LA CROSSE COUNTY NOTICE OF MEETING COMMITTEE OR BOARD: Health & Human Services Board DATE OF MEETING: TUESDAY, MARCH 10, 2020 TIME: 6:30 PM MEETING PLACE: La Crosse County Administrative Center Room 1107

212 6th Street North La Crosse, WI 54601

PURPOSE OF MEETING: See Attached Agenda

NOTICES FAXED/MAILED/EMAILED TO: NEWS MEDIA COUNTY DEPARTMENTS COMMITTEE MEMBERS La Crosse Tribune County Board Chair Sharon Hampson, Chair Coulee News County Administrator Mike Giese, Vice-Chair WKBH County Clerk Monica Kruse WLSU Corporation Counsel Doug Weidenbach WKBT-TV Health Director Maureen Freedland WIZM Human Services Director Tom Jacobs WLFN Ebony Hyter WXOW-TV OTHER Laurie Logan Onalaska Community Life Peg Isola Ya Sayaovang Holmen Courier Bob Kellerman Fox News TV Kathie Knoble-Iverson Andrea Richmond Marilyn Hempstead Bryan Jostad David Trapp

MEMBERS: If unable to attend, call County Clerk’s Office at (608) 785-9581.

* PUBLIC COMMENT: The Board may receive information from the public, but the Board reserves the right to limit the time that the public may comment and the degree to which members of the public may participate in the meeting. PERSONS WITH DISABILITY: If you need accommodation to attend this meeting, please contact County Clerk’s Office at (608) 785-9581 as soon as possible. PUBLIC ACCESS TO BUILDING: The east entrance to the Administrative Center will be the only door to the building open after 4:30 p.m. DATE NOTICE FAXED/MAILED/EMAILED AND POSTED: March 5, 2020

NOTE TO BOARD MEMBERS: If you have questions re: Director Reports or Consent Agenda Items, you are encouraged to contact the appropriate Dept Head before the board meeting to get additional information.

Health Dept: Jennifer Rombalski, 785-6425, jrombalski@lacrossecounty.org Human Services Dept: Jason Witt, 785-6095, jwitt@lacrossecounty.org

LA CROSSE COUNTY NOTICE OF MEETING

HEALTH & HUMAN SERVICES BOARD

Date: Tuesday, March 10, 2020 Time: 6:30 PM Place: La Crosse County Administrative Center, Room 1107

212 6th Street North La Crosse, WI 54601

1. Announcements A. February County Board Action B. Board Members Report on Conferences/Meetings/Workshops C. National Public Health Week (April) D. National Child Abuse Prevention Month (April)

2. Public Comment (See * on page 1 of this notice)

3. Board Education

A. Policy, Practice and People of Health – Nutrition B. Health Department Priorities 2020 C. New Public Charge Rule D. HHS Board Chair’s Year End Summary/Accomplishments

4. Policy

A. Request to Modify 2020 La Crosse County Permits, Fees and Charges for Human Services B. Wisconsin Opportunity Act

5. Resolution

A. Resolution Re: In Support of the Wisconsin Opportunity Act (SB 467, AB 508)

6. Director Reports A. Health Department Written Director’s Report B. Human Services Written Director’s Report

7. Consent Agenda

A. Minutes 1. Health & Human Services Board 2/11/20 2. Family Policy Board 2/3/20 3. Criminal Justice Management Council 1/15/20

B. Department Reports 1. Human Services Vendor Audit Report

8. Items for Future Agendas

9. Adjournment to the next meeting to be held on Tuesday, April 14, 2020

Start time for agenda items

6:30

6:50

6:55 7:15 7:20 7:40

7:50 8:00

8:15

8:20

8:25

8:30

1C

AGENDA ITEM NUMBER: 1D MEETING DATE: 3/10/20

REPORT TO THE HEALTH & HUMAN SERVICES BOARD DEPARTMENT: Human Services X INFORMATION/DISCUSSION SECTION: Family and Children’s Services SUBJECT: National Child Abuse Prevention Month PREPARED BY: Tracy Puent FILING ID: REVIEWED BY: Jason Witt IMPLEMENTATION DATE: April is National Child Abuse Prevention Month, a time to recognize that we each play a part in promoting the social and emotional well-being of children and families. It is an opportunity for professionals and concerned community members to work together to raise awareness about the effects of child abuse and to promote prevention and early intervention efforts underway in our community. To bring more focus and attention to local efforts, the Coulee Region Child Abuse Prevention Task Force (CRCAPTF) spends a significant amount of time each year on heightening awareness and coordinating activities that take a positive approach, emphasizing the many ways our community can support and strengthen families. The task force is in its 23rd year. The primary reason the task force was created was to focus on awareness, prevention and intervention of child abuse. Even though child maltreatment is a difficult subject to talk about, when we name it, we can come together as a community to address the issue. The task force is made up of approximately 22 organizations and community members with the mission of bringing education and understanding about child maltreatment. By creating free events for caregivers and children, we create moments where maltreatment is less likely to occur. In addition, we create moments of joy that can be stored as health within the caregiver and child relationship. We promote the theme “Great Kids Start with YOU” to raise awareness and let the community know that it takes a village to raise a child and we all have a part in that effort. Local area 4th & 5th graders also submit entries for the annual t-shirt contest promoting the theme “Great Kids Start with You”. A brief outline of the task force activities is as follows:

Family Fun Expo Sunday, March 15th, from 11am-4pm at Onalaska Omni Center, 255 Riders Club Rd, Onalaska, WI Fun, informative day filled with booths, inflatables for the kids, food/refreshments, entertainment,

education, giveaways, and more!

Proclamation and Blue-Ribbon Appreciation and Award Breakfast Friday, April 3rd, 9:00 (doors open at 8:45am) – 11:00 am at the Lunda Center-Western Technical College, La Crosse. If you are a professional who works with or cares about children and families,

please join the Coulee Region Child Abuse Prevention Task Force in recognition of Child Abuse Prevention Month. Please RSVP NAMES to Jen Scaccio at youth@nhagainstabuse.org by March 27th if

you wish to attend.

Pinwheels for Prevention

Friday, April 3rd, 4:00pm at Myrick Park, La Crosse. Plant a pinwheel for a child as a caring adult in our community; you have the power every day to make a difference in the life of a child.

7th Annual Family Fun Walk and 5k Race

Saturday, April 18th, 11am – 1 pm, Myrick Park-Main Shelter, La Crosse. Join the Coulee Region Child Abuse Prevention Task Force for a free family fun walk or 5k race! There will be a shorter route

available for those people who are unable to walk the entire 3.1-mile distance of the 5k. Registration: https://raceroster.com/events/2020/28630/child-abuse-prevention-task-force-family-fun-runwalk-5k?fbclid=IwAR1PvA4eN9nsG3Z1-Zg2lHtWbHWvgr5v3fj15gFMY8tQCreMOpTS5XoyW54

Child Maltreatment Conference Thursday and Friday, April 30th & May 1st, 2020, Radisson Hotel, 200 2nd Street South, La Crosse, WI.

The conference focuses on current issues in child maltreatment. Information and registration available at http://mayoclinichealthsystem.org/locations/la-crosse/education/child-maltreatment

AGENDA ITEM NUMBER: 3A MEETING DATE: 3/10/2020

REPORT TO THE HEALTH & HUMAN SERVICES BOARD

DEPARTMENT: Health X INFORMATION/DISCUSSION SECTION: Nutrition SUBJECT:

Fit Families SNAP-Ed

PREPARED BY: Jenni Loging, Nutrition Manager FILING ID: REVIEWED BY: Jen Rombalski, Health Director IMPLEMENTATION DATE:

Policy: Fit Families Supplemental Nutrition Assistance Program – Education (SNAP-Ed) is a successful behavior change program targeting families of 2-4 year old children enrolled in WIC. This evidence-based program strives to prevent childhood obesity by empowering families to adapt healthy eating and physical activity behaviors. Fit Families provides the framework for healthy environments by promoting Policy, Systems, and Environmental (PSE) changes in communities. Program evaluation shows children participating in Fit Families increased fruit and vegetable consumption, decreased juice and sugar sweetened beverage consumption, increased physical activity, and decreased screen time. Participant satisfaction surveys show a high level of program satisfaction.

In Federal Fiscal Year 2020, the Fit Families program will include 41 Fit Families projects across Wisconsin administered by WIC projects: Barron, Bay Area, Buffalo-Pepin, Chippewa, Columbia, Dunn, Eau Claire, Family Health/La Clinica, Fond du Lac, Forest, Great Lakes Inter-Tribal Council (GLITC), Healthfirst Network, Green, Jackson, Jefferson, Juneau/Adams, Kenosha, Kewaunee, La Crosse, Marinette, Milwaukee (City), Monroe, Northwest Community Services Agency (NWCSA), Oneida, Outagamie, Pierce, Polk, Portage, Sauk, Shawano, Sheboygan, St. Croix, Southwestern Wisconsin Community Action Program (SWCAP), Trempealeau, Vernon, Walworth, Waukesha, Waupaca, West Allis, Winnebago, and Wood.

The Fit Families Mentoring and Training projects will be: La Crosse, Waupaca, Chippewa, Sauk, Portage, Polk, and Kewaunee. These projects mentor and train other SNAP-Ed projects. Fit Families agencies receive training on program operations, management, and evaluation. Fit Families materials and resources are available to all projects and guidance is available from the Fit Families Mentoring Team. The Mentoring Team developed Fit Families Staff Competencies and an assessment tool for use by all projects.

Practice:

A Fit Families Coach (registered dietitian) connects with the participating families monthly for one year, providing individualized guidance, support, and tools to the family to assist them in meeting their goals. In La Crosse County, we strive to have 100 participants complete the program annually. For 2019, 84 children completed the program, while 93 continued into 2020 and 33 children discontinued before the one-year completion.

The three core messages of Fit Families are: 1: Move More… Watch Less 2: Make Every Bite Count… More Fruits and Vegetables 3: Make Every Sip Count… More Healthy Beverages

WIC staff and community partners support program concepts by participating in trainings, challenges, and the development of wellness policies. In addition to monthly direct education contacts with families, Fit Families Project sites engage in multi-level public health approaches to support healthy eating and active lifestyles. This approach includes implementing intervention approaches including Policy, Systems, and Environmental (PSE) activities, adopting PSE changes, and building partnerships with community organizations across a variety of sectors, such as Head Start Agencies, YMCAs, Community Centers, and Parenting Resource Centers.

Statewide 2019 program evaluation data show nutrition and activity improvements for the 1,180 children who completed the year-long program. This 2019 data shows increases in the number of children who ate > 4 servings fruit/vegetable servings/day (from 25% to 39%), who drank < 6 ounces’ juice/day (from 66% to 77%), who drank < 1 sugar sweetened beverage/week (from 73% to 79%), who watched < 2 hours TV/screen time/day (from 73% to 85%), and who achieved 60 minutes of physical activity/day (from 87% to 92%). In addition, WIC clinic environments modeled healthier atmospheres and staff showed increased knowledge and confidence in promoting healthy eating and active lifestyles.

La Crosse data is included in the attached infographic. A Statewide Infographic provides an overview of state success. It should be noted that La Crosse was an original site and played a large role in the development and implementation of the Fit Families Program. People: La Crosse County Fit Families participant TBD. Mandated Program: No Tax Levy: None Funding Source: SNAP-Ed Population Targeted: Families of children ages 2-4 years old Number of People Served: La Crosse County Target is 100 children annually Essential Public Health Service: Inform, educate, and empower people about health issues. Wisconsin 2020 Public Health Objective: 1. Adequate, appropriate, and safe food and nutrition, 2. Healthy growth and development.

Fit Families 2019 – La Crosse County

Parent Satisfaction

Survey responses

showed that families who

completed Fit Families

were highly satisfied.

What parents say

about Fit Families…

Children actively

enrolled in FY19

Program Reach and Dose

Over the 13-

month program…

• 92% of families

received 10+

contacts

• 8% of families

received 5-9

contacts

Program Retention

Family time Screen time

Fruits & veggiesActivity Staying healthy

Incentives Eating better

Goals

Healthy beverages

Children

discontinued

Fit Families

Children

completed

Fit Families

Children

continued Fit

Families

20% 35% 60%

79% 89%80%

70% 82% 85%

80% 85% 87%

88% 98%90%

Fruits and

Veggies

Juice

Sweetened

Beverages

Screen Time

Move

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Progress in Achieving Program Goals

Legend

Markers indicate

percentage of children at

recommended levels at:

Enrollment

One Year

Target

https://www.dhs.wisconsin.gov

/nutrition/snap-ed.htm

For more information, please contact

the Wisconsin SNAP-Ed Coordinator at

DHSSNAP-Ed@dhs.wisconsin.gov

Wisconsin Fit Families SNAP-Ed 2019The information in this infographic reflects the 2019 SNAP-Ed federal fiscal

year (FFY) that ran from October 1, 2018 through September 30, 2019.

Reach Children EnrolledAnnually

253

1,736

1,535

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Num

ber

of

Childre

n E

nro

lled

Fit Families Year

Since 2010, the annual number of

enrolled children has increased

586% consistently exceeding

enrollment goals.

ABOUT FIT FAMILIES

Fit Families Supplemental Nutrition Assistance Program-

Education is a 13-month nutrition education program targeting

families of 2- to 4-year-old children enrolled in WIC. Fit

Families empowers families to adopt healthy eating and

physical activity behaviors through in-person and phone/text

coaching. Fit Families strives to prevent childhood obesity.

FIT FAMILIES CORE MESSAGES

MOVE MORE, WATCH LESS Engage in active play and

physical activity. Reduce screen time.

MAKE EVERY BITE COUNT, MORE FRUITS AND VEGETABLES

Eat the recommended amount of fruits and vegetables.

MAKE EVERY SIP COUNT, MORE HEALTHY BEVERAGES

Reduce or eliminate sugared beverages.

EAT HEALTHY, BE ACTIVE, YOUR KIDS ARE WATCHING

Be good role models for children.

Counties ServedFit Families 35 project

sites served children

in 44 counties

Served in 2019

Original Sites

in 2010 (also served in 2019)

FFY 19 Enrollment

Enrollment Goal

5,597Parents and children

served in FFY 2019

70% of parentsWho completed Fit Families in FFY 2019

received the intended dose

of 10+ coaching sessions

The percent of children meeting or exceeding the recommended levels of healthy

behavior significantly increased from enrollment to the 13 month discharge.

Children’s Dietary Behavior Outcomes

This material was funded by USDA’s Supplemental Nutrition Assistance Program - SNAP.

This institution is an equal opportunity provider.

25%

66%73% 73%

87%

39%

77% 79%85%

92%

Perc

ent

of

Childre

n M

eeti

ng o

r Exceedin

g R

ecom

mended L

evels

Enrollment 13 Month Discharge

Fruits & Veggies

Daily Fruit & Vegetable

Servings

Recommendation:

4 servings/day or more

Sugary Beverages

Weekly Sugar-Sweetened

Beverages

Recommendation:

1 beverage/week or less

Screen Time

Daily Hours of

Screen Time

Recommendation:

2 hours/day or less

Juice

Daily Juice

Consumption

Recommendation:

6 ounces/day or less

Physical Activity

Daily Physical Activity

Recommendation:

60 minutes/day or more

Parent Satisfaction with Fit Families

Surveys were received from

620 parents of children who

completed Fit Families

during FFY 2019. Parents

rated their satisfaction with

various aspects of their

engagement with Fit

Families coaches.

Most parents were very satisfied or somewhat satisfied with their contact with Fit Families

coaches.

Wisconsin Fit Families SNAP-Ed 2019

85%

77%

74%

79%

78%

15%

22%

23%

20%

20%

Percent of Parents

Overall relationship with coach

Frequency of contact with coach

Amount of time spent speaking with coach

Guidance from coach about goals

Education materials provided by coach

La Crosse County Health Department Priorities 2020 Each year, the Leadership Team spends intentional time reviewing existing plans and finalizes priorities for the next year. This results in a set of priorities for 2020. These priorities are as follows: 1. Strategic Plan

Continue to implement current plan. Complete a new strategic plan to guide our department for 5 years from 2021 through 2025.

2. Nitrates in well water Work continues from 2019 efforts to include a potential placeholder of $40,000, proposed by Health and Human Service Board Chair Sharon Hampson, to conduct an assessment using geo-probes strategically placed with water testing to help identify the potential source. This will guide policy decisions in the future.

3. Compass/Community Health Assessment The 2018 COMPASS NOW identified priorities of community health that are not part of the current Community Health Improvement Plan (adopted in 2016, expires in 2021). These include: livable wage jobs (#1), wellbeing of children and youth (#4), and inclusion of socially diverse people (#5). In addition, the 2021 COMPASS NOW process is just beginning and our department will work to support improvement in the Random Household Survey and data collection.

4. Resilience and Trauma Informed Care In alignment with the Resilience and Trauma Informed Community (RTIC) framework, we are working towards becoming more trauma-informed in our department. This is an opportunity to intentionally build a collaborative foundation with Human Services as our Champions Teams are already beginning to work together.

5. Reaccreditation In 2020, we will make the determination about and steps necessary to achieve reaccreditation, which would be due in late 2021.

6. Community Health Endowment Fund To support community health improvement plan efforts in future years, we are working with the La Crosse Community Foundation to set up a community health fund specific to addressing health priorities.

7. Financial Strategy This includes a consistent process for fee-setting, assuring grants are aligned with department priorities, and preparing for the 2021 budget.

8. Section Specific Each section in the department has its own priorities, which the Leadership Team will work to support.

3B

AGENDA ITEM NUMBER: 3C MEETING DATE: 3/10/20

REPORT TO THE HEALTH & HUMAN SERVICES BOARD DEPARTMENT: Human Services X INFORMATION/DISCUSSION SECTION: Economic Support SUBJECT: New Public Charge Rule PREPARED BY: Lorie Graff FILING ID: REVIEWED BY: Jason Witt IMPLEMENTATION DATE: Policy: Certain immigrants who apply for a green card (lawful permanent residence) or a visa to enter the U.S. must pass a “public charge” test which looks at whether the person is likely to use certain government services in the future. In making this determination, immigration officials review all of the person’s circumstances, including their age, income, health, education or skills (including English language skills), and their sponsor’s affidavit of support or contract. Under a new federal rule effective February 24th, use of specific public benefits will be added to the Department of Homeland Security’s (DHS) public charge test. DHS’s new public charge test considers receipt of the following program benefits:

• Supplemental Nutrition Assistance Program (SNAP), known as Food Share in Wisconsin • Medicaid (except for emergency services, children under 21 years of age, pregnant women, and new mothers) • Cash assistance programs, including Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF)/W2 • Federal Public Housing and Section 8 assistance

There are a number of immigration statuses that are not subject to the public charge rule. This includes refugees and asylees. Current Green card holders are also not subject to the public charge test unless they travel outside of the U.S. for more than 6 months. The Department of Homeland Security only looks at benefits the immigrant themselves uses, not their children or other family members. Most immigrants that are subject to the new rule are not eligible for the programs listed above. Practice: Income Maintenance (IM) Consortia have been given guidance to assist customers calling with concerns over the public charge rule. Consortia staff will also be referring customers to Covering Wisconsin’s website www.coveringwi.org/immigration , which has information about the rule and a list of free and low cost legal services..

HHS Accomplishments 2019

Announcements:

Tom Jacobs welcomed as a new board member

Friend of Public Health: Catherine Kolkmeier

Juvenile Justice name change to Youth Justice

Steve O’Malley and Jason Witt recognized by WCA for statewide work done on child welfare

Art Reception with ADRC clients

Ya Sayaoyang welcomed as new board member

Board education:

Rabies Prevention

Federal government shut down effects on county programs

Measles Report; national outbreak

CDC Drinking Water Grant

State Juvenile Corrections Reform: will we or won’t we?

Plans for Trauma-Responsive Agency

HEAL: Alliance to End Addiction Locally

Economic Support Work-From-Home Pilot

Report on Tuberculosis

Accreditation Update: will we or won’t we?

3D

Policy:

Ethics committee formed for recertification of Health Dept

Opioid Epidemic Media Grant

Water Quality Concerns, specifically Babcock CAFO and wells

Governor’s Budget Request:

Child Protective Services increase

Juvenile Justice: return 17-year-olds to Juvenile Justice

Children’s Long Term Care: waitlists

Mental Health Services: full funding

Healthy women expansion

Increase access to cancer screening

Healthy Smiles: expanded funding

Prevent childhood lead poisoning

2020 Budget Process for Health and Human Services

2020 Budget Review: proposal of $40,000 towards Nitrate Pollution

Resolutions:

Authorizing Acceptance of Community Development Block Grant Funding from the City of La Crosse to Support La Crosse Area Family Collaborative

Crisis Stabilization Innovative Incentive Award

Changes to Ordinance Chapter 11 updating language relating to changes in Vector Control; Changes to Smoke and Tobacco Free Campus

Authorizing Acceptance of Additional Funding From the US Dept of Agriculture to Expand the Coulee Region Farm2School Chili Program

AGENDA ITEM NUMBER: 4A MEETING DATE: 3/10/20

REPORT TO THE HEALTH & HUMAN SERVICES BOARD DEPARTMENT: Human Services X INFORMATION/DISCUSSION SECTION: Integrated Support & Recovery Services SUBJECT:

Request to Modify 2020 La Crosse County Permits, Fees and Charges for Human Services

PREPARED BY: Christin Skolnik and Lanae Nickelotti FILING ID: REVIEWED BY: Jason Witt IMPLEMENTATION DATE: Background: The 2020 La Crosse County Permits, Fees and Charges were initially approved with the 2020 budget. Human Services is requesting a modification to the originally approved list as described below. Due to changes in state statute and county policies, the crisis rates were modified to reinstate 2019 billing practices.

Basis of 2020 Approved

2020 Modified

Section / Unit NWS Account #

Account Name NWS

Rate Type Unit Rate Rate

ISRS / Crisis Services

210.445.1000-46591.01

Client Fees General Client Fees

APNP Hourly $ -

$ 231.00

ISRS / Crisis Services

210.445.1000-46591.01

Client Fees General Client Fees

PhD Hourly $ -

$ 174.00

ISRS / Crisis Services

210.445.1000-46591.01

Client Fees General Client Fees

Masters Hourly $ -

$ 138.00

ISRS / Crisis Services

210.445.1000-46591.01

Client Fees General Client Fees

Bach Hourly $ -

$ 140.00

ISRS / Crisis Services

210.445.1000-46591.01

Client Fees General Client Fees

Para Hourly $ -

$ 123.00

Action Needed: Request approval from the Health & Human Services Board to accept the modifications to the 2020 La Crosse County Permits, Fees and Charges for the Human Services Department.

rweston

Text Box

5A

Health Department Recognition Event: The employee recognition event for the Health Department on February 19th was a great success. The following employees were recognized for their years of service and exceptional work:

25 years – Al Bliss (Health Educator)

20 years – Maomoua Vue (Nutrition Educator)

10 years – Tiffany Lein, Maggie Smith, Becky Lakowske (Health Educators)

5 years – Aron Newberry (Sanitarian); Kelly Stefferud and Gretchen Lindahl (Nutrition Educators)

Push Pin Awards (for Health Department Values) – Maggie Smith for Communication; Al Bliss for Collaboration; Judi Zabel for Advocacy; Julie Dietz for Service; and Jennifer Miller for Leadership

Preparedness Award (state) – Brenda Hanson (Health Educator)

Special thanks go out to Tara Johnson, Sharon Hampson, Monica Kruse, Maureen Freedland, and Jane Klekamp for attending the event. Having this many board members and administration present tells the staff that what they do every day DOES matter.

Four new staff were welcomed in 2019, including Casey and Rachel in Health Education, Sheila in Nutrition (Community Health Worker), and Jacquie in Public Health Nursing (Manager). In addition, the following highlights from 2019 were shared:

1. Rabies program – new veterinary advisor Dr. Weigel 2. Accreditation - Ethics Committee

a. Car seats, Nitrates in water, lead in homes, human health hazard condemnations, WIC and substance use, water test in lab

3. WIC client postcards to federal legislators advocating for the service 4. Breast Feeding Peer Counselor shared success story on statewide call and with Dietitian Abbie Loos attended

National WIC Leadership Conference and met with federal legislators at the capital in DC 5. Salmonella outbreak, c-diff outbreak, lung disease in vaping, active TB case (AUGUST) 6. Shiga-Toxin producing E. Coli (STEC) cases in December

a. Aron recognized for response and specimen collection/shipping from state/FDA with romaine lettuce (E Coli) 7. Presentations on Nitrates to Committees, County Board, Water Taskforce, and more 8. More than 1700 communicable diseases across 3 sections (1602 in Nursing/Education) 9. Tobacco education mailer to 6500 residents with youth 10-17 10. Grant to educate Hmong women on breastfeeding 11. Branding & Marketing (BAM) developed - Facebook page and first quarterly newsletter to community in May

La Crosse County Health & Human Services Board

Health Department – Director’s Report

March 2020

6A

12. Improvements to workforce environment including the lobby (Wallflowers) 13. Drug Trends Forum by Drug Free Communities and Alliance 2 HEAL (we lead both) with 120 present 14. Water sampling outreach collection events 15. Farm 2 School: 135 Hamilton students taste test green bell peppers + $100k USDA grant to expand F2S chili 16. Tobacco-free campus passed 17. Certified for testing water for lead with Atomic Absorption Spectrometer (AA) machine in Lab 18. Dental programs - new opioid dental grant collaborating with emergency rooms and increases to Seal-a-Smile 19. HMO battles to increase our revenue – billing and more billing despite claim denials 20. 2900 vaccines to 2400 people with 73% flu over 2019!

a. 47 vaccination clinics in community and more than 1400 flu vaccines Oct 15-Nov 25 + Occ Health 219! *Office support (Lisa, April, Nor; Lisa, Tammy, Tamara, Darlene; Megan) are the foundation and leaders of customer service! WALHDAB February 2020 State Legislature Additional Session Update: (Written by Hoven Consulting)*

An update on more details of the bills is included by viewing the two legislative updates this month by clicking here.

As many of you know, the legislative session is potentially coming to an end. Last Thursday, the Assembly finished their business and adjourned for the session after having passed a number of bills that will be sent to the Governor and State Senate. The Senate is expected to be in session the last week of March to take up bills that have been sent by the State Assembly. We will keep you updated on those developments.

Tuesday February 18 action in the State Assembly

There were a number of water quality task force bills that passed in bi-partisan manner. From AB-789 to AB-801 are all bills that WPHA/WALHDAB supported with the exception of AB-794. The bills have now been sent over to the State Senate for their consideration.

Wednesday February 19 action in the State Senate

The Senate had a long session day, dealing with a number of issues including several HOPE bills and criminal justice reform bills. WPHA/WALHDAB supported a number of HOPE bills that all passed in bi-partisan fashion on a voice vote and will be sent to the Governor's office for his consideration. The Senate also took up several GOP Criminal Justice Bills that WPHA/WALHDAB opposed. The debate over the bills was lengthy and contentious at times.

Thursday February 20 action in the State Assembly

On Thursday the State Assembly conducted a marathon session that started on Thursday afternoon and ended on Friday morning. They passed a number of bills of which several were of interest to WPHA/WALHDAB.

The Assembly passed AB-422 increasing the legal age for sale, purchase, and possession of cigarettes and nicotine and tobacco products and possession of vapor products. There was an amendment that was adopted adding vaping products back into the bill and regulated previously unlicensed vaping retailers. The bill passed on a voice vote and will now be sent to the State Senate for their consideration. WPHA/WALHDAB is presently registered against the bill.

The Assembly passed AB-869 (Alcohol Permits) on a vote of 83-13. The bill has been sent to the State Senate where it will be considered when they come back into session in late March.

The bill originally created a private event venue permit issued by the Department of Revenue for the purpose of regulating wedding barns and the issuance by the DOR retail alcohol beverage permits for Road America and State Fair Park. The bill also extended closing hours for certain alcohol beverage retailer the DNC convention. The bill also sought to limit serving hours for breweries who have unlimited serving hours due to change in law in 2011.

There were two amendments that were adopted that stated, bars could stay open until 4 a.m. in just 14 counties in southeastern Wisconsin during the DNC instead of allowing the hours statewide. In addition the wedding barn provision was eliminated and the provision to bring breweries serving hours in line with bars was also eliminated meaning, breweries would continue to have unlimited serving hours. The amendments also increased the fee drunken drivers pay from $50 to $75, revenue which helps pay for a state program that provides free rides home from bars. WPHA/WALHDAB is presently registered against the bill.

We will continue to update members on legislation that remains active in the State Senate as well as the Governor's office. Once the State Senate has adjourned in later March we will provided a compressive overview of the legislative session based on our priorities.

Please find more on the committee, including the February meeting notes by clicking here.

Coronavirus Communications: The Health Department continues in a lead role communicating with our community about novel Coronavirus, now known as COVID-19. Our Public Information Officers Jenni Loging and Paula Silha along with the Health Director, key Public Health Nursing staff including the Manager Jacquie Cutts, and representatives of the Branding and Marketing (BAM) team have put together messaging, which has been shared with all healthcare and infection control partners, media and the public, airport, businesses, and other community partners via email, news media, the Health Department Facebook page and the Health Department and County websites. Meetings set up with many public and private school administrators to prepare for possible school closures. Key Message: The risk to Wisconsinites is low. The risk could change. Let’s be ready.

Health Department Director’s Report - Addendum

February 2020 Activities

Goal 1: Assess – Conduct and disseminate assessments focused on population health status and public health issues facing the community. Health Education staff working with the Overdose Fatality Review Team (OFRT) compiled recommendations from the Team’s

review of overdose cases and presented key recommendations to the OFRT for confirmation and next steps. Health Education staff working with the Safe Routes to School Program conducted follow up with Lincoln Middle School staff

regarding transportation concerns around the school. Public Health Nursing staff continued working with nursing students on a comprehensive equity profile that will explore

health and social determinants of health by key sub-populations in La Crosse County. Public Health Nursing staff responded to numerous calls from healthcare providers with specific questions about novel

coronavirus risk determination for individuals with international travel history. No clients were found to require evaluation as a person under investigation (PUI).

Health Director and Public Health Nursing Manager working on COMPASS survey team to improve and finalize the random household survey.

Health Director attends Better Together meeting with review/discussion on Youth Risk Behavior Survey (YRBS) data. Significant inequities identified in LGBT youth.

Goal 2: Investigate – Investigate health problems and environmental public health hazards to protect the community. Health Education staff working on communicable disease investigation investigated 36 cases of disease as required by state

statutes (22 chlamydia, 3 gonorrhea, 3 campylobacteria, 2 salmonella, 1 shigellosis, 2 E-coli-EPEC, 1 E-coli -ETEC, 2 E-coli – STEC).

Health Education staff working with the Alliance2HEAL collected data on Medicated Assisted Treatment (MAT) availability, coordinated discussions on treatment available and interruptions for people in the County Jail and coordinated discussion to develop a plan to reduce treatment interruptions for those in the County Jail.

Health Education staff working on animal control and rabies responded to 14 bite report (5 bat exposures) facilitated 18 contacts to gather information from owners, vets, victims with 11 citations issued for noncompliance.

Between January 15th and February 15th, Public Health Nursing staff investigated 92 cases of communicable disease: 2 reports of tick-borne disease (can include anaplasmosis, babesiosis, ehrlichiosis and lyme disease), carbon monoxide poisoning (2), hepatitis B & C (22), invasive streptococcal disease (2), invasive streptococcus pneumoniae (1), influenza associated hospitalizations (23), invasive haemophilus influenzae (1), bacterial meningitis (1), MRS/ORSA (3), mumps (1) latent tuberculosis (6), mycobacterial disease (non-TB)(1), pertussis (2), poliomyelitis (1), and varicella/chickenpox (6).

Goal 3: Inform & Educate – Inform and educate about public health issues and functions. Health Education staff working with the Child Safety Seat education program wrote and submitted a newsletter article for the

County wide Newsletter on car seat services available through the Health Dept.

Health Education staff coordinating the Employee Wellness program continued to promote and test the Motion Connect app to monitor employee participation in fitness activities.

Health Education staff working with the Alliance2HEAL provided information to the County Criminal Justice Management Council on strategies being explored to provide Medicated Assisted Treatment to County Jail inmates.

Health Education staff working on public health preparedness facilitated an AED demo and coaching instruction event for the 7 Rivers Center-LGBTQ annual breakfast.

Health Education Manager provided a media interview to WIZM on spring flood preparations in anticipation of spring flood risks being increased.

Public Health Nursing staff continues to coordinate weekly meetings to provide updates on 2019 novel coronavirus (COVID-19) for our regional communicable disease partners, as well as participating in weekly Western Region Health Emergency Response Coalition (HERC) meetings and weekly WI DHS meetings on the same topic.

Public Health Nursing staff worked with WI DHS to quickly craft and disseminate communication and education for parents whose pre-school children may have been exposed to the communicable disease Neisseria Meningitidis.

• Managers from Public Health Nursing, Health Ed, and WIC/Nutrition worked with the Health Director and the cross-departmental Branding and Marketing (BAM) team to develop multiple layers of internal and external communication for public health education regarding 2019 novel coronavirus. Education was provided via Facebook, emails to all County employees, emails to media partners, emails to communicable disease partners, and newsletter subscription base.

Goal 4: Community Engagement – Engage with the community to identify and address health problems. Health Education staff working with the Farm2School program co-coordinated the Farm2School chili recipe at the Beer By

Bike Brigade Chili fest. Health Education staff and Manager coordinating the recognition of Healthy Living Heroes by the La Crosse Healthy Living

Collaboration at a community wide event – 3 hero awards were provided to community members with media coverage by WKBT, WXOW and the La Crosse Tribune.

Health Education staff working with the Alliance2HEAL coordinated 1 Alliance2HEAL meeting of the whole with 37 participants and 7 workgroups working with A2H priorities.

Health Education staff working with public health preparedness began planning an educational outreach for Human Services Foster Family program on preparedness planning.

Health Education staff working with the Branding and Marketing Team completed the Meet the Team Monday Facebook campaign which involved 47 members of the Health Department staff. Link to the campaign is included here view them here.

Public Health Nursing staff continued to coordinate the multi-agency “Community Data Team” to field and address requests for aggregated data from our two major healthcare systems.

Public Health Nursing, WIC/Nutrition, and Environmental Health started collaborating with City of La Crosse Planning meeting to partner on a grant opportunity that will provide funding for lead abatement in homes where children have a high lead level or have a high risk of developing a high lead level.

Nutrition Manager provided WIC Farmers’ Market Nutrition Program information to farmers at Cameron Street Market meeting at the library.

Nutrition staff working to secure 6 new student volunteers and one adult volunteer for leading Strong Seniors classes. Nutrition staff are working with two Viterbo research students. Their projects are related to well-water testing for WIC

participants and shopping/vendor connections with WIC approved area grocery stores.

Goal 5: Policies & Plans – Develop public health policies and plans. Health Education staff participated in the SharePoint team in the Health Dept. to explore SharePoint use. Occupational Health Nurse and manager (in the Public Health Nursing section) and Laboratory staff and manager worked

together to provide needed Safety Data Sheets for a new program that will be used county-wide to ensure compliance with chemical safety requirements.

Goal 6: Public Health Laws – Enforce public health laws. Health Education staff working with the Tobacco Prevention and Control program participated in webinar and

teleconferences on the Tobacco-21 Policy adopted at the national level and the FDA partial flavor ban for e-cigarettes. Staff provided guidance for the Health Department’s Leadership team and shared information for the 7C’s tobacco program partners.

Health Education staff working on animal control and rabies worked with County Sheriff’s Dept. to issue 11 citations for owner noncompliance related to bite reports.

Public Health Nursing staff participated in a webinar shared by The Network for Public Health Law to better understand a change to the “Public Health Charge” rules, governing green card issuance and the ways that it might or might not impact health department programs.

Department of Ag, Trade, and Consumer Protection Audit for Food Safety and Recreational Licensing Program in Environmental Health.

Goal 7: Access to Care – Promote strategies to improve access to health care services. Public Health Nursing staff provided 41 immunizations to 20 people. Occupational health in the Public Health Nursing section provided immunizations to 7 county employees.

Goal 8: Workforce – Maintain a competent public health workforce. Health Dept. Leadership Team provided Section overviews to the Intern orientation provided on February 5th. Health Education and Nutrition staff -4, participated in the diversity equity training provided on MLK day. Public Health Nursing started a new professional development series in which each month, staff participate in a new daily

practice related to evidence-based improvement of staff productivity, health, wellbeing or efficiency. Topics addressed so far have included daily gratitude and mindfulness.

Public Health Nursing started using a new framework for program progress tracking and accountability, called a log frame, which provides structure and organization to each program’s activities and outputs as they relate to objectively measurable purposes and overarching goals.

Public Health Nursing hosted two Viterbo Nursing students and provide a breadth of experiences related to public health practice, in addition to mentorship for the students to work on an equity profile and a video that talks about experiences of racial microaggressions and their impact on public health that is being entered in the Viterbo ethics video competition.

All Staff Recognition event was held on 2/19/2020. Awards were given out for benchmark anniversaries and Push Pin awards for our 5 value areas (collaborate, advocate, lead, serve, communicate).

Multiple Managers/leaders attended a presentation on leadership by Jim Hunter at Viterbo.

Goal 9: Quality Improvement – Evaluate and continuously improve processes, programs, and interventions. Health Education staff wrote and submitted a QI study on grants and projects role delineation. Project was accepted as a QI

project for work during 2020. Public Health Nursing staff and manager partnered with Viterbo faculty and grants management staff to utilize grant dollars

towards the purchase of technology to improve data-collection for our joint-run CARING (homeless nursing care) clinic. This improvement will help CARING better assess impact and seek evidence-based funding to meet client needs.

Goal 10: Evidence-Based Practice – Contribute to and apply the evidence base of public health. The Health Department Leadership team started systematic review of objective dashboard items to ensure that each

objective represents a SMART (specific, measurable, attainable, realistic and time-bound) goal that is linked to evidence-based practice whenever applicable.

Goal 11: Administrative & Management – Maintain administrative and management capacity. Health Education staff working with the Safe Routes to School program submitted the Transportation Alternative Program

(TAP) grant proposal for Safe Routes to School grant funding for 2022-2024. Health Educ. Manager and staff working with Safe Routes to School prepared a resolution for review by Corp Counsel which

was discussed at the Feb. Health and Human Services Board, Executive Committee and the County Board supporting the grant proposal submitted.

Managers and staff working to complete the 2019 Health Department’s Annual report. Public Health Nursing Manager helped to write a $400,000 grant application to the Robert Wood Johnson Foundation for a

project to expand and evaluate the HUB model on health equity. LCHD was 1 of only 27 applicants of 151 applications to be forwarded to semi-finals.

Public Health Nursing and WIC/Nutrition Managers worked together with the Health Director and the Great Rivers United Way HUB Director to start drafting a $1,000,000 grant application for a project that would expand the HUB to directly target

equity in maternal-child health outcomes and compare outcomes for related populations between Great Rivers HUB and prenatal care coordination (PNCC).

Interviews for Lab Technician position as 34-year veteran Sue Schreiner announces retirement. Multiple staff in various Sections involved in writing grants for HUB, equity, tobacco prevention and control, overdose death

review, and overdose data/prevention. Year-end close in progress including financial reviews and improvements.

Goal 12: Governance Board member Ya Sayaovang agrees to be on the Health Department Strategic Planning Committee to develop the next 5-

years strategic plan.

Page 1

Human Services Director’s Report To the Health & Human Services Board

March 2019

Activity Program/ Section

Brief Description

Contact Person Attach-

ment

Children’s Mental Health Listening Session

Administration Several team members from La Crosse County Human Services participated in a February 12th local listening session on children’s mental health that was organized by the Wisconsin Office on Children’s Mental Health. Attendees of this “invite-only” event which took place at English Lutheran Church included First Lady Mrs. Evers, Wisconsin Department of Children and Families Secretary Emilie Amundson and Wisconsin Office of Children’s Mental Health Director Linda Hall. It was an opportunity to share perspectives on the status of children’s well-being in La Crosse County and offer thoughts on how State Government could support the many collaborative efforts underway in our community.

Jason Witt 785-6095 jwitt@lacrossecounty.org

No

State Budget 2022-2023 Initiative

Administration/Aging & Disability Resource Center (ADRC)

La Crosse was one of the original pilot counties that developed Aging and Disability Resource Centers in Wisconsin. At that time, we were promised that the Department of Health Services (DHS) would fully fund ADRCs with no levy requirements. ADRCs have expanded across the state from the original 9 pilot sites to now having an ADRC in every county. Aging and Disability Resource Centers in Wisconsin have received no increase in funding from the State of Wisconsin since 2006. Since that time, the number of individuals ADRCs work with has grown. The number of individuals who may benefit from ADRC services in our state also continues to grow due to the growing number of individuals age 60+. A committee working on how to solve the funding gap in providing ADRC services has determined what it would cost to fully fund ADRCs to provide the services requested in the contract. The committee also projected the funds needed to expand ADRCs to include additional services that are sporadically provided through the state, but which significantly impact and improve the lives of adults with disabilities and those who are aging or who are caregivers. Please see the attached document as a reference to this information; additional information will be provided at an upcoming HHS Board Meeting.

Audra Martine 785-6108 amartine@lacrossecounty.org

Yes

Nutrition Services Aging & Disability Resource Center (ADRC)

March is National Nutrition Month! The ADRC provides nutrition services at 8 local congregate dining sites and delivers meals to more than 400 homebound older adults. In 2019, ADRC provided a total of 80,157 meals! The ADRC’s Senior Nutrition Program is available to seniors 60 years of age or older and their spouses, regardless of age. Its purpose is to reduce hunger and food insecurity and promote socialization, health and well-being among older adults.

Carissa Pagel-Smith 785-6172 cpagel@lacrossecounty.org

No

6B 6B

Page 2

Activity Program/ Section

Brief Description

Contact Person Attach-

ment

Caregiver Support Roundtable Event

Aging & Disability Resource Center (ADRC)

A caregiver roundtable discussion was held in La Crosse on Monday, March 9. The roundtable included Governor Evers, Department of Health Services Secretary-Designee Andrea Palm, area legislators, caregivers from around the region and representatives from the ADRC. Caregivers were given the opportunity to share their caregiving story along with any challenges faced when caring for their loved ones. The State wanted to learn firsthand how the State might be able to better support caregivers.

Carissa Pagel-Smith 785-6172 cpagel@lacrossecounty.org

No

Child Welfare Workload Time Study

Family & Children’s (FC)

WI Department of Children and Families (DCF) and WI County Human Service Association (WCHSA) are conducting a statewide child welfare staffing and workload evaluation to identify valuable, research-driven findings to support DCF’s mission to ensure the safety, permanency, and well-being of all children and youth in Wisconsin. The overarching goals of the study are to:

• Establish a comprehensive picture of child welfare workload, case management, and staffing levels throughout the state;

• Recommend manageable workloads for local child welfare caseworkers, supervisors, case aids, and related staff; and

• Identify areas where there may be efficiencies that could decrease workload.

Our agency has been selected to participate in the time study portion of this effort. The time study will help the study team address the amount of time spent on the various services, tasks, and other work and non-work activities that are required to comply with law, policy, and regulations and to provide critical client outcomes across the State of Wisconsin. It is a critical component of the workload study that informs the way work is currently performed. The time study will take place from March 1-31, 2020, and the entire Family & Children’s Services section will participate in this. A month-long data collection period helps ensure that casework requirements based on monthly cycles are captured.

Tracy Puent 785-6083 tpuent@lacrossecounty.org Jason Witt 785-6095 jwitt@lacrossecounty.org

No

Triage/Intake Process for the ISRS Section

Integrated Support & Recovery Services (ISRS)

The ISRS Section has restructured triage/intake for consumers to access programs and services. This new process has just begun as of March 1, 2020. The ISRS section is in the process of meeting with internal and community partners to share the new process and answer questions they may have. We are also exploring adding information to our Human Services/ISRS website. Stay tuned as we will be sharing the new process with the Health & Human Services Board in the upcoming months.

Christin Skolnik 785-6019 cskolnik@lacrossecounty.org

No

Page 3

Activity Program/ Section

Brief Description

Contact Person Attach-

ment

Crisis Unit Integrated Support & Recovery Services (ISRS)

The Collaborative Crisis Intervention Services to Youth Grant (CCISY) has unexpectedly been extended for an additional year. The grant period is from July 1, 2020, through June 30, 2021. The ISRS Section will be looking to use collaborative services funded through this grant to reach children and youth within La Crosse County school districts that we currently serve through our Crisis program.

Christin Skolnik 785-6019 cskolnik@lacrossecounty.org

No

Aging & Disability Resource Centers -

Nationally Recognized

Established in 1998

Problem: The current funding allocation for ADRC’s is based on cost estimates that are more than 10 years

out of date and treats ADRCs differently depending on when they began operations. ADRCs that have been

open the longest are funded at a higher level than those that started at a later date. The allocation for each

ADRC has not been increased since 2006, nor does it take into account health equity and poverty.

The Result: The result is an inconsistent approach to funding the State contracted services every ADRC is

required to perform. It does not account for the optional services recommended in the current contract.

The lack of adequate funding directly impacts the ability to assist individuals with disabilities and older

adults throughout our communities.

Increase in demand for services: Formula factors used:

Age 60 + population 30% Age 18+ population with disabilities 30% Age 18+ population of minorities 15% Age 18+ population of poverty 15% Age 75+ population 10%

Additional components:

Populations served by ADRCs based on 2019 Encounter Data Bureau of Labor Statistics Wage Data & DHS Fringe Rate

Calculation of FTE Calculation of Training Costs Calculations of Personnel Annual Costs Calculation of Space Costs Calculation of Supplies and Services Calculation of AMSO 10% federal limit Breakout Fully Fund ADRCs $27,410,000 Fully Fund Elder Benefit Specialists $2,300,000 Expand Dementia Care Specialists Statewide - $3,320,000 Fund ADRC services in Tribes $1,180,000 Expand Caregiver Support Programs $3,600,000* Expand Health Promotion Services $6,000,000* Expand Care Transition Services $6,000,000 Fully Fund ADRC Support Systems $2,650,000 *to provide services to disabled adults 18 to 59

Consumers Contacts

2016 130,588 512,413

2019 141,692 571,424

Increase 8.5% 11.5%

WISCONSIN 1 out of 4

The number of ADRC customers that report staying in

their homes instead of going to a nursing home or

assisted living because of the ADRC

The ability to stay at home is what most people want

and also cost effective, preserving personal resources.

By receiving options counseling at a local ADRC, people

are 89% more likely to access privately paid resources

rather than Medicaid funded long-term care.

ADRCs are available statewide

ADRCs have a local office in EVERY county

ADRCs are the only provider of local, unbiased decision

support

ADRCs have a live person answering the phone

ADRCs meet with people in their homes and in

the community

ADRCs serve individuals, regardless of

income and assets

ADRCs help individuals prevent or prolong the need for

more costly services and support

ADRCs serve the largest and fastest growing

demographic of Wisconsinites

ADRCs: A Wise Investment

Make ADRC’s whole with an investment of

$52,460,000.00*

*amount is estimated with Tribal allocation final figures to be determined

Wisconsin, Ages 60 and Older as Share of Total Population

HEALTH AND HUMAN SERVICES BOARD Tuesday, February 11, 2020 Administrative Center, Room 1107 6:30 P.M. MEMBERS PRESENT: Sharon Hampson (Chair), Mike Giese, Monica Kruse, Doug

Weidenbach, Laurie Logan, Maureen Freedland, Ebony Hyter, Tom Jacobs, Ya Sayaovang

MEMBERS EXCUSED: None MEMBERS ABSENT: None OTHERS PRESENT: Steve O’Malley, Jason Witt, Audra Martine, Jen Rombalski,

Paula Silha, Becky Lakowske, David Steinberg, Greg Mooney, Mandy Bisek, Lanae Nickelotti, Alice Sorenson

CALL TO ORDER Chair Sharon Hampson called the meeting to order at 6:30 p.m. ANNOUNCEMENTS

A. January County Board Action: There was no County Board action that related specifically to the Health and Human Services Board for January.

B. Board Members Report on Conferences/Meetings/Workshops • Supervisor Tom Jacobs attended a meeting that Jen Rombalski and Carol Drury

held with local owners of animal businesses, i.e., dog daycare, dog boarding. Supervisor Jacobs complimented Jen and Carol for how the meeting was run and personally felt the owners left the meeting knowing that their voices were heard.

C. County Recognition of Human Services in March

The La Crosse County Board proclaims that the month of March 2020 is Human Services and Family Court Month and urges all citizens to join in recognizing the valuable contribution of Human Services and Family Court staff. MOTION by Kruse/Jacobs to approve. Motion carries unanimously.

PUBLIC COMMENT: NONE BOARD EDUCATION

A. Policy, Practice and People of Human Services – Juvenile Detention Facility In May 2017, a resolution was brought before the HHS Board requesting an addition of 3 full time and 2 part time staff to the La Crosse County Juvenile Detention Facility, in direct response to the highly complex issues youth present within the facility, a spike in suicide attempts that year, and an increased trend in average daily population of the facility. This request, in accompaniment with physical changes made to the facility itself, including the replacement of bunk beds with single beds and plexiglass to cover the bars of cells, have led to significant decreases in all around incidents within the facility. David Steinberg, Superintendent of Western Regional Adolescent Services, shared some incident report statistics for 2018 and 2019 and wanted to let the Board know how their decisions impact the Juvenile Detention in a positive way. Greg Mooney, a staff member who has worked within Juvenile Detention for over 20 years, was present to share his perspective as to how the investment has significantly improved the ability for his colleagues and him to provide a safe, stable and secure place for youth in their care.

HEALTH AND HUMAN SERVICES BOARD Tuesday, February 11, 2020 Page Two

B. Human Services Trauma-Informed Event Summary Jason Witt, Human Services Director, indicated that the first goal of the 2019-21 Human Services Department Strategic Plan is to make significant strides toward becoming a Trauma-Responsive Agency. Human Services held a Trauma-Informed All-Agency Kick-Off event on January 8, 2020. The presentation title was “Putting Humanity Back into Human Services”. Scott A. Webb from Wisconsin Department of Health Services was the Trauma-Informed Care Coordinator. His presentation covered what it meant to become a Trauma Responsive Agency:

A. Understands and applies the following in its program and services: a. Knowledge of trauma and resilience. b. The centrality of supportive relationships to healing. c. We cannot do our best in helping others get healthy if we don’t

keep ourselves healthy. B. Acknowledges that historical practices in our field have not always helped

as intended. NEXT STEPS:

1. A perspective shift that growing number of Human Services staff demonstrate and model every day.

2. Our journey toward becoming a Trauma responsive agency will involve actions and system change.

3. This journey, like all those involving change, will be challenging, messy and will take time. It may sometimes be uncomfortable.

4. Our leadership is committee along this journey to keeping everyone safe, involved and informed.

RESOLUTION

A. Resolution Re: Authorizing Application for State Funding for the County-Wide Safe Routes to School Program for Fiscal Year 2022 through 2024 The La Crosse County Safe Routes to School Program increases physical activity among K-8th grade children and facilities by encouraging safety and active commuting to and from school. From 2007 to 2022, approximately $1,570,325 in grant funding was awarded to La Crosse County from the Wisconsin Department of Transportation’s Safe Routes to School program for implementation of Safe Routes to School non-infrastructure activities, including required 20% match since 2018 totaling $134,065. It is recommended that the Commission supports the La Crosse County Transportation Alternatives Program’s application for funding in the amount of $345,585 (80% from the state and 20% local match of $69,117) for state fiscal year 2023 and 2024 in order to continue providing this service to schools, children and families in La Crosse County. MOTION by Logan/Hyter to approve. Motion carried unanimously.

DIRECTOR REPORTS A. Health Department Written Director’s Report. B. Human Services Written Director’s Report MOTION by Jacobs/Weidenbach to approve the Director Reports. Motion carried unanimously.

HEALTH AND HUMAN SERVICES BOARD Tuesday, February 11, 2020 Page Three CONSENT AGENDA MOTION by Kruse/Giese to approve the following Consent Agenda/Minutes. Motion carried unanimously.

A. Minutes: 1. Health and Human Services Board 1/7/20 2. Family Policy Board 1/6/20 3. Criminal Justice Management Council 11/2/19 4. Aging & Disability Resource Center Advisory Committee 12/2/19

B. Department Reports

1. Health Department Quarterly Dashboard Report 2. Human Services Quarterly Activity Report 3. Human Services Vendor Audit Report

ITEMS FOR FUTURE AGENDAS:

• New Immigration Issues – Lorie Graff ADJOURNMENT TO THE NEXT MEETING TO BE HELD TUESDAY, March 10, 2020 MOTION by Jacobs/Hyter to adjourn. Motion carried unanimously. The meeting adjourned at 7:30 p.m. Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting. Alice Sorenson, Recorder

FAMILY POLICY BOARD Monday, February 3, 2020 Health & Human Services Building – Basement Auditorium 12:00 p.m. MEMBERS PRESENT Tita Yutuc, Kristi Arenz, Sue Mathison, Heather Quackenboss, Teresa Pierce, Tracy Puent, Jenni Loging, Ann Kappauf, Megan DeVore, Jane Klekamp, Mandy Bisek, Gloria Doyle, Isaac Hoffman, Mary Kay Wolf, Catherine Kolkmeier, Chris Crye, Elizabeth Wright, Jason Witt, Sharon Hampson, Jodi Widuch, Vie Matty, Lacie Ketelhut, Barbara McPeak, Hetti Brown, Karolee Behringer, Bridget Todd, Nicole Brei GUESTS/OTHERS PRESENT Melissa Myers – Workforce Development Board, Matt Numenel – Workforce Development Board, Leisha Lucas – Garrison Counseling, Kelsey Whalen – Garrison Counseling, Katie Kress – Great Rivers United Way, Bethany Matsick – La Crosse County Human Services, Logan Bjerkos – La Crosse County Human Services CALL TO ORDER Chairperson Tita Yutuc called the meeting to order at 12:00pm APPROVAL OF MINUTES MOTION by Catherine Kolkmeier, seconded by Isaac Hoffman to approve the January 6, 2020 minutes as presented. Motion carried unanimously. HUMAN SERVICES DEPARTMENT AND BOARD UPDATES HHS Board Update: No updates at this time per Sharon Hampson. HS Director Update: Jason Witt Scott Webb presented at the La Crosse County Human Services Trauma Informed Care Kick Off Event on January 8. His presentation was titled, “Putting the Humanity Back in Human Services,” recognizing that years of resource challenges, automation, increased focus on documentation and other factors have has made what we do less personal and connected. This comes at the time that science is showing us how a greater focus on relationships, building resilience, well-being and effectively responding to trauma can make human services more effective. The presentation included an overview of concepts related to Adverse Childhood Experiences (ACEs), resilience and what it looks like to be a trauma responsive agency. Nearly all approximately 300 Human Services staff attended the training. The increased knowledge of Trauma Informed Care will be driving many changes to La Crosse County Human Services in the months and years to come. Family and Children’s Section Update: Tracy Puent Tracy Puent introduced Bethany Matsick as a new Access Unit Supervisor. Bethany has been with the Family and Children’s section for about five years. Tracy also reminded members that one role of the supervisors is to help educate the community. Feel free to contact her if you would like any trainings done for your staff regarding mandatory reporting or other Family and Children’s Section issues.

PRESENTATION: Lisa Kilmer from the United States Census Bureau Lisa Kilmer, a Partnership Specialist for the Census Bureau’s Community Partnership and Engagement Program, provided information about the 2020 census. Her goal is to help every community to get the best count possible. The objective of the census is to count how many people reside in the United States. Those numbers are then used to distribute over 675 billion dollars in federal funds to communities each year for programs that support education, housing, health facilities, transportation, food assistance, and more. Many of the programs and services our agencies provide tie back to census data in some manner so please encourage everyone to fill out their questionnaire.

The survey will arrive in the form of a letter to a physical address, not to a post office box or by telephone. The census will ask for the name, sex, date of birth, and race of each person living in a household. The questionnaire will also ask what type of housing you live in and for one phone number for the household. The census will not ask for your social security number, household income information, for money or bank account information, or whether you are a citizen. The census partners with other federal agencies to ensure no personal information is shared. In addition, data is held 72 years before it is released for public uses like ancestry searches.

The city and county are tasked with making an extra effort to count certain demographics such as individuals who are currently homeless. Public libraries will be having census events to assist people in these hard to reach categories to complete surveys. Coulee CAP will also be aiding their clientele to ensure they respond and are counted. The census bureau itself takes care of counting people in group living situations such as nursing facilities, college dormitories, and group homes.

Information about the count and employment opportunities can be found at https://2020census.gov. Lisa Kilmer can be reached at (262) 227-3622 if you have additional questions or would like to arrange a census education event. AGENCY ROUNDTABLE

• Per Hetti Brown eight appropriation bills for homeless issues were signed by the governor but due to special rules must have senate approval before release. Seven of the bills have to do with funding services. The remaining bill, Senate Bill 119, is a shelter subsidy and has not been approved yet. Shelters currently receiving this subsidy would see a 50% increase in their funding if it is approved. After discussion it was decided that Hetti will author a draft letter of support for the appropriation bills. The draft will include the names of agencies represented on the Family Policy Board. As the draft circulates please express to Tita if you prefer your agency name be withheld.

• Tita led a review of the questions and responses from the December meeting about how the board wants to be made aware of and use data. Next month a draft plan will be presented on how to incorporate data into the 2020 meetings.

ADJOURNMENT TO THE NEXT MEETING TO BE HELD MONDAY, MARCH 2, 2020, AT NOON

Chairperson Tita Yutuc adjourned the meeting at 1:00pm. Approved March 2, 2020, Rachel Klistaui, Recorder

CRIMINAL JUSTICE MANAGEMENT COUNCIL JANUARY 15, 2020 LAW ENFORCEMENT CENTER – ROOM 1615 MEMBERS PRESENT: Tim Gruenke, Kim Cable, Ramona Gonzalez, Troy Harcey,

Jeff Wolf, Jerri Hertel, Monica Kruse, Margaret Larson, Araysa Simpson, John Medinger, Jayne Rifenberg, Joella Strieble, Jason Witt, Stephanie Young, Suthakaran Veerasamy, Mai Chao Duddeck

MEMBERS EXCUSED: Lisa Kruse, Chuck Ashbeck, Sharon Hampson, Rob Abraham, Carrie Rein

OTHERS PRESENT: Scott Horne, Jim Verse, Jane Klekamp, Kristi Arenz, Becky Spanjers, Mandy Bisek, Jordan Vian, Mike Kiefer, Al Bliss, Sam Seefeld

CALL TO ORDER Chair Tim Gruenke called the meeting to order at 7:30 a.m. APPROVAL OF NOVEMBER 20, 2019 MINUTES OF THE CRIMINAL JUSTICE MANAGEMENT COUNCIL RETREAT MOTION by M. Kruse/Wolf to approve the November 20, 2019 minutes of the Criminal Justice Management Council Retreat. Motion carried unanimously; L. Kruse, Ashbeck, Hampson, Abraham and Rein excused.

PUBLIC COMMENT: There was no public comment. STATUS REPORTS: Sheriff/Jail – current jail population is at 141; we’ve been holding extended supervision inmates (we are under 20). Public Defender - Private bar rates went into effect January 1st, so they are seeing a little bit of the backlog begin to get under control. If you know of any attorneys who are willing to take these cases, please encourage them to get certified and take some of these cases. Department of Corrections – busy end of year; their division went through a reorganization.

Human Services – last Wednesday, the Human Services Department had an all-agency kick-off for Trauma Informed Care. They’ve had many sections that have done a lot with trauma informed care, but this was an effort to bring up the whole agency. Sam Seefeld was hired to replace Donna Christianson as the Crisis Intervention Supervisor. District Attorney – hired 2 new people, both of whom will be going on maternity leave soon; they still have one position to fill. Judges – happy that more individuals are having attorneys appointed to them, but the backlog will take awhile to get it under control. Judge Gonzalez is appointing Judge Horne to take her place on the CJMC, as her position as President of the National Council of Juvenile and Family Court Judges is taking up more of her time than anticipated.

County Board – the County Board passed the 2020 budget; at their last meeting they received a report on the Holmen Community Center; also Administrator Steve O’Malley provided the County Board with an overview of the effects of reassessment in the County Pretrial Workgroup: met yesterday and have a good handle on the level of data that they would like to collect on an ongoing basis; they did review of 2019 pretrial data; they have decided to meet on a quarterly basis now. JAIL MENTAL HEALTH & MEDICATION ASSISTED TREATMENT (MAT) OFFERED IN THE JAIL – SHERIFF’S DEPARTMENT This topic came out of the CJMC retreat. We will start off with this topic, which will then lead us into topics outside of the jail, i.e. lack of housing, homelessness, mental illness, lack of services, etc. Sheriff Jeff Wolf discussed MAT (Medically Assisted Treatment) for those suffering from addictions, and what they are doing for the jail population. These individuals need to be on some type of program, such as Methadone, Suboxone, Vivitrol, etc. Inmates coming in to the jail that are dope sick, recovering, or currently using, are highly intensive on jail staff. A couple of things happened in 2018, one of which was the jail went to a new Medical Provider, ACH. At approximately the same time, the Alliance to Heal was rebranded from the Heroin Task Force, and a number of subgroups were set up within the Alliance to Heal. One of these subgroups was identified to target MAT and what we could do for these inmates in the jail. The previous Medical Provider did provide Vivitrol, however, we had not established a Vivitrol program with ACH when they took over the jail medical. This program is now up and running and are now focusing on other programs that individuals were on prior to coming into the jail. Members of the MAT subgroup, Dr. Jackie Jaeger, Carrie Sulter, R.N., Al Bliss, Health Education Coordinator, Mike Kiefer, Program Coordinator, and Sam Seefeld were present to discuss. Al Bliss distributed a couple of handouts from the Alliance to HEAL: Alliance to HEAL Summary of Work Group Activity September 27, 2018 – December 31, 2019, and the Alliance to HEAL Driver Diagram. The main outcome of the Alliance to Heal is “Reversing the Opioid Crisis in our Community” with the four primary drivers being:

1. Limit supply of opioids. 2. Prevent opioid use disorder – raise awareness of the risk of opioid use disorder 3. Identify/assess individuals at high risk for opioid use disorder 4. Treat individuals opioid use disorder

10 different work groups were formed, as well as subgroups. Dr. Jaeger and Carrie Sulter, R.N. discussed the collaboration on getting successful coordination of all of the issues involved with individuals of MAT. There are several different types of programs, and various things to consider when inmates arrive in jail, including starting them on Vivitrol, the withdrawal process, treating symptoms, needing frequent vital sign checks, etc. There are 2-4 inmates withdrawing from Heroin every day in the jail. In 2018, out of 6,000 coming through the jail, approximately 2,700 were on some type of detox protocol. There are several complications that can arise, and MAT is a very complex

topic. Suboxone, Vivitrol, and Methadone are the 3 drugs used when a person enters the jail suffering from addiction, and helps them to move forward in their addiction. In addition to these medications, these individuals need ongoing therapy, counseling, engaging in services, assess motivation for change readiness, etc. NACO ACTION ALERT – SUPPORT LEGISLATION PROTECTING FEDERAL BENEFITS FOR PRE-TRIAL DETAINEES Included in the packets was information regarding pending federal legislation regarding Medicaid Inmate Exclusion Policy (MIEP). MIEP strips federal health benefits from individuals admitted to jail before they are convicted of a crime. This policy violates constitutional rights and individuals’ fundamental presumption of innocence and strains our local judicial, law enforcement, public safety and human services systems and results in higher rates of recidivism and poorer health outcomes. There are currently two bills in the US Senate that would aid pre-trial individuals who have not yet been convicted of a crime:

• The Restoring Health Benefits for Justice-Involved Individuals Act, which would allow for continued access to Medicare, the Children’s Health Insurance Program (CHIP) and veterans’ health benefits while an individual is awaiting trial.

• The Equity in Pretrial Medicaid Coverage Act, which supports continued access to Medicaid benefits while an individual is awaiting trial.

We need more research and information on this topic, and will be put on next month’s CJMC agenda. INFORMATIONAL/MISC ITEMS: Article about republican “Tough on Crime” bills. Chair Gruenke will get a summary and send out to the CJMC. FUTURE AGENDA ITEMS:

• Viterbo’s Criminal/Community Justice System Program ADJOURN: There being no further business, Chair Gruenke adjourned the meeting at 8:42 a.m. Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting. Recorded by Terri Pavlic

AGENDA ITEM NUMBER: 7B1 MEETING DATE: 3/10/20

EXCEPTION ANALYSIS/REPORT

TO THE LA CROSSE COUNTY HEALTH & HUMAN SERVICES BOARD DEPARTMENT: Human Services Department X INFORMATION/DISCUSSION SECTION: Contract Unit SUBJECT: Vendor Audit Policy Step #3 Notification PREPARED BY: Chris Sander FILING ID: REVIEWED BY: Jason Witt IMPLEMENTATION DATE: 1/1/2020

Background: The Human Services Vendor Audit Policy states “As La Crosse County Human Services enters into Steps 2-4, information will be regularly forwarded to the La Crosse County Health and Human Services Board”. Step 3 of the Vendor Audit Policy states “If the Provider’s Audit report is not received by 365 days after the Provider’s year-end, the Provider will stop receiving payment for services until the Provider provides La Crosse County Human Services with the audit report.” Exception: No exception to the Vendor Audit and Financial Reporting Policy. Analysis The following vendors are out of compliance with the policy and are having payments held until the audit is received. Audits Needed: Central States Investigation – (provides fraud investigation services for the Western Region for Economic Assistance). An engagement letter was received from the auditors, audit is being finalized. Coulee Connections – no longer contracted for services, so we are not holding payment. They have responded and have an auditor working on their audit. The following vendors were previously out of compliance and are now in compliance with the requirements, as they have submitted their audits: Person First Homes and Person First Supportive Services – (provides CCS and CLTSW residential and community services). Action Needed: No action is needed by the Health and Human Services Board at this time.