County residents. S-4 Proposal (Provide a brief description of the service change) The contract for the Fatherhood Program with Harvey Reid will be reduced from $25,000 to $15,000. This program assists non-custodial fathers, of Work First children, who are unemployed or underemployed to obtain employment, provide for their families (financially and emotionally), and contribute to the community. S-4 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($1 0,000) (The remaining funds are made up of 100% federal TANF money or the required Maintenance of Effort to receive these funds.) 20 S-4 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction of this contract, the program will no longer provide one-on- one counseling with the men in the group and will be limited to the group sessions. Staff will be reassigned to manage these one-on-one meetings if possible. S-5 Proposal (Provide a brief description of the service change) The Transportation Manager contract with Orange Public Transportation will be eliminated. The purpose of this contract is to assess the transportation needs of Work First families and develop individualized transportation plans. It also includes administration of ROAP funds to assist with car repairs and Wheels for Work to provide used cars for Work First clients. S-5 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($15,000) S-5 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the elimination of this contract, the duties described above will be brought in-house and the funds will be used to continue to assist with the transportation needs of Work First clients.. There will be a reduction in the effort to solicit and repair donated cars for low income families. S-6 Proposal (Provide a brief description of the service change) The contract with North Carolina Baptist Hospital to provide assessment services for Work First clients will be added. This service is mandated and funds are appropriated by the state specifically for this purpose. S-6 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $20,000 (These funds are made up of 100% federal TANF money or the required Maintenance of Effort to receive these funds.) S-6 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This contract will allow Baptist Hospital to provide work assessment services for Work First clients. S-7 Proposal (Provide a brief description of the service change) There is an increase in contract funds due to the increased amount of supplies needed to bring other formerly contracted services in-house. This includes 21 household budgeting materials for clients, funds for car repairs and other supplies related to these services. S-7 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $32,115 (These funds are made up of 100% federal TANF money or the required Maintenance of Effort to receive these funds.) S-7 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow services formerly contracted out to be administered by existing staff. Department Social Services — 4030 Economic Services 10403010 760100 CHIPS Reserve S-1 Proposal (Provide a brief description of the service change) The amount of funding for the CHIPS Reserve will be reduced by 10% per budget directives. This fund assists families in paying their premium for North Carolina Health Choice, a health insurance program for children of low-income families. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($100) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This reduction is equal to the amount of premium payments for two children receiving Health Choice. Failure to pay the premium could result in ineligibility for the health insurance program. Department Social Services —4030 Economic Services 10403010 761000 Program Payments S-1 Proposal (Provide a brief description of the service change) The amount of funding for program payments will be increased from $50,000 to $70,000 due to the increased demand and the absorption of funding previously 22 included in within the Skills Development Center section of the budget. Program payments include funds for gas, clothing, books, and supplies related to obtaining a job. S-.1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $20,000 (These funds are made up of 100% federal TANF money or the required Maintenance of Effort to receive these funds.) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase should allow the agency to meet the increased participation expenses in the Work First program. Department Social Services —4030 Economic Services 10403010 511000 71080 Temporary Personnel • S-1 Proposal (Provide a brief description of the service change) The amount of funding for temporary personnel will be increased to the revised budget amount for FY2008-09. These funds are used to allow Work First clients to be hired on as temporary staff members in the Department of Social Services and other county agencies to help meet the Work First participation rate and assist clients with obtaining employment experience. (This program is 100% funded by the state and federal government.) S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $27,344. Although this appears as an increase, there is no county increase since these costs are funded with 100% federal funds. S.-.1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the program to continue its success. It will allow clients to work part-time in county jobs in order to gain work experience. Department Social Services —4030 Economic Services 10403020 530500 71080 Personal Mileage, 540000 71080 Telephone, 560900 71080 Motor Pool, 590000 71080 Duplicating, 621000 71080 Office Supplies, 629000 71080 23 Other Supplies S-1 Proposal (Provide a brief description of the service change) The amount of funding for all of the above line items will be eliminated in this section per budget directives and Work First Demonstration Grant funding allotments. Partial funding for the following items will be moved to Central Administration: Motor Pool $1,800; Duplicating $1,350; Office Supplies $2,000; and Other Supplies $2,000. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($15,374) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction and/or elimination of these funds, staff involved in the Work First Demonstration Grant will have less money available for most of the administrative functions of the program. These funding cuts could restrict home visiting, reduce telephone follow-ups, lessen paper materials used in classes, • and curb other work activities designed to assist clients in obtaining jobs. Department Social Services —4030 Economic Services 10403010 761000 71080 Program Payments S-1 Proposal (Provide a brief description of the service change) The amount of funding for program payments will be reduced from $85,000 to $20,000 per budget directives and Work First Demonstration Grant funding allotments and related realignment. Program payments include clothing allowances, work incentives and other supplies used to help clients find and maintain employment. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($65,000) (These funds are 100% federal) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due the reduction, 80 fewer clients will be able to receive work supplies, clothing allowances, and incentives for job retention and behavioral modification. This could result in loss of employment, failure to find employment and a decreased participation rate. State and county funding in this program is tied directly to the participation rate. 24 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Social Services —4031 Skills Development Center 10403120 540000 Telephone, 550000 Postage, 590000 • Duplicating, 591000 Printing, 600000 Advertising, 610000 Dues, 611000 Subscriptions, 621000 Office Supplies, 629000 Other Supplies, 683000 Transportation Parking, 761000 Program Payments SA Proposal (Provide a brief description of the service change) The amount of funding for all administrative line items for the Skills Development Center has been reduced or eliminated per budget directives. Any remaining funds will be used for Social Services staff located or working on-site. Partners co-located at the Center will be asked to pay their own costs. Partial funding for the following items will be moved to Central Administration: Printing $1,000; Office Supplies $1,000; and Other Supplies $1,500. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($13,401) • S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction and/or elimination of these funds, staff located at or working in the Skills Development Center will have less money available for most of the administrative functions of the Center. These funding cuts could restrict activities designed to assist clients in obtaining jobs. Partners co-located at the Center will be asked to pay all of their own ccists. • 25 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Social Services -4000 Public Assistance 10400020 760001 Special Assistance to Adults S-1 Proposal (Provide a brief description of the service change) The amount of funding mandated for Special Assistance will be increased based on state estimates. This is a program that pays for rest home care for eligible clients in Orange County. The amount budgeted represents the county share (50%) of these costs. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $33,851 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The increase is related to the rates, which are set by the North Carolina Legislature and will allow the agency to maintain the current service level. Department Social Services —4000 Public Assistance 10400020 760020 TANF County Initiated S-1 Proposal (Provide a brief description of the service change) The amount of funding for county initiated TANF payments will be reduced by 10% per budget directives. The State of North Carolina and all 100 County DSS agencies are under Federal Court order (Alexander vs. Britt) to provide Work First benefits to eligible clients within a specified time frame from the date of application. This requires counties to issue the first Work First check for each client and then claim federal and state reimbursement in order to comply with this 26 order. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($100) (This money is 100% federal) S-1•Description — Describe, in detail, the service delivery impact of the . proposed reduction/change.. This decrease could result in noncompliance with the Alexander vs. Britt court order if payments cannot be made timely. This funding has 100% matching revenue. Department Social Services —4000 Public Assistance 10400020 760050 Crisis Intervention S-1 Proposal (Provide a brief description of the service change) The amount of funding mandated for Crisis Intervention will be increased based on state estimates. This program provides emergency funds for costs related to eligible clients' heating and cooling expenses. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $31,176 (This money is 100% federal) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This increase will allow the county to serve 51 more clients than the FY2008-09 original appropriation. Department Social Services —4000 Public Assistance 10400020 760070 EMS Assistance Program S-1 Proposal (Provide a brief description of the service change) Funding for the EMS Assistance Program will now be included in the Social Services budget instead of the EMS budget. This funding pays the costs of ambulance transportation for indigent Orange County residents. C 27 S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $5,000 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This funding will allow indigent residents to receive emergency ambulance services and continues the program previously funded outside the Social Services budget. ( 28 l Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Social Services — 7050 Orange Chatham Justice Partnership 29705020 530000 Travel, 530500 Personal Mileage, 540000 Telephone, 550000 Postage, 590000 Duplicating, 591000 Printing, 620000 Departmental Supplies, 621000 Office Supplies SA Proposal (Provide a brief description of the service change) The amount of funding for many administrative line items for the Justice Partnership has been reduced or eliminated per budget directives. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) ($13,809) S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to the reduction and/or elimination of these funds, staff will have less money available for most of the administrative functions of the program. 29 C 7 FY 2009-10 Departmental Budget Summary Department Health 2008-2009 Performance Highlights • Investigated and responded to 14 whooping cough (pertussis) cases through February, requiring antibiotics for more than 300 children and over 200 hours of staff time. * Averaged 19 new refugee arrivals each month requiring 4-6 hours of services for each refugee. o Prenatal, immunization, and child health services have increased by an average of 15% over the previous year. O Demand for the full suite of water tests has exceeded projections by 200% through February. O Food, lodging and institutional inspection compliance rate for 07-08 estimated by the state was 94%. O 1223 children and adults received a total of 6,164 dental clinical services in the first six months, a 24% increase in services and an 11% increase in unduplicated patients. • Increased number of patients receiving language services by reducing costs through additional new telephone service and by recruiting 5 Burmese/Karin/Chin contract interpreters. • More than 270 volunteers are active through the Orange County Medical Reserve Corps. • Received renewed 3 year grant award for Youth Tobacco Prevention Program (2009-2012). 2009-2010 Budget Impacts a Eliminate Student Stipend for Community Health Assessment ($9,000) • Eliminate Development of New "Time Study" ($5,000) * Reduce Information on Community Health Needs and Policymaking to Community ($1,000) • Suspend Hiring for the Dental Hygienist/Community Dental Care Coordinator Position for the 09-10 year ($10,170) • Discontinue Recruitment of Participants for the Mouthguard Project. ($2,195) O Reduce Dental Services Operating Expenses ($3,805) * Eliminate Student Stipends for Administrative Projects in Dental Health Services ($2,325) O Reduction in Certification and Licensure Allocations for Clinical Dental Staff ($1,489) 30 • Eliminate Access to Dental Clinical Services at Carr Mill Mall ($67,641) • . Reduction in Staff Training, Continuing Education and Professional Development for Health Promotion and Education Services ($3,437) • Eliminate Community Outreach Education and Reduce Technical Support, Training, and Service to Community ($2,520) • Eliminate Elements in the Quality Assurance — Program Improvement Program in Environmental Health Services ($1,300) • Eliminate Response to Community Concerns about Environmental Issues, Environmental Complaints with No Formal Program Mandate, and Radon Testing Services for Water and Air ($5,750) • Eliminate Mailing of Permits, Educational Material, Forms, and Information ($2,300) • Reduce Professional Development for Environmental Health Services Staff ($1,000) • Reduced Permitting Activity Due to Economic Downturn and Reduced • Building and Development Activity ($177,001 revenue reduction; $22,150 operating expense reduction) • Suspend Hiring for the Office Assistant Position for the 09-10 Year ($37,723) • Suspend Hiring for One EH Specialist Position for the 09-10 Year ($52,624) • Suspend Hiring for the EH Program Specialist Position in Food and Lodging Program for Latter Half of 09-10 ($36,483) • Discontinue Chronic Disease Care Coordination Program ($5,010) • Discontinue Refugee Health Assessment Program ($11,000) • Discontinue HIV Community Testing Program ($5,652) a Suspend Hiring of Medical Office Assistant for 09-10 Fiscal Year ($37,704) and Switch Funding Sources for Family Nurse Practitioner Training ($1,230) • Discontinue Operating Costs Associated with Public Health Nurse II in Preparedness ($2,110) • 31 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Health—By Alphabetical Order by Division/Unit S-1 * CAS -- Proposal (Provide a brief description of the service change) • Eliminate Student Stipend for Community Health Assessment S-1 * CAS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $9,000 Reduction S-1 * CAS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Elimination of a stipend for a master's level student from School of Public Health or Public Health Administration to conduct various projects for the health department. In previous years projects have included development of community survey for required community health assessment, data analysis for community surveys, acting as staff support for community assessment work groups, development of a quality assurance manual, development of a primary care business plan, developing and running a cost analysis for dental fees, preparation of a research review paper for the Board of Health on pharmaceutical and personal care products disposal into the wastewater stream. Community health assessment is required every four years and will require a staff diversion of resources to accomplish the requirements without the use of an intern. Generally the staff diverted would be from the Health Promotion and Education staff who have these skills. Community education on chronic disease management such as diabetes education would have to be discontinued in an assessment year. S-2 * CAS -- Proposal (Provide a brief description of the service change) Eliminate Development of New "Time Study" S-2 * CAS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $5,000 Reduction S-2 * CAS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. An annual agreement with the State of NC appropriates approximately $500,000 in State & Federal funds to Orange County Health Department. In order to claim these funds, a time study report (staff time & effort program) needs to be prepared each month. This report reflects staff time in various programs and the data in the report is used to claim 32 state &federal funds. A system of documentation (such as the time study) is required. The time study that OCHD is currently using is over 15 years old, written using an old version of Excel, and can no longer grow to accommodate newer programs. Inaccuracies and • inefficiencies are present in the current program that is unable to be updated. In addition, this documentation is used to calculate the amount of Medicaid cost settlement that the department may be eligible for on an annual basis. For the past 8 years, the cost settlement amount has been approximately $200,000 annually. If the documentation is inaccurate, an audit could result in a county pay back situation. Failure to have a functional staff time and effort program could result in a loss of up to $700,000 annually. S-3 * CAS -- Proposal (Provide a brief description of the service change) Reduce Information on Community Health Needs and Policymaking to Community S-3 * CAS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $1,000 Reduction S-3 * CAS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The Health Department provides a variety of population-based services to the community. In addition to clinical services for personal health & dental, awareness of other services/programs is crucial to having/maintaining a healthy community. Printing has been used to defray the costs of producing the Community Health Assessment and the Annual State of the County Health Report (required documents) when donated or private funds cannot be located. If the Board of Health engages in making a new rule or modifying an existing rule, advertising the rule change in a local newspaper is required and provides the public with a notice to be able to comment. Should a need arise for this purpose, the department would need to identify funding from an alternative line item. S-4* DHS -- Proposal (Provide a brief description of the service change) -- Suspend Hiring for the Dental Hygienist/Community Dental Care Coordinator Position for 09-10 S-4 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $10,170 county funds reduction; Revenue reduction of$36,687. S-4 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This position was scheduled to work two days per week providing 492 dental clinical treatment visits generating $36,687 in revenue. There will be a reduction in 492 dental visits. Of the total patient visits, 142 were for prenatal clients of the OCHD. In an effort to reduce premature and low birth weight infants, the health department was going to offer dental cleanings to prenatal clients through the OCHD Dental clinics. 33 It has been documented that pregnant women who have periodontal disease maybe as much as seven times more likely to have a baby that is premature. "Pre-existing gum disease or gum disease that increases in severity during pregnancy can also increase a woman's chances of a pre-term or low birth-weight baby. Because gum disease is often "silent" many women don't know they have it, so a dental evaluation is definitely encouraged." In addition to providing dental clinical treatment services, the program was going to educate new mothers about the importance of their oral health and how it is related to their baby's health, infant oral health prevention for their child, and establishing early dental homes for families. There also have been studies linking the spread of dental disease from parent and/or caregiver. In 2005, Orange County had an 8.1 low birth weight, 8.7 rate of perinatal deaths, 5.1 fetal deaths, 3.5 neonatal (under 28 days) deaths, 2.9 post neonatal (28 days-1 year) deaths and 6.5 rates of infant (under 1 year) deaths. In 2004 there were 2.1% of pregnant mothers that received late or no prenatal care. Standards of Care, recommendations and studies are through the American Dental Association and American Academy of Pediatric Dentistry. The Smart Start Dental Screening, Education and Referral Program will continue in FY 09- 10 with grant funds of$33,850 through contract services and a small amount in temporary personnel. The grant funds were distributed in project codes in the dental budget. Approximately 1,800 preschool children receive screening and education services including follow up for identified problems. The reduction in revenue ($36,687) in the dental program for 09-10 is revenue that would have been earned by this vacant dental hygienist position. S-5 * DHS -- Proposal (Provide a brief description of the service change) Return Funding for Smart Start Dental Screening, Education and Referral Project to Grant Funds Only Reallocates only grant resources to dental budget. Related to S-4 *DHS • S-5 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) (0) Return funding of Smart Start Dental Screening, Education and Referral Project to grant funds only. S-5 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The Orange County Partnership for Young Children (the local Smart Start agency) has funded the Preschool Dental Screening and Treatment Project since the early 90s. This reallocation returns grant funds to line items that have been used to accomplish the grant outcomes in previous years. These funds are used to conduct only grant authorized services that include dental screenings and education to children age 0-5 in childcare facilities in Orange County and follow-up services for those children that were found to have dental needs. Approximately 1,800 children receive services through this ( program each year. The program operates with a temporary dental hygienist funded for $8,200 to provide dental screenings and education to children and education workshops to 34 child care providers. At no cost to the program, dental hygiene students from UNC School of Dentistry provide the bulk of the dental screenings and education through their Community Dentistry curriculum that is coordinated by the Smart Start Dental Program Coordinator with a contract through the grant for $14,500. Included in the total grant funds of $33,850 are operating expenses of$8,450 and $2,700 for follow-up services. This program does not generate revenue; direct costs are paid by the grant as detailed above. S-6 * DHS -- Proposal (Provide a brief description of the service change) Smart Start Dental Screening, Education and Referral Program with 10% Reduction in Revenue and Expenses S-6 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Cut $3,385 from Smart Start grant funds and $3,385 from revenue S-6 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. $2,700 was cut from Contract Service to pay for a contract person to provide follow-up services for those children that were found to have dental needs through the Smart Start Dental Screenings. For fiscal year 09-10, the Dental Health Service Division Director will be responsible for the follow-up services. Approximately 1,800 children receive dental screenings and of those 1,800, 150 children may have dental needs. The follow-up services include contacting the parents to determine barriers to dental care and assist with access to dental care for those children with needs. The diversion of the director's duties will be in the area of quality assurance, with fewer audits being performed and less time available for program oversight and coordination with community dental providers such as for Project Homeless Connect. $685 was cut from Departmental Supplies that were used in follow-up to re-screen the children with dental needs. The re-screening of children with dental needs was done to determine if the children actually did receive dental care after being screened. The re- screen cannot be done since a public health dental hygienist must do the screenings. S-7 * DHS -- Proposal (Provide a brief description of the service change) Discontinue Recruitment of Participants for the Mouthguard Project. S-7 * DHS Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Costs associated with the Mouthguard Project = $2,195 total. $ 695 in Printing $1,500 in Medical/Dental Supplies S-7 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. 35 Printing cut $695: In order to promote the use of Mouthguards to prevent oral injuries to student athletes in five high schools and seven middle schools in Orange County Schools, 120 Mouthguard Manuals will not be distributed. Each manual costs $5.00 to produce for a total of$600. The manuals were to be distributed to coaches of 120 teams targeting the following athletic teams: basketball, soccer, field hockey, girl's lacrosse, baseball, softball, wrestling and volleyball. The 20 page color manual was used by the coaches to assist them in recruiting parent volunteers to be responsible for the Mouthguard Programs for each of their teams. The manual includes information on the OCHD Mouthguard Program and the Prevention of Oral Injuries. • One in ten youthful athletes can expect to suffer an orofacial injury every season. It can happen in any sport to both male and female players. Mouthguards can help stop oral injuries and make them less devastating and even prevent them. Studies show that properly-fitted mouthguards can also reduce the incidence of concussions and other impact-related injuries to the face, head and neck. Upon recruitment of student athletes through their teams, volunteer dental students from the UNC Dental School travel to the school, make impressions of the student's teeth and manufacture the mouthguard either at the dental school lab or at the health department. Each student is responsible for paying $10 to recover the cost of the supplies. Distribution of 2,500 Mouthguard Brochures to 2,500 student athletes approximately 20 players per team for 120 teams from 5 high schools and 7 middle schools in Orange County. 5 reams of color paper @ $4.00 each = $20 and printing of 2,500 brochures @ .03cents = $75 for a total of$95. Medical/Dental Supplies cut $1,500: The OCHD received two grants from previous years from Stroud-Roses Foundation to pay for the Mouthguard dental equipment, fixed supplies and disposal supplies. For the past year, after the grant funding, the expenses for the Mouthguard project included the purchase of disposable items. The disposable supplies to make 250 mouthguards includes the cost of the following supplies: $195 Disposable trays $259 Jeltrate impression material $166 Mouthguard Containers $100 Mouthguard Brochures $780 Mouthguard Material With active recruitment, it was anticipated that 250 athletes would seek mouthguards at a cost to the athlete of$10 each. Without active recruitment as detailed above, it is anticipated that fewer than 100 student athletes will participate in this program that is primarily provided by volunteers from the UNC Dental School. Staff will respond to direct requests from coaches but will not seek active participation. S-8 * DHS -- Proposal (Provide a brief description of the service change) • Reduce Dental Services Operating Expenses S-8 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 36 Reduce $3,805 in operating line item expenses: $600 Advertising $405 Printing $2,800 Bloodborne Pathogens S-8 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Advertising cut $600: There will be no advertisements to let residents know about the services offered by the OCHD Dental Clinics. Typical purchases were an ad in the Chapel Hill News Back to School insert and one advertisement for Give Kids A Smile and Children's Dental Health Month encouraging good dental hygiene. Printing cut $405: Distribution of 7,500 OCHD Dental Brochures at community events, school nurses and social workers, Headstart, private dental providers and medical providers in Orange County. 15 reams of color paper @ $4.00 =$60; and printing of 7,500 brochures @ .03cents =$225. Printing of Recall Reminder Cards are mailed out to dental patients for their six- month dental cleanings (average of 30 per month per dental clinic). The cards are mailed out to remind patients to call for their dental cleaning and check-up appointment. 720 recall reminder cards @ .25 cents each = $180. Many of OCHD patients do not have email or have consistent working phones. It is projected that this will decrease the number of patients who remember to call for an appointment and lead to increased tooth decay and gum disease in 25% (approximately 180) of these patients. Bloodborne Pathogen Supply cut $2,800: Through evaluation of our disposal of amalgam scraps and silver recovery from x-ray solution, the number of containers purchased for silver recovery, amalgam scraps and aluminum x-ray foil can be reduced. Prior to the institution of the ADA and NC Dental Society best practices for the disposal of amalgam and silver recovery, the OCHD projected the estimate of disposable containers annually. After two years, the supply usage was evaluated with Safety Kleen, Inc. and it was determined that supply and disposal rate could be reduced by $2,800. S-9 * OHS -- Proposal (Provide a brief description of the service change) Eliminate Student Stipends for Administrative Projects in Dental Health Services S-9 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $2,325 reduction • S-9 * OHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Students from UNC School of Public Health, Health and Policy Administration Program and UNC Dental School have worked on special projects for the Dental Health Service ( Division. Past special projects included the following: *Developed a Cost Study Analysis of our dental program in order to determine the cost of 37 dental clinical services that provided a formula for setting dental fees. *Formatted the Dental Policies and Procedures Manual for the Dental Health Service Division to meet Accreditation Guidelines. *Assisted in researching and writing the Oral Health Section of the 2007 Community Health Assessment. *Developed an Assurance Methodology Tool to be used in conjunction with Community Health Assessments in determining access to dental services in Orange County. Future projects included writing a Business Plan for the Dental Health Service Division, Access to Dental Care in Orange County for Safety Net Dental Providers; Developing plans for the addition of a dental clinic at SHSC and the new Hillsborough Commons Center. The students extend staff resources by surveying current research, developing tools and analyzing data. S-10 * DHS -- Proposal (Provide a brief description of the service change) Reduction in Certification and Licensure Allocations for Clinical Dental Staff S-10 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $1,489 reduction: $1,208 Reduction in the Certification and Licensing expense. $281 Reduction in Training. S-10 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Reduction in Certification & Licensing of$1,208: There are six clinical dental staff members (one dentist, one dental hygienist and four dental assistants). All need continuing education credits to renew their license and/or certification annually. The Certification and Licensing expense also includes payment renewal fees for their license and/or certification and for a total of eight dental staff to attend the NC Dental Public Health meeting. These are the minimum requirements for the dental staff to obtain updates in public health dentistry from the Oral Health Section. Currently the UNC School of Dentistry offers a reduced rate for certain classes to health departments that accept dental students on regular rotations. The proposed reduction is based on this reduced rate. If the dental school no longer can provide the reduced cost, the dental staff would not meet the requirements for licensing and/or certification, and would not be able to keep up with new techniques and best practices potentially increasing the risk for malpractice liability. The staff would incur the cost of license renewal fees and continuing education courses. Reduction in Training of $281: Two Dental Office Assistants will not be able to attend any workshops or trainings. The amount budgeted in the training line item is for the Dental Division Director to attend two courses from UNC School of Dentistry at the reduced rate for Bloodborne Pathogen Annual Update Training and Medical Emergencies/Risk Management which are mandatory. This training is used to keep policies and practices current with requirements. 38 S-11 * DHS -- Proposal (Provide a brief description of the service change) Eliminate Access to Dental Clinical Services at Carr Mill Mall S-11 * DHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Total Reduction for S-11 is $67,641: $62,291 Eliminate Building Rent $1,100 Eliminate copier rental $4,250 Eliminate telephones (& cost of monthly cable charges in the IT budget). There will be costs associated with moving and storage of the dental equipment and furniture unless a decision is made to auction it and there may be costs associated with premature termination of building lease. All of the office equipment except for two desks, 10 chairs and one table are from 1980 and should be surplus equipment. The desks, chairs and table can be utilized in other health department locations. We are projecting no loss of earned revenue since the client base will shift to the northern part of the county. Staff projections are that the demand is sufficient in the northern end of the county to serve an equivalent number of patients at the Hillsborough location. S-11 * DHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Closing the Carr Mill Dental Clinic would decrease access to dental clinical services for children and adults in the southern part of Orange County. Dental services would continue to be available to all Orange County residents but they would have to travel to the Hillsborough Dental Clinic. The Hillsborough Dental Clinic would operate Monday through Friday serving all Orange County Residents. The Carr Mill Dental Clinic currently serves 665 unduplicated patients annually for a total of 1400 returning patient visits and 186 new patient visits. Of those total visits, 38% are Hispanic/Latino patients. There are 802 children patient visits and 606 adult patient visits. Carr Mill Mall dental patients will likely not travel to Hillsborough for services, as their transportation resources are limited and the bus to Hillsborough requires a lengthy time commitment. These patients will need to find other safety net providers (Carrboro Community Health Center and UNC Dental Clinic) in the Southern part of the county. UNC Dental Clinics require upfront payment of services and operates their clinical appointments through a lottery system due to the demand for services. They report that usually patients entering the lottery are able to secure an appointment within three months of first entering the lottery. Carrboro Community Health Center Dental Clinic provides mainly urgent care dental services due to their demand volume and limited physical facility. Both the UNC Dental Clinic and Carrboro Community Health Center are not limited to Orange County residents and accept patients from all surrounding counties. In addition, Dental SHAC is a free dental clinic run by dental students from UNC School of Dentistry, operating two or three evenings a week at the Carr Mill Dental Clinic. If the clinic is closed, Dental SHAC would have to find another suitable dental office to continue their services. Approximately 380 patients are served annually through the Dental SHAC clinic receiving 800 free dental treatment services. Patients who are served through the Dental SHAC clinic are patients that are experiencing dental pain and are not able to receive regular dental care due to financial constraints. 39 S-12 * HPES -- Proposal (Provide a brief description of the service change) Reduction in Staff Training and Professional Development for Health Promotion and Education Services 5-12 * HPES -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction of$3,437: $205 --Travel • $1,000 -- Training $433 -- Certification & Licensing $1,000 -- Mileage $779 -- Telephone S-12 * HPES -- Description Describe, in detail, the service delivery impact of the proposed reduction/change. $2,205 Reduction for Travel, Training and Personal Mileage The remaining amount is necessary to cover required programmatic regional meetings and/or training updates. • This will impact Accreditation benchmarks that require additional annual training for professional staff that will be unable to be attended. (i.e.: Legal or Ethics training, Media training, job-specific training, etc.) Health Promotion staff will be less prepared to handle emerging issues and stay abreast of best practice methodologies. This reduction may also impact technical assistance and input to over 10 local boards, community coalitions and community task forces. • $433 Reduction in Certification and Licensure for our Registered Dietitians is reduced to cover only license renewal and an online training course for 2 staff—limited training and continuing education may jeopardize meeting licensure requirements and increase exposure to malpractice. RD Licensure is also necessary for billing and required for employment. $779 Telephone reduced due to reallocation of staff. S-13 * HPES – Proposal (Provide a brief description of the service change) Eliminate Community Outreach Education and Reduce Technical Support, Training and Service to Community S-13 * HPES -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction of$2,520: $ 1,125 Dept Supplies $ 1,320 Educational Supplies $ 75 Postage 40 S-13 * HPES -- Description – Describe, in detail, the service delivery impact of the proposed reduction/change. $2,445 Reduction in Departmental & Educational Supplies: Elimination of interactive educational exhibits at over 12 historically well attended community events --affecting 1200+ residents. Elimination of a third of requests from agencies, faith based organizations and community groups. These groups will not able to receiving training, skill building classes, educational resource materials, or technical assistance—affecting 350 staff, clients or group members. This reduction will also limit participation on approximately 12 community boards, community coalitions or community task forces to which 8 staff are assigned, further impacting technical assistance provided to community agencies and organizations. This will also impact Accreditation benchmarks that require active community engagement. $75 Reduction in Postage will mean 170 residents or agencies will not receive an educational campaign mailing. S-14 * HPES -- Proposal (Provide a brief description of the service change) 10 % Grant Reduction (Healthy Carolinians) and Corresponding Reduction in Revenue S-14 * HPES -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $1,000 in Printing; $1,000 corresponding reduction in revenue 5-14 * HPES -- Description – Describe, in detail, the service delivery impact of the proposed reduction/change. The Kate B. Reynolds grant received for support of Healthy Carolinians efforts is not anticipated to be cut for the 09-10 year. This is year 2 of a three year small grant award of$10,000 per year. This reduction will eliminate the production of kits -- training materials and clinical tools -- essential to the Obesity Project planned by Health Carolinians. This would affect the training and capacity building of 6 Medical practices and 6-10 community agencies or non-profit organizations. Failure to adhere to the grant deliverables and eliminating the use of funds as budgeted will jeopardize the draw down of the full grant award. • S-15 * EHS -- Proposal (Provide a brief description of the service change) Eliminate Elements in the Quality Assurance– Program Improvement Program in Environmental Health Services S-15 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction of $1,300: Postage ($250) Motor Pool ($500) Duplicating ($200) Printing ($250) 41 Departmental Supplies ($100) S-15 * EHS Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The Quality Assurance-Program Improvement Program currently includes customer satisfaction surveys and supervisory field reviews of staff work. While some elements of the program would remain, these cuts would eliminate the supervisory field review portion of the program and customer satisfaction survey mailings. This has the potential to: • impair the ability to assure compliance with rules, regulations, and production of quality documentation. * inhibit the ability to identify the need for program improvements. • reduce the opportunity for feedback and response to customer needs. • increase the likelihood of errors in permit documentation that could lead to litigation or claims against the county. EH Specialists are required to exercise judgments • where errors may lead to losses ranging from $250,000 to $500,000. O affect a favorable re-accreditation of the health department. S-16 * EHS -- Proposal (Provide a brief description of the service change) Eliminate Response to Community Concerns About Environmental Issues, Environmental Complaints with No Formal Program Mandate, and Radon Testing Services for Water and Air. • S-16 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction of$5,750: Postage ($200) Motor Pool ($1,000) Printing ($250) Departmental Supplies ($300) Educational Supplies ($1,000) Contract Services ($3,000) S-16 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. • Examples of past responses to Community Concerns about Environmental Issues include: Mill Creek Road area study, concerns over biosolids activities, groundwater sampling surveys, Governor's Grove area survey. • Examples of past responses to Complaints without a Formal Program Mandate include air quality complaints, mold consultation visits, bedbug complaints, and vector control concerns (rats, mice, roaches, mosquitoes, etc.). • The Health Department would be unable to fulfill its responsibility to respond to communities and citizens who have health concerns related to environmental conditions. Citizens concerns may go unanswered and public health risks may go 42 uncorrected as a result. Environmental Health responds to approximately 2500 phone call complaints and 500 complaint field visits per year. O The health of citizens experiencing bedbug infestation would be compromised and apartment building infestations would be expected to spread without the intervention that Environmental Health provides with the property manager and exterminator services. ® Citizens with indoor air quality problems ranging from mold to carbon monoxide will not have access to no-cost assessment of their living conditions and most could not afford the high cost of a private environmental assessment company. Approximately 90% of citizens who utilize this service do not own their own home. S-17 * EHS -- Proposal (Provide a brief description of the service change) Eliminate Mailing of Environmental Health Permits, Educational Material, Forms, and Information S-17 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction of$2,300: Postage ($1,000) Duplicating ($200) Departmental Supplies ($100) Educational Supplies ($1,000) S-17 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Environmental Health utilizes the mailing of permits and file information as an opportunity to also mail out valuable educational material regarding wells, groundwater protection, and septic systems. If discontinued, this would result in 2500 fewer people receiving permits and/or file information by mail. Clients without email or those needing hard copies would be required to make a trip to the office to pick up copies. We would lose a viable way of serving our clients while at the same time, offering proactive educational material. We would likely see a significant rise in client dissatisfaction as the mail-out option is eliminated. S-18 * EHS -- Proposal (Provide a brief description of the service change) Reduce Professional Development for Environmental Health Services Staff S-18 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $1,000 Training and Development reduction S-18 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Staff will not be allowed opportunity for training to acquire new job skills or to keep current with changing state of practice. Only the minimum number of continuing education hours will be allowed in order to maintain registered sanitarian status. Failure to keep staff well 43 • informed and properly trained may prevent public access to latest technology advances and will limit the ability of staff to properly train installers, operators, and well contractors. S-19 * EHS -- Proposal (Provide a brief description of the service change) Reduced Permitting Activity Due to Economic Downturn and Reduced Building and Development Activity S-19 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Projected Impact on Revenue ($177,001 reduction) SEPTIC-CONST AUTHORIZ 56,000 SEPTIC-EXST SYST INSPECT 25,000 SEPTIC-SITE INS/IMPRV PERMS $ 56,000 SEPTIC TANK MANUF YARD INSP $ 500 WELLS 55,000 BACTERIOLOGICAL SAMPLES 1,861 INORGANIC CHEMICAL SAMPS 4,750 PETRONOLATILE ORG SAMPS 1,385 • PESTICIDE SAMPLES 1,630 NITRATE/NITRITE SAMPLES 1,875 WATER SAMPLES-FULL SUITE (6,000) PUBLIC POOL INSPECTIONS (1,000) WTMP FEES (20,000) Operating Line Item Reductions ($22,150 reduction) TELEPHONE (150) POSTAGE (1,500) MOTOR POOL (15,000). LAB SERVICES (5,500) S-19 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The service delivery level associated with permitting activity is closely tied to land development, construction and home building, and building permit activity. Applications for well permits, septic permits, and existing system authorizations are in lower demand when the economy negatively affects the building industry. These cuts reflect the projected loss in revenue and corresponding decreases in operating expenses due to fewer applications for permits. As permitting activity picks up, revenue will increase accordingly. There are a few increases in revenue that reflect historic trends and the increase in the number of WTMP inspections that are required will continue. The corresponding reductions in expenses are travel, postage, and laboratory services. It should be noted that the majority of the costs associated with permitting activities are personnel costs, not operating costs. Please.see also S-20 through S-22. 44 S-20 * EHS -- Proposal (Provide a brief description of the service change) Suspend Hiring for the Office Assistant position for the 09-10 year S-20 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $37,723 Office Assistant salary and benefits S-20 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This suspension in hiring is proposed only until demand is restored and revenues are restored to 08-09 levels. Not having a filled Office Assistant position means that there is only one "front desk" person available to respond to both calls and walk"-in clients. ® Current administrative staff would not be able to respond to phone calls and walk-in clients in a timely manner, particularly during the busiest hours of business. This would lead to client dissatisfaction as phone calls would go unanswered at times. Waiting times at the front desk may exceed 30 minutes as other clients are being served. Wait times would increase as permit activity is restored to higher levels. ® Administrative staff would be unable to provide service during the lunch hour. The office would need to close during the lunch hour. An alternative to closing the office would require higher salaried field staff to return from the field and cover office duties for the one hour period. ^ • 4 - / a S-21 * EHS -- Proposal (Provide a brief description of the service change) Suspend Hiring for One EH Specialist Position for the 09-10 Year S-21 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $52,624 EH Specialist position salary and benefits S-21 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This suspension in hiring is proposed only until demand is restored and revenues are restored to 08-09 levels. EH Specialist Position ® Currently with a full staff in the well/onsite program and with a reduced demand the backlog for services is 1.5 to 2.5 weeks from application submittal to delivery of the permit. The standard for an acceptable backlog is generally considered to be two weeks or less. A vacancy in the program would lengthen the backlog to 2.5 to 4.5 weeks. This backlog would be further lengthened by 20% if field staff were expected to fill office duties due to the vacancy of the office assistant. -the ranges above reflect the current rate of permit application receipts , • Response to contractor requests for inspections would potentially be delayed beyond the "same-day as requested" standard. Contractors would be required to leave equipment and employees idle for up to 24 hours if"same-day" service could 45 not be delivered. • Time-sensitive complaint response time would increase leading to longer environmental and public exposure to sewer line leaks and failing septic systems. • Proactive and preventative consultative field contacts would be reduced or eliminated as fewer field staff would be available to cover the pending applications. S-22 * EHS -- Proposal (Provide a brief description of the service change) Suspend Hiring for the EH Program Specialist Position in Food and Lodging Program for Latter Half of 09-10 S-22 * EHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $36,483 6 months of salary and benefits for EH Program Specialist S-22 * EHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This suspension in hiring is proposed only until demand is restored and revenues are restored to 08-09 levels. An Environmental Health Program Specialist Position has announced a retirement date of 11/30/09. While this position does not earn substantial revenue, it was determined that this six month hiring suspension would allow all current staff members to retain their positions. • Staff would be unable to achieve,the mandated inspections of restaurants, daycare centers, schools, and other foodservice establishments. Inspection percentages would fall an additional 12% to approximately 82%. * Staff would be unable to respond to requests for consultative visits from establishments and from the public as emphasis would be shifted to do inspections only. * Environmental Health staff would discontinue involvement in Servsafe training missing an opportunity for educational contact with over 100 students per year. O With a reduction of inspection visits overall, the likelihood of a foodborne outbreak increases. • Staff would be less able to respond to foodborne outbreaks and other • communicable disease occurrences without a program specialist who is trained and competent in these investigations and able to dedicate the time it takes during the investigative process. • The time required for plan review process for new and renovated restaurants would increase 300% to 400% as the demand for staff time in the field doing inspections increases. S-23 * PHS -- Proposal (Provide a brief description of the service change) 09 -10 Operating Line Item Budget Re-alignments for Personal Health Services S-23 * PHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) No change in operating bottom line (zero impact) 46 S-23 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Operating line items are realigned to reflect actual/projected costs S-24 * PHS -- Proposal (Provide a brief description of the service change) Discontinue Chronic Disease Care Coordination Program S-24 * PHS -- Fiscal Impact (This number should,correspond to the amount included on the department's budget request excel spreadsheet) $5,010 Reduction: $160 Dept. supplies $200 Education Supplies $3,680 Medical Supplies • • $970 Personal Mileage S-24 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Adults with chronic diseases (Diabetes, Cardiovascular disease, Asthma, etc), many who are elderly, will not receive home visits or care coordination to help them adhere to care plans and medication regimens, to learn to manage their disease, and to assure follow-up with their medical providers and other community resources. In calendar year 2007, 8 clients received 38 home visits, while in 2008, 7 clients received 31 home visits. Coordination of care for these clients with professionals/family required 3-5 consultations per client. Failure to manage chronic diseases results in higher numbers of visits to the emergency department, higher rates of hospitalization, and higher rates of complications for patients. In order to meet demands in a mandated program area, the Public Health Nurse assigned to this program (new in 2007) has already been reassigned into the Communicable Disease and Lead Prevention Programs (both mandatory). She has stopped marketing this service to referral sources, discontinued taking referrals, and is completing services to clients on her caseload. There is no revenue associated with this program. S-25 * PHS -- Proposal (Provide a brief description of the service change) Discontinue Refugee Health Assessment Program S-25 * PHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $11,000 Reduction: $250 Travel [Refugee Health Conference] $3,000 Lab services $750 Medical Supplies $7,000 Interpreter costs 47 S-25 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The Department will continue to provide the mandatory Communicable Disease screening and provision of needed immunizations. Following this screening, refugees will be referred to community medical providers to establish a medical home and receive ongoing care. Because of their poor health status, they often require specialty services. Approximately 240 Refugees (children and adults) will be impacted by this change in service. Communicable Disease screening on all arriving refugees is a mandatory service, but refugee health assessments (comprehensive physical exams) are not. Nonetheless, a comprehensive physical exam is highly recommended. Many refugees arriving with complex health conditions that the Health Department staff is not trained to handle, are already being referred to medical providers who provide more comprehensive services for assessment, treatment and ongoing care. As we discontinue the health assessment service, we will need to work with our community partners to assure.a clear delineation of roles (Communicable Disease screening by Health Department, Refugee Health Assessments by community medical providers). Since the Refugee Health Assessment is a Medicaid-reimbursable service and refugees are eligible for Medicaid in the first 8 months after arrival, there is a funding stream available for community medical providers to be paid for this service. This will likely impact other community providers such as Carrboro Community Health Center who already provide services to a large number of refugees. The .5 Family Nurse Practitioner, currently assigned to refugee health assessments will be reassigned to provide an additional 720+ services in our traditional mandatory prevention/treatment programs. This includes mandatory clinical services such as Sexually transmitted diseases, Family Planning, Maternal, and Child Health care. As a safety net provider during difficult economic times, there is a greater request for these services. We anticipate that the Medicaid-revenue earned for Refugee Health Assessments ($15,608) will be replaced by Medicaid and fees generated providing the above traditional services. In addition, since Refugee Health Assessments (including the use of interpreters) take on average 1.5 hours to complete, we will be able to increase Family Nurse Practitioner productivity 3-fold with other services (averaging 20-30 minutes to provide). S-26 * PHS -- Proposal (Provide a brief description of the service change) Discontinue HIV Community Testing Program S-26 * PHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $5,652 Reduction in medical supplies S-26 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This reduction will result in the loss of opportunity for higher-risk individuals to receive rapid HIV (Human Immunodeficiency Virus) testing results in a discreet community setting. 48 In the year prior to the retirement of staff, 85 rapid HIV tests were provided in 3 community settings with 0 positive results. Since resuming limited testing in October, 2008 at ( Hargraves Community Center, 10 individuals have been tested with 0 positives. The SHAC clinic (Student Health Action Coalition) will continue to offer rapid HIV testing at their Wednesday evening clinics held at the Carrboro Community Health Center. Any individual may also receive confidential testing and counseling at either of our clinical locations. Although this is considered an important and valuable screening and referral service for higher-risk communities, we have not had personnel available to provide this service since the retirement of the HIV Counselor. (This position has been reassigned to a Medical Office Assistant position, which is being recommended for suspension of hiring for 09-10 due to budget reductions — see proposal directly below)). Currently, a Nurse Volunteer has committed to providing this service one day per week for 3 hours at the Hargraves Community Center through October 2009 (as part of her Doctoral Research Program). We will purchase enough supplies this fiscal year to continue until October 2009 at which point the program will be phased out. Testing and counseling are available Monday through Friday at both OCHD clinical locations (Chapel Hill and Hillsborough). Both locations have extended hours one day per week. S-27 * PHS -- Proposal (Provide a brief description of the service change) Suspend Hiring of Medical Office Assistant for 09-10 Fiscal Year and Switch Funding Sources for Family Nurse Practitioner Training S-27 * PHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $37,704 Salary and benefits of position $1,230 Reduce funding in Certifications & Licenses S-27 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This proposal is to suspend hiring the Medical Office Assistant for the entire fiscal year or until revenue allows the position to be re-opened. Suspending the hiring of an additional Medical Office Assistant impacts the ability of clinics to process patients in a timely manner. Delayed appointment scheduling and slowed check-in and check-out services leads to long wait times for clients. In addition, the prolonged time for check-in and financial processing impacts the provider efficiency of the clinic since clients are not seen at their scheduled appointment times. As a result, the clinic runs late and staff must work beyond their scheduled time. The reduction of$1,230 in Certifications and Licenses is a switch of funding sources and is not an actual reduction in training providing for the nurse practitioners. It will narrow the ability of nurse practitioner's to select courses in some locations as the funding available through the AHEC funds may be limited. Reduced the county funding by $1,230 for mandatory training to maintain Family Nurse Practitioner (FNP) licenses. Replaced with 49 Area Health Education Center (AHEC) funds that Family Nurse Practitioners earn for serving as Preceptors for FNP students. These are in a separate fund earmarked for this purpose. S-28 * PHS -- Proposal (Provide a brief description of the service change) Revisions to Revenue Projections S-28 * PHS -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Increase of$6,657 in earned revenue S-28 * PHS -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Revenue projections reflect the changing economic picture with more individuals unemployed, uninsured, and eligible for Medicaid. Sliding Scale Fees are projected to drop $24,581 (19% decrease) while Medicaid revenue is anticipated to increase $31,238 (5% increase) for a slight overall increase in revenue. S-29 * QA/RM Proposal (Provide a brief description of the service change) Discontinue Operating Costs Associated with Public Health Nurse II in Preparedness S-29 * QA/RM -- Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $2,110 Reduction S-29 * QA/RM -- Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Transferred Public Health Nurse II (Preparedness Coordinator) FTE to Personal Health Services in FY 08-09 and that position was re-tasked to be a Licensed Practical Nurse (LPN) to assist in increased need for immunizations and communicable disease program. A Public Health Preparedness Coordinator will be available part-time through a contract with Person County Health Department. This staff change was approved by BOCC through approval of contract with Person County in December 2008. This adjusts the budget to reflect reduced county operating costs associated with the reduction of a full-time nurse in this unit. Public health emergency preparedness planning may be more difficult without a fulltime staff person housed in the health department who is directly responsible for these responsibilities. Preparedness and response plans are less individualized and county partner collaboration and coordination suffers due to lack of consistent, familiar agency representative at planning meetings and exercises. Event response coordination will need to be handled by the Quality Improvement/Risk Manager as will some plan writing, exercise coordination, training, and nursing volunteer oversight. 50 (I ci FY 2009-10 Departmental Budget Summary Department Housing and Community Development 2008-2009 Performance Highlights • An average of 620 low-income families received rental assistance monthly under the Section 8 Housing Choice Voucher Program, The current waiting list for voucher subsidies is 1,379. 9 Twenty (20) homes owned and occupied by low-income elderly and/or disabled households were repaired under the Urgent Repair Program 9 Three (3) substandard homes owned and occupied by low-income families were repaired to standard condition. o Fourteen (14) first-time homebuyers received second mortgage assistance to enabled them to obtain affordable private first mortgages. o Impact fee reimbursements were provided for 12 newly constructed homes for low/moderate income first-time homebuyers. 2009-2010 BUdget Impacts 9 Reductions in the Urgent Repair Program will prevent one less elderly/disabled homeowner from receiving urgent repairs. O Federal funding for the Section 8 Housing Choice Voucher Program and the HOME Investment Partnership Program is expected to remain constant in the next fiscal year. No new funds will be available for these programs from the recently passed Federal Stimulus Bill., • The Stimulus Bill does provide the State of NC approximately $15 million in additional Community Development Block Grant (CDBG) funding for small cities and counties in the state. There is no news regarding how the State plans to allocate those funds. Traditionally, CDBG funds have been the revenue source for the County's housing rehabilitation programs. 51 C C C 02/04/2009 Orange County, NC Service Reduction Impact Statement • FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Housing/CD Department— Urgent Repair Program S-1 Proposal (Provide a brief description of the service change) Reduce the total amount available for urgent repair costs. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $5,807 • S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The service delivery impact would mean one less home would receive urgent repairs since the average cost per dwelling is $5,000. ■ 52 C C C FY 2009-10 Departmental Budget Summary Department Child Support Enforcement 2008-2009 Performance Highlights • CSE will collect $5.9 million for Orange County children e Over 2800 families will be provided services that include: location of non- ' custodial parents, establishment of paternity, establishment of support orders, and enforcement of orders ® 66% reimbursement through Federal Financial Participation (FFP) O Received for all direct and indirect (IT, HR, Finance, PW) expenditures; and, incentive payments based upon collections for Work First families 2009-2010 Budget Impacts o Vulnerable families depend even more heavily upon child support to meet food, shelter, clothing and medical expenses during an economic downturn. o Our operating budget contains many legally required and non- discretionary items such as attorney fees, court ordered paternity tests and filing fees. • Caseloads expected to increase from the current 357 cases per Child Support Officer (CSO) to 370 per CSO. The State recommends a caseload size of 300 to 325. 53 C ( ( Orange.County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Child Support Enforcement (CSE) 02/20/2009 S-.1 Proposal (Provide a brief description of the service change) Vulnerable families depend even more heavily upon child support to meet food, shelter, clothing and medical expenses during an economic downturn. The ability to provide basic services: location, paternity, establishment and enforcement is made more difficult by the 10% reduction in operations. CSE collected $5.97 million for Orange County children in FY 07-08 and we currently provide service in 2863 cases. The State recommends caseload sizes of 300- 325 and our average caseload is 357. Caseloads are projected to increase to an average of 370 cases per Child Support Officer (CSO). S-.1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $14,625.00 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Many operational line items are non-discretionary (attorney, court ordered paternity test and filing fees). New cases will require court activity to establish paternity and orders; and, we anticipate more court activity to enforce existing orders. We will continue to receive 66% Federal Financial Participation (FFP) as • reimbursement for all our direct and indirect expenditures; and, incentive payments based upon our collections for Work First families. 54 C • C C FY 2009-2010 Departmental Budget Summary Department Emergency Services 2008-2009 Performance Highlights O Moved to new Administrative Offices — September 2008 O Tropical Storm Hanna EOC activation — September 2008 • Municipal police departments to 800 MHz radio system — November 2008 • Total calls for service in 2008 for all agencies: 186,443 ® Fire Marshal Office responded to and investigated 227 fires in 2008 • Inspected 4.8 million sq. feet of commercial, county and school structures • Managed 2.5 million dollars in grants o Opened new E911 Communications Center— January 2009 o EOC Snow activation —January 2009 o New EMS training program for fire departments — February 2009 O Developed "phased" Fire Rescue Study project— March 2009 O Developed enhanced safety dispatching program — March 2009 O Fire/Rescue/EMS units to 800 MHz radio system — March 2009 • Opened EMS Station 4 (Efland Community) April 2009 • Budget presented shows the mandated decrease of 10% • 2009-2010 Budget Impacts ® Will not be able to meet increased demand for services. •o Response times will increase from 17 minutes to 20 minutes or above. ® Personnel fatigue will increase and Worker's Comp claims may increase. o Needed upgrades to EMS stations will not take place. • Upgrades to field radio system cannot be achieved. • Staff support personnel will not be filled. o Cannot place ambulances in Eno and Cedar Grove communities. ® Cannot provide sufficient levels of uniforms.. • Communications service levels will be pushed to unacceptable levels. ® Medical supplies and patient treatment equipment will be in short supply. O Patient safety equipment will not be purchased. • Personnel Protective Equipment (PPE) will not be provided. O EMS and Communications training will be reduced. ® Vehicle maintenance, gas and oil may be in short supply. ® Disaster planning capabilities will be limited. o Aging ambulance fleet will not be replaced. ® EMT, Paramedic and Telecommunicator slots cannot be filled. ® OCRS monthly payment will have to be used for rent elsewhere. o Fire/Rescue Study: funds must be encumbered to a vendor this FY. ® Public education and outreach programs will be cut. O Hazardous materials spills will be charged to companies or not recouped. 55 (I (1 C Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Orange County Emergency Services S-1 Proposal (Provide a brief description of the service change) Training/Certifications/Dues/Educational Supplies — all out of state training has been canceled due to the budget constraints. Emergency Management training has been canceled by the director. The dues have been reduced to save money and by allowing senior staff to still be members, staff can participate in training offered around the state that is either free or at a reduced rate because of the membership. Supplies are reduced and lunches will no longer be provided for employees. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10750020-530200: -4227.00 10750020-620050: -3350.00 10750520-530200: -6724.00 10750520-620050: -500.00 10755020-530100: -3000.00 10755020-530200: -2000.00 10757520-530100-71030: - 667.00 10755020-610000: - 2000.00 10757520-530100: - 2675.00 10757520-530200: - 2000.00 • 10757520-620050: - 850.00 10757520-61000-71030: -80.00 56 SA Description — Describe, in detail, the service delivery impact of the proposed reduction/change. As an emergency management agency it is important to have all staff cross trained to work in the Emergency Operations Center during major events. This includes knowing how to fill out documentation, your role in the EOC and expectations of the position. This will cause a delay or certain staff having to work extra hours to ensure that someone is available for questions, guidance, etc. In addition training will be done on line and reduce the in-service training where staff is required to report for duty for 4-8 hours of training a month. The negative impact is taking away the one on one interaction with each person. This leads to more question and answers with the group to ensure all personnel are understand the instructions and training in the same way. This leads to consistency on all shifts. The on line training is more open to interpretation by the shift personnel. You can have many different points of view and this leads to inconsistency on each of the shifts. No longer providing promotional items to the public due to the budget reduction. S-2 Proposal (Provide a brief description of the service change) Contract Services - Contract Service reduction is with the Fire/Rescue Study in which we will now have it done in phases. S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10750020-620050: -51,563.00 S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Fire/Rescue is a work in progress and is not stopping just now broken into phases. It will take a little bit more time, but that is needed to ensure the report is done correctly and covers the needs of the county with objectivity. Funds for Study must be encumbered in 08-09 FY. S-3 Proposal (Provide a brief description of the service change) Departmental/Printing — no longer using film for fire, but now using digital cameras. The NFPA use to have us purchasing the documents needed and it is now available on line. C 57 S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10750020-591000: -385.00 10750020-629000: -1,000.00 10750520-629000: -300.00 10755020-591000: -250.00 10757520-591000: - 2,250.00 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. We will use what is left of supplies and come up with creative ways to either produce in house or demonstrate through power points. The impact is mainly on the school children and community events where we share what the department can do for the residents. 58 Department Oran.e Count Emere enc Services S-4 Proposal (Provide a brief description of the service change) Interns/Overtime —The interns were going to be working on special projects and the overtime is to cover the regular schedules with automatic overtime over the 40 hour workweek. This also covers vacancies. S-4 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10750010— 510100 —490.00 10750010 — 511003 —4800.00 1075751 0-51 1003 — 2322.00 10755010-511003- 71030 —2322.00 10755010- 510100 — 3,732.00 10755010-511003- 793.00 S-4 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Special projects are either put on hold or will be done by available staff as time permits. The overtime reduction will reduce the ability to have the minimum ( required personnel staffing each shift, which means one less transport vehicle on line and available, communications staffing to ensure fire/ems/law enforcement are listened to and answered on the Operations Channels with the new 800 radio system. The impact would mean for both extended response time to the scene for ems and communications will not be able to separate out the operations channels from the dispatch channel, which leads to the possibility of missing emergent traffic. This missed traffic could be where there is an injury of • firefighters/ems/law enforcement personnel while on scene. • S-5 Proposal (Provide a brief description of the service change) Equipment Repair and Rental —deduction in repair was due to repair and maintenance agreement coming in at 10,000 less than stated. The entire amount budgeted in FY 08-09 will be spent to cover costs for additional repairs for 800 MHz radios not needed in FY 09-10. The copier monthly fees are less than projected in the budget. 59 S-5 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10755020- 571000: -10,000.00 10755020 - 581000: - 700.00 10757520- 581000-71030: -7600.00 10757520-65000-71030: -10405.00 S-5 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Neither reduction would cause any impact in delivery of services. Orange County Rescue— Station 1 is no longer being used as a station location for our department. We are looking at strategic locations around the county—working • with fire departments in the north, east, west and south to hopefully co-locate with them. This may result in monthly rental for each location in the county. S-6 Proposal (Provide a brief description of the service change) Bloodborne Pathogens/Hep B Vaccines S-6 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10757520- 62100 — 3410.00 10757520 — 623001- 250.00 S-6 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Due to conflicted interpretations of OSHA coupled with lack of overhead staff to arrange and manage tactical staff physicals, OCES has suspended this imitative. 60 S-7 Proposal (Provide a brief description of the service change) ( HazMat - The reduction in HazMat is now covered by our department billing out the cost to the company involved in the -Spill and recouping the cost spent. S-7 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 10750520 710075 — 5,000 S-7 Description —.Describe, in detail, the service delivery impact of the proposed reduction/change. There is no change in service impact for Hazmat other than billing. • 61 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Orange County Emergency Services — Emergency Telephone Funds SA Proposal (Provide a brief description of the service change) Overtime S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 35755110-510100: -4000.00 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This will not cause any service delivery impact. There are no outstanding projects to complete in the coming year as the cutover has been completed for the 9-1-1 center as of January 2009. S-2 Proposal (Provide a brief description of the service change) Travel/Training —Administrative personnel cannot use emergency funding for any classes/conferences/workshops that do not specifically pertain to 9-1-1 phones so any training has to come from the Communications budget. S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 35755120-530100: - 6,000.00 62 S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This will not have any impact on services. This money is covered under the General Statue 62A which prohibits the use of the funds for other than is what is outlined in the statue. S-3 Proposal (Provide a brief description of the service change) Telephone — covers the 911 lines in the communications center. S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) 35755120-540000: 34256.00 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. This budget is covered under the General Statue 62A for prohibited use of the funds for other than what is outlined in statue. • 63 FY 2009-10 Departmental Budget Summary Department Aging 2008-2009 Performance Highlights The Dept. on Aging provides a comprehensive, integrated approach to meeting the basic needs of older adults through its multi-purpose senior centers, providing health, nutrition, mental health, social services, recreation, employment and other services under federal, state and local authority. With the opening of two new Senior Center facilities we are experiencing an increased demand for services to an Orange County population that is aging. * Developed the Orange County Master Aging Plan Annual Report covering an eighteen-month period from July 2007 through 2008 and priorities for calendar year 2009 • Completing the planning for transitioning the senior food service program, continuing to serve 130 balanced meals per day at the Senior Centers to primarily low-income older adults • Opened the new Central Orange Senior Center facility at the Sportsplex and celebrated the first anniversary of the Seymour Center • Senior Center participation is projected to be at least 163,500 contacts, a 22% increase from FY 2008 and a 79% increase over FY 2007. An estimated 35% of all contacts are basic health and well-being services, such as health screenings, blood pressure checks, flu shots, cholesterol screenings, fitness classes, health education, and health-related support groups. The daily luncheon program serves 135 seniors, many of whom are low income • 160 persons have purchased Seymour Center Fitness Studio memberships since January 2008 ® Aging Transitions (Eldercare) staff will respond to more than 3,000 inquiries'from seniors and their families; 338 frail older adults are given case assistance service that helps them to continue to live, independently ® 140 persons will receive in-home, adult day care, or group counseling service ® 585+ RSVP older adults help 100+ agencies provide vital services with over 65,000 service hours. This equates to 31 full-time paid employees. Over 50% of the volunteers are serving in high-impact areas, such as literacy, crisis intervention, outreach, tax preparation and senior food service • Volunteer Income Tax Assistance program will serve 2,100 clients during this tax season. (This does not include the 400 economic stimulus returns completed last fall.) This total increases by approximately 100 clients annually and saves the low/moderate income clients an average of $175 in tax preparation fees. • 64 2009-2010 Budget Impacts • Discontinue stipends for student interns for the Department Director o Limit Advisory Board & Committee notifications to email only, when possible o Reduce the evening hours at Seymour Center from four to two weeknights • Cut funds available for senior center activities and special programs, such as food, decorations, and entertainment • Reduce the Seymour Center Fitness Studio trainer hours from 45 to 35 per week • Discontinue mobility-related minor home repair project (grab bars, ramps) • Transfer Friend-To-Friend volunteer project to a non-profit agency • Cut 410 hours of in-home service administered by the Aging Transitions (Eldercare) program staff o Reduce sites for Volunteer Income Tax Assistance (VITA) service in response to the 2/3 reduction of temporary coordinator's time, resulting in 500 fewer returns completed c ( 65 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Aging — Central Administration • S-1 Proposal (Provide a brief description of the service change) Discontinue use of paid student interns to assist Department Director S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $1,214 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Interns will only be sought from programs that do not require a stipend, which will limit student selection pool S-2 Proposal (Provide a brief description of the service change) Limit use of postage and duplicating $1,000 in postage; $2,000 in duplicating S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Expand electronic notification of Advisory Board and committee meetings, where possible; reduction in mailings and printed materials 66 S-3 Proposal (Provide a brief description of the service change) (. Reduce Orange County support for the weekly In Praise of Age public television program on TVVC channel 8 S-3 Fiscal impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $237 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Reduce the number of copies of program video made of each show C 67 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Aging — Community Based Services S-1 Proposal (Provide a brief description of the service change) Reduce evening hours at Seymour Center from four to two nights per week S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $4,370 in temporary personnel and fringe S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Senior Center classes/programs/meetings will be limited to two evenings per week at each location; evening programs at Seymour will either be discontinued, offered during the day or other nights, or relocated to the Central Orange Center S-2 Proposal (Provide a brief description of the service change) Reduce funds for supplies used for major events held at each Senior Center S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $2,800 ($2,500-dept supplies: $300- contract services) S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Senior Center programming budget will be reduced by 12.5% per month; reduce 68 food and supplies available for special events C S-3 Proposal (Provide a brief description of the service change) Reduce trainer/monitor hours for the Seymour Center Fitness Studio S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $6,300 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. The work schedule for the Seymour Center Fitness Studio trainer/monitor will be reduced from 45 to 35 hours per week; those wanting or requiring personal assistance will have fewer hours to work out • z, • 69 Orange County, NC Service Reduction'impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Aging-Elder Care S-1 Proposal (Provide a brief description of the service change) Discontinue payment for home modification and up-fit service S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $6,000 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Will no longer pay for minor mobility modifications (grab bars, hand-held showers, etc.) or wheelchair ramps; will continue to assess the need and refer requests to family members or volunteer and civic organizations that provide this service in the community S-2 Proposal (Provide a brief description of the service change) Discontinue management of Friend-To-Friend volunteer match project that provides non-medical assistance such as companionship, grocery shopping and household tasks S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $6,817 ( temp salary and fringe) 70 S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Attempt to place the 20 volunteer/client matches with a non-profit agency or faith- based group interested in this kind of service S-3 Proposal (Provide a brief description of the service change) Reduce funds available for purchase of in-home aide services S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $5,900 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Reduces available service by eight hours per weeks; two less persons will be served, since the Department's policy is to limit the hours allocated to each person and rely on family and friends in developing a care plan C C 71 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Aging — Retired Senior Volunteer Program S-1 Proposal (Provide a brief description of the service change) Reduce the seasonal VITA tax service coordinator hours S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $3,549 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. VITA tax preparation sites will be reduced in response to 2/3 staff reduction; 500 fewer tax returns will be completed 72 FY 2009-10 Departmental Budget Summary Department Orange Public Transportation (OPT) 2008-2009 Performance Highlights Orange Public Transportation (OPT) is an integral component of the Orange County Human Service agency network, providing transit dependant residents (Medicaid/Non-Medicaid) access to life sustaining services such as dialysis, medical appointments, pharmacy, utility services (electric, water, fuel), food, and senior centers. Public transit is an economic stimulus that has a positive impact on the lives of citizens and _ ______the_environment. The importance of OPT services by citizens, especially life sustaining transportation, is reflected by a 9% growth in ridership in 2007 and an additional 12% growth in 2008, the largest sector being in medical transportation (14%) and disabled transportation (4%). O Continued operating the I I 420 route with an increase in FY 08/09 of 3.5%. • Operate six life sustaining (medical) routes daily with an increase in ridership of 14% in FY 08/09. • Operate disabled transportation with an increase of 4% in FY 08/09. • Combined senior routes from Cedar Grove, Efland, and Hillsborough to access the Central Orange Senior Center for medical services, food, other county agencies, and social activities. 2009-2010 Budget Impacts • Discontinue the Wheels for Work Program which will affect 32 current recipients. DSS will administer NCDOT funds for future vehicle repairs. Financial Impact: Save $21,909 in permanent payroll O Discontinue Saturday dialysis transportation which will affect 15 residents. These clients may be able to access dialysis if family, neighbors, and/or • friends are available to transport. Financial Impact: Save $6,956 ($4,520 temp payroll; $2,436 vehicle costs) • Discontinue Department on Aging, Senior Center day trips or provide at a rate that would capture all OPT expenses. Financial Impact: Collect $1,458 through fees from day trip participants 73 ( C Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service • change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Orange Public Transportation S-'1 Proposal (Provide a brief description of the service change) Discontinue Wheels For Work program S-'41 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $21,909 in Orange County funding SA Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Work First funding ($11,239) from NCDOT can be administered by DSS; the Transportation Manager position will be phased out and the current employee is being offered another position within OPT. Currently there are 32 recipients of donated vehicles that would no longer be served. No new vehicle donations would be accepted and additional repair funds from maintenance fees (generated from new donations) would not be available. S-2 Proposal (Provide a brief description of the service change) Discontinue Saturday dialysis transportation S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $6,956 74 S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. There are currently 15 clients that utilize Orange Public Transportation for Saturday dialysis. These clients may be able to access dialysis if family, neighbors, and/or friends are available to transport. Some of these clients may have an option to change their dialysis service to Monday-Friday. However, OPT is currently experiencing an increase in dialysis transportation and may not be able to accommodate. • 75 FY 2009-10 Departmental Budget Summary Department Animal Services 2008-2009 Performance Highlights • Approximately 4500 animals sheltered and 7,000 field service responses (2008) • Adoptions, owner returns, and rescue transfers totaled 2239 animals (2008) • Stable service contracts with Chapel Hill, Hillsborough and Carrboro * Growing volunteer program-5838 hours in 2008 * Impending opening (April/May) and integration of three divisions * Preparation work for the new center and division integration ® Low-Cost Vaccination Clinics and preventative educational efforts • Rabies exposure investigations and enforcement actions • Community Spay/Neuter Fund and The $20 Fix in Orange County • Continuing pre-adoption spay/neuter program 2009-2010 Budget Impacts ($42,968 Reduction) • Service Reductions ($12,750) o Eliminating the microchipping of adopted pets (while offering it electively) o Eliminating school educational programs o Eliminating leash sales and the bathing and grooming of adopted pets * Savings from Division Integration and Resource Realignment ($14,779) o Transportation (employee mileage and field service mileage) o Photocopiers; office supplies; and telephone lines and services o In-house versus outsourced spay and neuter of adoptable animals • Line Item Reductions ($15,439) o Training and staff development o Uniforms and gear Future Considerations • Service levels, staffing challenges and the operation of the new Animal Services Center ® Revenue streams and options 76 C C Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Animal Services S-1 Proposal Cost savings associated with the move in to the new Animals Services Center and realignment of resources to perform in-house sterilization for adoptable animals. S-11 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $14,779.00 S-1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. There should be no service delivery impact associated with the line items listed in these categories. Instead, these will be cost savings associated with the move to the new facility and the realignment of resources to provide sterilization services on an in-house. Due to the fact that we have three divisions that are currently located in three separate locations within the county and will be coming together •for the first time in one location, or resource realignment, we should see decreases in the following areas: 1-Mileage (-$1,200.00) reimbursement and motor pool (-$5,104.00). We will be able to conduct staff and manager meetings without having to travel between two or three different locations. Travel that is usually associated with Animal Control officers having to transport animals to the Animal Shelter in Chapel Hill and then returning to the Animal Control Office in Hillsborough will no longer be a cost factor. Similarly, there will be savings insofar as the Animal Control Officer that currently works in the Chapel Hill will no longer have to drive to Hillsborough for staff meetings The largest cost savings will be from performing in-house sterilization versus outsourcing these surgeries since the latter requires transporting animals to veterinary clinics in Mebane and Hillsborough. 77 2- Building Repairs (-$1,500.00) is being decreased because for most, if not all of FY0910, building repairs will be covered by warranties for the new Animal Services Center. 3- Duplicating and printing (-$775.00) based on the purchase of a new color printer that will allow us to produce forms and brochures in house. 4- Postage- (-$200.00) should be a service reductions from all three divisions being in the same location. 5-Telephone (-$3,000.00) is being reduced due to a decreased number of phone and fax lines and the purchase of a smarter, more cost efficient telephone system for the new facility. 6-Contract services (-$1,000.00) are being decreased because we will be reducing the number of copiers that we currently have from three to one or two (depending on the penalties imposed by our lease agreements). 7- Spay/Neuter Funds-An overall reduction of$2000 (Spay/Neuter Veterinary Services) is being made given the realignment of resources from spay/neuter line item in the FY0809 budget to cover the costs of the services needed to perform in-house sterilization via the FY0910 budget. S-2 Proposal (Provide a brief description of the service change) Operational reductions not tied to service reductions S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $15,439.00 S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. 1-Travel, Training and Certifications (-$12,118.00)-These are significant reductions in regard to staff training and development. However, it is expected that appropriated training monies will be used in new ways to ensure basic training and continuing staff development. These include bringing trainers to Animal Services (as opposed to sending staff to conferences) and using emergent electronic technologies and training opportunities such as "webinars"in a more deliberate and systematic manner. 2-Office Supplies (-$1,000.00)-ltems that we currently purchase in order to maintain a well organized and professional filing system for the department will be reduced and more effort will be devoted to making operations and procedures "paperless." One step in this direction will be a reduction in the number of printers, and if possible, the use of only networked printers. 3-Capital$250.00 (-$500.00)-We have preserved equipment repair funds but reduced this item, recognizing that if necessary we may need to realign other funds to replace aging or broken equipment(until such time as recurrent capital items again may be budgeted). 78 • 4-Uniforms (-$1,821.00)-Available funds will be used in a more circumspect manner, and in the case of Animal Shelter staff, uniform items themselves will be more limited than in past years. S-3 Proposal (Provide a brief description of the service change) Service Reductions-combined S-3 through S-6 S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) $12,750.00 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. 1-Microchips (-$10,000.00)-As a reliable form of permanent identification, microchips will no longer be provided as part of an animal adoption. No data is known to us about the affects of such a change on animal recoveries (or even euthanasia) but experience indicates that in some instances microchips are the difference in whethQr an animal is recovered by an owner or a custodian. Note that revenues presently associated with microchips will continue to be collected but under the category of adoption itself since the overall adoption fee does not ( cover the full costs of care associated with adopted animals, and that staff will recommend adding elective microchipping for a separate fee. 2-Educational Activities (-$2,100.00)-We will discontinue programs such as elementary classroom education that we have historically provided in Orange County and Carrboro-Chapel Hill schools. More generally, all internal program and volunteer resources will be aligned to the greatest extent possible with outreach and special events insofar as these are integral to the recovery or placement of sheltered animals and assurance of compliance with the County's Animal Control Ordinance. 3-Goods sold and miscellaneous services (-$650.00)-We will no longer sell leashes to customers but only collars insofar as the latter are required for identification tags. In addition, the grooming and bathing of adopted animals will no longer be done for adopters on a paid basis. (Note that the latter affects only our small, miscellaneous revenue line item.) 79 C C C FY 2009-10 Departmental Budget Summary Department Library Services 2008-2009 Performance Highlights • Increases in usage: (Main only, reflective across branches) o Door Traffic from 113,504 to 127,386 = 13,882 or 10.9% o Circulation from 179,411 to 194,510 = 15,099 or 7.8 %; o Computer usage from 24,231 to 27,914 = 3,683 or 132%; o Programming attendance from 9,086 to 9,936 = 850 or 8.5% • Lost Page Positions — to fulfill 6 months utilized a Work First graduate employee for a 6 month appointment. • Reduction in State Aid to the region of $6,307. • Library.Director retired after 32 years of service O Branch Manager retired from Carrboro McDougle • 2009-2010 Budget Impacts o Open a new library facility for main with three access points on two floors. O Implement new user fee for Inter-library loans from outside of the region ($1 per loan) O Replacement of 6 year old server for Hyconeechee Automation System. The server cost is shared one-third by the regional counties. Orange's cost is $5,604. O Recommendation to provide quality versus quantity by reducing services and reallocating staff and resources in order to maintain quality services in two locations. • As an applicant for Library State Aid, the Main facility must remain open to the public at least 40 hours per week. O When reducing the main library from 64 to 54 hours, management took into account the usage statistics of patrons. Hours of operation would be Mon Wed 10 — 8pm; Th — Sat 10 - 6 pm. These hours similarly reflect public service hours of Chapel Hill Public Library. 80 ( C C • 2009 -10 Budget Scenarios Orange County Public Library Scenario Summary: • Scenario#1 is the only outcome that does not reduce or limit current public service hours for libraries of Orange County. ® As an applicant for Library State Aid, the Main facility must remain open to the public at least 40 hours per week. • When reducing the main library from 64 to 54 hours, management took into account the usage statistics of patrons. Hours of operation would be Mon—Wed 10—8pm; Th— Sat 10—6 pm. These hours similarly reflect public service hours of Chapel Hill Public Library. • Scenario #1 Fiscal Impact Main-move to new facility and remain 64 hours Personnel $ 1,244,415 Carrboro McDougle—open 26 hours Operations $373,110 Cedar Grove—open 36 hours Revenue ($152,140) Cybrary—open 44 hours Total $1,465,385 Scenario #2 Fiscal Impact Main-move to new facility and reduce to 40 hours Personnel $ 1,035,769 Carrboro McDougle—open 26 hours Operations $373,110 Cedar Grove—open 36 hours Revenue ($145,000) Cybrary—open 44 hours Total $1,263,879 Scenario #3 Fiscal Impact Main-move to new facility& open 54 hours Personnel $ 1,029,286 Carrboro McDougle—open 26 hours Operations $327,865 Close Cedar Grove & Cybrary Revenue ($150,090) Total $1,207,061 Scenario#4 Fiscal Impact Main-move to new facility &reduce to 40 hours Personnel $ 854,516 • Carrboro McDougle—open 26 hours Operations $327,865 Close Cedar Grove &Cybrary Revenue ($142,590) Total $1,039,791 Scenario#5 Fiscal Impact Main- Do not move—reduce hours to 40 Personnel $ 854,516 Carrboro McDougle—open 26 hours Operations $239,210 Close Cedar Grove &Cybrary Revenue ($150,090) Total 943,636 Scenario#6 Fiscal Impact Main- Do not move—reduce to 40 hours Personnel $ 854,516 Close Carrboro McDougle & Cybrary Operations $231,114 Cedar Grove—open 36 hours Revenue ($135,140) Total $950,490 81 Scenario#7 Fiscal Impact Main- Move to new facility—reduce to 40 hours Personnel $ 854,516 Close Carrboro McDougle Operations $289,404 Close Cedar Grove Revenue ($134,590) Close Cybrary Total $1,009,330 C \.. 82 Orange County, NC Service Reduction Impact Statement FY 2009-10 In the table below, provide details regarding the proposed changes/reductions in current service delivery models. Include as much detail as possible including comparisons of current and next year work caseloads, clients, etc. Each service change/reduction outlined on the department's budget request excel spreadsheet must have a corresponding explanation on this form. NOTE: This form includes pre-formatted sections for three service delivery change proposals. Departments may need to expand this form to include all changes being proposed. Department Library S-'1 Proposal (Provide a brief description of the service change) Close Cybrary Branch, re-allocate all permanent staff to main library. S-1 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction in overall library operational cost of$13,490. S-.1 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Close the Cybrary Branch — re-allocate permanent staff of 1.25 to the main library to assist with the new library facility staffing needs. Eliminate all operational funding for this branch, totaling $13,490. The Budget Request for 2009-10 would place the Orange County Libraries at 13.41 / per capita. The new library facility required at a minimum 7 new FTEs in order to provide • library operations of 54 hours per week. With the increase of 1.25 permanent staff members. This increase will not support the library operations of 54 hours per week, but rather operations of 36 hours per week. 83 S-2 Proposal (Provide a brief description of the service change) Close Cedar Grove branch, re-allocate all permanent and non-permanent staff to main library. • S-2 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Reduction in overall library operational cost of$17,243 S-2 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Close the Cedar Grove Branch — re-allocate permanent staff of 1.25 to the main library to assist with the new library facility staffing needs. Eliminate $17,243 in operational funding for the Cedar Grove Branch. Re-direct $11,012 in operational funding to 1)$2, 500 -training for re-assigned staff in children's services, reference services, and use of electronic resources; and 2)$8,512 - non-permanent staffing needs for shelving and circulation duties. The Budget Request for 2009-10 would place the Orange County Libraries at 13.41 / per capita. The new library facility required at a minimum 7 new FTEs in order to provide library operations of 54 hours per week. With the increase of 1.25 permanent staff members from Cedar Grove and the increase of 1.25 permanent staff members from the Cybrary branch, the main library will have an addition of approximately 2.5 FTEs. This increase will not support the library operations of • 54 hours per week, but rather operations of 39 hours per week. • S-3 Proposal (Provide a brief description of the service change) Initiate charge to patrons of$1 per inter-library loan to offset charge for postage & shipping. S-3 Fiscal Impact (This number should correspond to the amount included on the department's budget request excel spreadsheet) Net effect is 0 S-3 Description — Describe, in detail, the service delivery impact of the proposed reduction/change. Inter-library loans — Initiate charge of$1 to patrons for inter-library loans. Currently the library has absorbed all shipping and handling fees for inter-library loans between libraries outside of the Orange County System and Regional System. It is a common practice to charge the shipping fees or $1 for inter- library loans. This fee would offset postage fees incurred over the year for inter- library loans. • 84