Title
Support request to:
a. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA004-8121 to delete 1.0 FTE vacant Public Health Program Manager II and add 1.0 FTE Public Health Nurse II; and
b. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA004-8121 to delete 0.5 FTE vacant Public Health Nutritionist II and add 0.5 FTE Occupational Therapist-Physically Handicapped Children; and
c. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA004-8121 to delete 1.0 FTE vacant Senior Therapist-Physically Handicapped Children and add 1.0 FTE Community Services Aide III; and
d. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Supervising Public Health Nurse and add 1.0 FTE Health Program Coordinator; and
e. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Laboratory Helper and add 1.0 FTE Office Assistant III; and
f. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 2.0 FTE vacant Chronic Disease Prevention Specialist I and add 2.0 FTE Community Service Aide II; and
g. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Principal Office Assistant and add 1.0 FTE Community Service Aide II; and
h. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Secretary and add 1.0 FTE Community Service Aide II; and
i. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE Supervising Public Health Nurse and add 1.0 FTE Public Health Nutritionist II; and
j. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 2.0 FTE vacant Public Health Nurse III and add 2.0 FTE Public Health Nurse II; and
k. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Public Health Licensed Vocational Nurse and add 1.0 FTE Public Health Nurse II.
Report
RECOMMENDATION:
It is recommended that the Budget Committee of the Board of Supervisors Support Request to:
a. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA004-8121 to delete 1.0 FTE vacant Public Health Program Manager and add 1.0 FTE Public Health Nurse II; and
b. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA004-8121 to delete 0.5 FTE vacant Public Health Nutritionist II and add 0.5 FTE Occupational Therapist-Physically Handicapped Children; and
c. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA004-8121 to delete 1.0 FTE vacant Senior Therapist-Physically Handicapped Children and add 1.0 FTE Community Services Aide III; and
d. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Supervising Public Health Nurse and add 1.0 FTE Health Program Coordinator; and
e. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Laboratory Helper and add 1.0 FTE Office Assistant III; and
f. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 2.0 FTE vacant Chronic Disease Prevention Specialist I and add 2.0 FTE Community Service Aide II; and
g. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Principal Office Assistant and add 1.0 FTE Community Service Aide II; and
h. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Secretary and add 1.0 FTE Community Service Aide II; and
i. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE Supervising Public Health Nurse and add 1.0 FTE Public Health Nutritionist II; and
j. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 2.0 FTE vacant Public Health Nurse III and add 2.0 FTE Public Health Nurse II; and
k. Amend Fiscal Year (FY) 2018-19 Health Department Budget 4000-HEA003-8124 to delete 1.0 FTE vacant Public Health Licensed Vocational Nurse and add 1.0 FTE Public Health Nurse II.
SUMMARY/DISCUSSION:
The Health Department recommends amending the allocated positions within the Public Health Bureau, Unit 8121 Children’s Medical Services and Unit 8124 Public Health.
Children’s Medical Services Unit 8121
Items a, b and c are recommended to improve operational efficiencies in the Children’s Medical Services (CMS) Unit of the Public Health Bureau as a result of the implementation of the Whole Child Model (WCM). In July 2018, the WCM transitioned approximately 97% of the California Children’s Services (CCS) covered children to the Managed Care Medi-Cal provider, Central California Alliance for Health (CCAH), for on-going nurse case management. This transition reduced CCS staffing by approximately 50%, as reflected in the HEA004 2018-19 Adopted Budget. However, Monterey County CCS remains responsible for the medical and financial CCS eligibility determination for all new referrals and annual reviews for the entire CCS population of approximately 3,100 children, including those transitioned to CCAH for on-going nurse case management.
The reallocation of 1.0 FTE Public Health Program Manager II to 1.0 FTE Public Health Nurse II will provide needed nurse case management, health passport tracking and required psychotropic medication monitoring and oversight (PMM&O) to meet Monterey County’s responsibilities for the health care needs of children in foster care (HCPCFC program). The reallocation of 1.0 FTE Public Health Nutritionist II and 1.0 FTE Senior Therapist-Physically Handicapped Children to 1.0 FTE Occupational Therapist-Physically Handicapped Children and 1.0 FTE Community Services Aide III will provide occupational therapy and ancillary services to the medically fragile children in the CCS Medical Therapy Program (MTP).
Public Health Unit 8124
Items d through j are recommended to improve management and operational efficiencies within the Public Health Bureau to accomplish programmatic needs and delivery of Public Health services to the community. The Public Health Bureau was recently restructured to consolidate management duties for multiple programs into fewer, but larger, divisions, creating the need for additional supervisorial and clerical support within the Bureau’s divisions.
Items d and e request reallocation of 1.0 FTE Supervising Public Health Nurse to 1.0 FTE Health Program Coordinator and 1.0 FTE Laboratory Helper to 1.0 FTE Office Assistant III as this will improve programmatic oversight and support within the Chronic Disease and Injury Prevention (CDIP) division by providing an appropriate supervisorial structure and clerical support. The 1.0 FTE Health Program Coordinator will be assigned to provide direct oversight of the Women, Infants and Children (WIC) program, which is comprised of three supervisors and 28 staff at three WIC clinic sites. The 1.0 FTE Office Assistant III will provide clerical support to the CDIP division manager and supervisors, which is comprised of four sections with 50 staff providing chronic disease prevention, violence prevention, and nutrition education and outreach, WIC services, and health promotion projects including the County Wellness Program.
Items f, g and h request the reallocation of 2.0 FTE Chronic Disease Prevention Specialist I, 1.0 FTE Principal Office Assistant and 1.0 FTE Secretary to 4.0 FTE Community Service Aide II (CSA II) in the WIC program. The 4.0 FTE CSA II will help increase the number of WIC client appointments provided by the current WIC Nutrition Assistants by relieving them of reception, orientation and intake duties. The 4.0 FTE CSA II will also provide much needed indigenous language translation and outreach to the County’s indigenous community.
Item i requests the reallocation of 1.0 FTE Supervising Public Health Nurse to 1.0 FTE Public Health Nutritionist II (PHNt II) as this will increase the Bureau’s ability to provide case management and nutritional guidance to some of the County’s most vulnerable and medically fragile children. The primary focus for the 1.0 FTE PHNt II will be the children and their families referred from the Childhood Lead Poisoning Prevention Program and the Medical Therapy Program.
Item j requests the reallocation of 2.0 FTE Public Health Nurse III to 2.0 FTE Public Health Nurse II (PHN II) in the Maternal Child Adolescent Health (MCAH) program. The focus of the 2.0 FTE MCAH PHN II is the provision of case management to improve the health and well-being of mothers, infants, children and adolescents through education and linkage to health care services. The PHN II is the appropriate level position to provide these services.
Item k requests the reallocation of 1.0 FTE Public Health Licensed Vocational Nurse to 1.0 FTE Public Health Nurse II (PHN II) in the Communicable Disease Prevention and Control (CDPC) program. The focus of the CDPC is the control and prevention of communicable diseases (e.g. tuberculosis, sexually transmitted diseases, pertussis) in Monterey County. There has been a 53% increase of reportable communicable diseases in the County since 2013. This is not only a significant increase in the number of communicable diseases, it is also the severity and complexity of the diseases; multi-drug resistant tuberculosis, infants and children with tuberculosis, congenital syphilis, etc. The PHN II is the appropriate level position to provide the higher-level case management skills needed to address the complexity of these types of infectious diseases.
These reallocations support the Monterey County Health Department 2018-2022 Strategic Plan Initiatives: 3) Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services; and 4) Engage Monterey County Health Department workforce and improve operational functions to meet current and developing population health needs.
OTHER AGENCY INVOLVEMENT:
The County Administrative Office Budget Office, Auditor-Controller, County Counsel and Human Resources have reviewed the recommendations.
FINANCING:
There are no financial impacts to FY 2018-19 HEA003-8124 and HEA004-8121 Adopted Budgets as there is an estimated cost savings of $43,000 and no net increase in the adopted total FTE, appropriations or revenues.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☒Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Carol Ann Corpus, Assistant Bureau Chief, 8972
Approved by: Elsa Jimenez, Director of Health, 4526
Attachments:
Attachment A Funding Table