No. 1692

Wake County Human Services Board Minutes

April 24, 2014

Members Present: Mr. Pablo Escobar, Chair Dr. James Smith, III, Vice Chair Mr. John Myhre Mr. Julian Smith Ms. Angie Welsh Commissioner James West Ms. Margaret Raynor Mr. McKinley Wooten, Jr. Ms. Fiorella Horna-Guerra Dr. Rosine Sanders Dr. Paul Scruggs Dr. Sharon Foster Ms. Leila Goodwin Ms. Stephanie Treadway Members Absent: Dr. Jacqueline Tavárez Mr. Frank Eagles Ms. Tameko Piggee Dr. Seth Wexler

Executive Staff: Mr. Ramon Rojano, Human Services Director Ms. Regina Petteway, Staff to the Board/Director of Division of Administration & Office of Community Affairs Ms. Ingrid Bou-Saada, Program Consultant Mr. Ken Murphy, Assistant County Attorney Ms. Michelle Ricci, Staff to Public Health Committee Ms. Caroline Harper, Human Services Data Analyst Mr. Britt Stoddard, Environmental Services Water Quality Director Ms. Rosena West, Staff to Social Services Committee Mr. Joseph Threadcraft, Environmental Services Director Mr. David Stratton, Information Technology Business Analyst Ms. Maria Robayo, Public Health Educator Ms. Karen Morant, Program Consultant, Community Affairs Ms. Denise Foreman, Assistant to the County Attorney Ms. Laura Jernigan, Interim Executive Assistant Ms. Rebecca Crawford, County Budget & Management Services Mr. Paul Gross, Human Services Finance Officer Staff Absent: Mr. Scott Warren, County Attorney Ms. Martha Crowley, Division Director ESS Mr. Joe Durham, Deputy County Manager Mr. Warren Ludwig, Child Welfare Division Director Ms. Katherine Williams, Cooperative Extension Director & Human Capital Development Ms. Sue Lynn Ledford, Public Health Division Director Dr. Kimberly McDonald, Human Services Medical Director Mr. Bob Sorrels, Human Services Deputy Director

Presenters: Mr. Warren Ludwig, Child Welfare Division Director Dr. Edie Alfano Sobsey, Epidemiologist/Laboratory Director Dr. Caroline Loop, Environmental Engineer/Consultant – Hydrogeologist Mr. Greg Bright, Environmental Health Supervisor – Ground Water

Guests: Ms. Kathryn Glaser, Public Affairs Officer Quorum Present: yes

No. 1693

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

I. Call to Order Chair Pablo Escobar called the meeting to order at 7:36 a.m. Ms. Fiorella Horna-Guerra shared a reflection. She reflected about making a living vs. making a life. She reflected on living a purposeful life, on being engaged in achieving a dream, doing something meaningful for your community or yourself. She quoted Jim Rohn “Let others lead small lives, but not you. Let others argue over small things, but not you. Let others cry over small hurts, but not you. Let others leave their future in someone else's hands, but not you.” She asked the Board to reflect on what they were doing to live a purposeful life.

N/A

II. Approval of Minutes Mr. McKinley Wooten motioned, seconded by Dr. James Smith, to approve the March 27, 2014, Board meeting minutes. The motion passed unanimously. Chair Escobar asked for the sake of time to try and be as succinct and direct as possible in their comments.

N/A

III. Confirmation of Next Board Meeting

The next Board meeting is scheduled for May 22, 2014, at the Wake County Human Services Center, 220 Swinburne Street, Rm. 2132, 7:30 a.m. – 10:00 a.m.

N/A

REGULAR AGENDA

No. 1694

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

IV. Review Procedure on Process for Board Participation in the Performance Evaluation of WCHS Director Chair Pablo Escobar and Ms. Regina Petteway

Before the first item was discussed Chair Escobar welcomed the new County Manager, Jim Hartmann. Mr. Hartmann said he wanted to stop by and meet the Board and say hello. He said he appreciated what the Board did, saying what they did was influence service distribution to people who needed help. He noted that the Board had both passion and compassion. He said that he was thankful to be chosen and join this incredible team and community. Chair Escobar then began to review the procedure. He suggested that they follow the same process that they did last year. He called attention to the Board’s packet where the process was well documented. Last year they solicited input from each of the members, each of the members wrote something to Chair Escobar which he then reviewed with the Executive Committee. Those comments were then shared with both the Human Services Director and with County Management as their formal input into the evaluation process. It was assumed that the County Manager then used that input to evaluate the Director. He reminded the Board that they were to couch their comments in light of the duties that were written on the position. The job description was included in the Procedure that was given to the Board in their packets. This was Board Procedure 200 2.0. Chair Escobar asked for any comment. Mr. John Myhre called the Board’s attention to a spelling mistake on page 4 and asked that the word “planning” be spelled correctly. The review is due in August. Chair Escobar said he would solicit the Board for comments in June. Those comments should be returned to him in June and he will compile them for the Executive Committee to review perhaps in July and share them with County Management that same month. Dr. Sharon Foster asked that they move that up due to a scheduling conflict. Chair Escobar said they could send out for comments in May so they could be compiled in June. Ms. Leila Goodwin suggested capturing Chair Escobar’s exact process (follow up, etc.) for future Chairs since he had been extremely successful getting responses last year. Chair Escobar said contacting members directly was the key. Chair Escobar concluded by saying they would try to get this wrapped up by the end of June.

PH Accreditation Benchmark #37.4 and 37.5 Correct spelling mistake Chair Escobar to send out requests for feedback on the Director in May.

Ms. Laura Jernigan and Ms. Regina Petteway Chair Escobar and all Board Members.

End of May.

No. 1695

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

V. Annual Review of Board Operating Procedures Ms. Leila Goodwin

Ms. Leila Goodwin referred the Board to the Board Operating Procedure in their packets. She spoke about how these operating procedures that had been put into place last year were a big change from the way the Board had done things in the past. The most significant change was putting into place the two main committees instead of the many committees there had been before. She asked how the members thought it was working. She asked if they had any changes or refinements. Dr. Smith asked how many committees there used to be. Mr. Ramon Rojano said 10. Dr. Smith asked if they were losing out. Chair Escobar said the paradigm was that instead of being Board led Committees most of them became staff lead. Mr. Julian Smith said that although it’s good from a management standpoint he feels they’re missing out on some key issues with Seniors. Chair Escobar asked Mr. Smith about his involvement with the Human Rights/Consumer Affairs Committee which meets quarterly. Mr. Smith goes to those meetings and reports back to the Board. He is the Board’s eyes and ears on that Committee. Also Ms. Stephanie Treadway sits on the staff lead Committees. She is on the Housing Committee, which meets as needed, and is the liaison to Alliance Behavioral Healthcare. She said that in the Public Health and Social Services Committee these issues are discussed regularly. She thinks it’s more focused and more directed and that if there is an issue that needs to be discussed that it can be addressed and vetted within those two Committees. Then whatever needs to be brought to the Board can be. Chair Escobar also spoke about Mayor Frank Eagles being the Board’s liaison to the Regional Networks Committee. Overall these make up four Committees that are pretty active but no longer lead by this Board. Dr. Foster spoke about the Public Health Committee, saying she felt it now had a critical mass, because for years it was just her and Mr. Benny Rideout. She feels like now they accomplish a lot more. Chair Escobar said it was similar in the past with the Social Services Committee. Now regularly they have five Board members show up at the Social Services Committee. Ms. Margaret Raynor commented that the Board member that she replaced had felt as if she weren’t doing anything. Ms. Raynor said this new structure gave the members ownership. Mr. John Myhre commented that with the standing Committees it didn’t have to be either/or, he attended both the Social Services and the Public Health Committees. Ms. Leila Goodwin asked if the new procedure for Public Comments should be referenced in item H2. Chair Escobar said they should suggest it and have staff review to see if it is appropriate or not. Mr. Julian Smith said he was hearing two main schools of thoughts. One being that the new structure means the members get more out of it. The other being that things are slipping through the cracks. Mr. Smith said he had previously suggested having Ad Hoc Committees from time to time. Chair Escobar commented that Ad Hoc Committees were in the structure in the Operating Procedure, pg. 5. (Cont.)

PH Accreditation Benchmark #34.2 Discuss addition of public comment reference.

Ms. Laura Jernigan, Ms. Regina Petteway, Mr. Ramon Rojano

No. 1696

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

V. Annual Review of Board Operating Procedures Ms. Leila Goodwin

(Cont.) Ms. Goodwin commented that the structure was never going to prevent things from slipping through the cracks. The Board members themselves have to keep things from slipping through the cracks. If there is an issue that they think needs to be addressed then they need to bring them up and make sure they are addressed. Commissioner James West observed that he served on four Committees as liaison to various key structures of the County. He wondered what the nexus was for all of the Committees for the Board of Commissioners, because they do not talk to each other. He asked that Mr. Ramon Rojano go through the 20 or so committees let him know which has the nexus with what committee. Mr. Rojano said that this was a brilliant idea. Ms. Regina Petteway gave a good example of synergy, being that the Wake County Commission for Women has a member who attends and observes the Human Services Board meeting.

Review and discuss connectivity of BOC committees

Mr. Ramon Rojano

No. 1697

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VI. Contaminated Ground Water Initiative and Introduction of Hydrogeologist Mr. Greg Bright and Dr. Caroline Loop

Mr. Greg Bright, Groundwater Programs Manager, introduced Dr. Caroline Loop, Hydrogeologist. He said that due to the Stony Hill incident they had asked how they could better position themselves to deal with future situations similar to that one. They started looking at other counties that addressed groundwater contamination. They liked the Mecklenburg County program which had a couple of hydrogeologists. They proposed an expansion for a hydrogeologist for Wake County. Dr. Caroline Loop came on board in October. Dr. Loop thanked the Board for inviting her and for their support. She stated they were going to talk about private water supply wells in Wake County. She said that the private well owner often knows very little about the water that’s in their well that they drink every day. She outlined the three things she would be talking about in her presentation: the program goal, the accomplishments, and the next steps. The program goal is to eliminate the consumption of contaminated well water through outreach, testing, and technical services. The testing is something they’ve always offered, the technical services they’ve always offered but hope to expand. With outreach they think of in two different ways. There is broad outreach telling everyone it’s important, and then they have a targeted outreach program for known contaminated sites. They would do this by:

• Investigate known contamination sites • Inform, educate, and empower people to make good decisions

regarding wells and water quality • Pursue community partnerships to identify needs and help address

them • Conduct research on groundwater contamination issues and solutions

to the problems we encounter There have been three major accomplishments. For the first they built a framework to address contaminated groundwater in private wells similar to the program in Mecklenburg. They created door hangers. The “well hangers” they developed are used when they identify a site and need to notify people that they have a well, there is known contamination in the area, and they recommend that they test for that. There is a Spanish one and an English one, and septic information also gets left on their door. The second accomplishment is the development of critical partnerships. Data and information is very important. Internally they work with Geographic Information Services, Planning, and Public Health. Externally they work with NC DENR, EPA, NC Geological Survey, and US Geological Survey. In terms of broad outreach they want to partner with everybody. For this internally they have partnered with Public Health, Cooperative Extension, Master Gardeners, Regional Centers, Soil and Water Conservation, Information Services, (Cont.)

No. 1698

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VI. Contaminated Ground Water Initiative and Introduction of Hydrogeologist Mr. Greg Bright and Dr. Caroline Loop

(Cont.) and WakeGov TV. Externally they have partnered with East Wake Issues (TV), Raleigh Regional Association of Realtors, Knightdale High School, and the NGWA. They have a public health educator that has been presenting at high schools. Her presentation is call “WATER you waiting for?” If anyone wants to have this presentation given the educator is available until the end of May. She also created a general information flyer “Wake County Wells: Maintenance and Testing.” The third accomplishment is an investigation of contaminated well water in an unincorporated area in east Raleigh surrounded by City of Raleigh municipal limits. This is the Bond Street Community: 273 properties in the area 184 properties were mailed letters (WCES) 165 properties visited (WCES) 108 properties sampled (DENR, WCES, EPA) 60 had no detected pesticides or PCE 20 well water samples exceeded standards 4 qualified for Bernard Allen assistance Report is in preparation As of December, these were the next steps and they have done these things: One to Three Months: Determine a procedure for area investigations of known contamination and begin investigations. Continue to meet with stakeholders and associated organizations to get buy-in and communicate role. Three to Six Months: Assemble a preliminary database for known contamination sites, assign priority numbers, and begin adding information. Develop draft educational materials for schools, realtors, and private well owners and begin conducting educational outreach activities. Things that they will continue to do: Investigations and building the database; outreach; reviewing proposed well sites; reviewing No Further Action (NFA) requests; and pursuing resources to best address citizens’ needs. Ms. Fiorella Horna-Guerra said when they identify a site and they leave the door hanger saying they should test their well, the prices for these things becomes a burden upon the citizen. She asked if there was a way for the County to pick up that price. Is there a way to assist with the cost of testing? Dr. Loop said they were working on that and they had proposed a sliding scale fee in the budget. There are resources made for the elderly. (Cont.)

No. 1699

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VI.

(Cont.) Commissioner West commented on Bond Street and how the community began to get organized and there was a positive change due to the education outreach. Bond Street, though unfortunate, has allowed them to plan for the future. Dr. Foster asked if there was someone with Dr. Loop’s credentials looking at potential fracking in North Carolina. Dr. Loop said she did not know. Ms. Leila Goodwin said that the State staff had licensed geologists. Dr. Loop said they had met with the North Carolina Geological Survey, they are very aware of what may happen and they did not feel at this point that the Wake zones would be exploited at this time. Dr. Paul Scruggs spoke about septic tanks and said that he would be willing to bet that 95% of the people who had septic tanks didn’t know very much about them or their maintenance. He spoke about the septic tank information on the flyers and how they should be given out when people buy homes with septic tanks. Dr. Loop said they celebrated National Ground Water Awareness Week by passing around those flyers to the regional centers. They have also been given to the Raleigh Realtors Association. Dr. Scruggs suggested giving them to Home Owners Associations. Chair Escobar thanked Dr. Loop and said the last item that Dr. Scruggs was discussing was of big concern to the Board and asked for any information Dr. Loop could give them on outreach regarding the maintenance of their septic tanks.

No. 1700

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VII. Public Health Quarterly Reports Dr. Edie Alfano- Sobsey

Dr. Edie Alfano-Sobsey started with the indicator report. She said that trying to assess the health and wellbeing of the citizens in a county is very difficult. There are many factors involved. These challenges were addressed by the data group INFORM. The 36 measurable indicators were selected by: Demographics & Social Determinants of Health Wake County’s Community Health Needs Assessment Priorities County Health Rankings Wake County Board of Commissioners Goals Wake County Human Services Board Priorities The indicator report was organized into 3 sections. Those are:

1) County Profile. Page2 and 3 provides a “snapshot” of the socio- economic conditions to the Wake County community with national comparison data.

2) Community Health. Pages 4 and 5 feature indicators that measure health outcomes and health factors.

3) Physical Environment. Page 6 provides indicators that measure access to food, physical activity, and water and air pollution.

They are going to try to update this report at least annually. She said that this was a 30,000 foot view of Wake County. With 36 indicators there is a lot of information to drill down and for that reason they created the Public Health Quarterly Report. She would be presenting two of those reports today. The first one covers July-December 2013 and is called Cancer, Heart Disease and Diabetes Trends and Disparities. Cancer is the leading cause of death in Wake County. It has dropped by 12%. They try to look at targets and there is a North Carolina 2020 target to reduce colon cancer mortality. Wake is at 11.5 and the target is 10. As for disparities, African American males and females have the highest cancer mortality rate. The second leading cause of death among Wake County residents is heart disease. The heart disease mortality rate has decreased 32%. The Healthy NC 2020 target is to reduce the cardiovascular disease mortality rate population to below 161.5. Wake County has met that target. Stroke is the 3rd leading cause of death in Wake County. The stroke mortality rate has declined 37%. As for health disparities, mortality rates from stroke are higher in African American males and females. Diabetes is the 7th leading cause of death. The death rate has come down. According to hospital data there are increasing amount of patients in emergency rooms with a diagnosis of diabetes. Wake County has met its 2020 target of reducing the percentage of adults with diabetes to 8.6%. Mr. Rojano said that now they would be presenting some of this data and connecting it with the Healthiest Capital County Initiative. Dr. Foster told a personal story about a nurse that she works with who was a smoker and recently had a heart attack. She talked about taking preventative measures with healthy behaviors. (Cont.)

Public Health Accreditation Benchmark #2.4

No. 1701

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VII.

(Cont.) Chair Escobar asked if the improvement had to do with more healthy people coming into the County, or if the sick people who were here got better? Mr. Rojano said they were tracking the population. Dr. Sobsey pointed out that this was surveillance data and they didn’t have data on some of the other populations. They are looking at a standard way of comparing to see trends. Dr. Sobsey then presented the Public Health Quarterly Report for January – March 2014 titled Communicable Diseases 2009-2013. Communicable diseases are diseases that are transmitted by an infectious agent from another person, an animal, a plant, or the environment. The ones in the report are the ones that are required by law to be reported. There are 71 reportable diseases. These were broken down into six different categories. The first category is general communicable diseases. In Wake County, as well as worldwide, novel influenza viruses have not been reported since 2009 when the pandemic influenza H1N1 was first identified and reported. Now they are looking to see if there are any new viruses circulating that could cause a similar pandemic. All though there have been some that they’ve worried about none have met the conditions to become a pandemic. Hepatitis C, acute, is reportable. These are just the tip of the iceberg because they are only the cases that are reported. They are seeing chronic Hepatitis C. For a while it was just reported in baby boomers but now it is being reported in younger generations, probably because of IV drug use. The next category is vaccine presentable diseases. The number of reported pertussis cases have been cut in half. They think this is because of the vaccination campaign. Influenza they are not seeing as much as they were before, however this year was a severe flu season, there weren’t as many cases but there were more deaths. Most of those had an underlying factor that made them more susceptible to getting sick or they did not get vaccinated. 90% were in the 25 to 64 years of age. The next category is foodborne diseases. The most common of these is norovirus which is not reported, followed by Salmonella, Clostridium and Campylobacter. The most reported is Salmonella. Dr. Sobsey thinks that instances of Clostridium perfringens are severely under reported. The next category is sexually transmitted diseases. She knows Ms. Sue Lynn Ledford has spoken to the Board about the County’s problems with chlamydia and gonorrhea. They are looking closely at chlamydia and gonorrhea because 8% are co-infected with both and they are getting re-infected (18%). The last category is tuberculosis. Although the number of clients diagnosed are coming down there is a disparity where the number has increased in the Asian population. Chair Escobar commented that the information they give the Board is just incredible and thanked Dr. Sobsey.

No. 1702

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VIII. Child Welfare Quarterly Report Mr. Warren Ludwig

Mr. Warren Ludwig started with the 3 core functions of Child Welfare. • Three core functions:

– CPS Intake and Assessment – CPS In Home Services – Foster Care and Adoption

• Three federally mandated outcomes – Children will be safe – Children will have permanent homes – Children’s wellbeing will be enhanced

• This report will focus on Foster Care and 2 initiatives: – Measuring wellbeing of foster children – Follow up to Making it Happen

They have an average of 900 children involved with CPS, assessment whether they have been involved with abuse or neglect, every month based on reports from the community. Of that they provide ongoing service to families that involve an average of 100 children. About 30 children each month enter foster care. Foster Care is about the most intrusive thing you can do to a family, taking children from the parent’s custody and putting them into the County’s custody. The children who enter foster care are children that have been exposed to severe and usually chronic abuse and neglect. Those children have been further traumatized by being removed from their family. Those children present often times when they enter foster care very challenging behaviors and they have to find homes that can contain and manage those behaviors. Over the last 15 years the number of children in foster care in Wake County has gone up and down, mostly remaining between a low of 500 and a high of 650 children at any one time. Wake County has fewer children per thousand than the rest of the state. A lot of people think that children in foster care are literally in foster homes. They are required first to look to see if they can place children with relatives. It’s less traumatic for the children, and less intrusive to the family. 30% of the children entering foster care in Wake County are placed with relatives. A little over 40% are placed in foster homes that Wake County recruits or that are recruited by private agencies. Another 13% are placed in therapy homes, about 9% in group residential homes, about 4% are placed back with their parents. Foster care is court supervised. (Cont.)

No. 1703

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

VIII.

(Cont.) • Parties to court hearings (all have attorneys)

– County – Each parent – Child’s appointed Guardian ad litem volunteer

• County must prove children were abused, neglected or dependent and at imminent risk of serious harm

• County must show reasonable efforts to prevent foster care and reasonable efforts to end foster care

• Court approves custody, visitation & service plans, and reunification, guardianship or adoption

A lot of what they do is governed by law or state police - The law prioritizes a child’s need to grow up in a permanent family. CW attempts to reunify (except in the most extreme cases) but parents are put on a clock. - Child Welfare must maintain children’s connections with relatives and

give preference to placements with fit and willing relatives. - Older youth receive special services through LINKS to prepare for

adulthood. • Safety and Permanence Outcomes:

Wake’s maltreatment rate in foster care is consistently less than 1% • Compared to other counties

– Wake County children stay longer in foster care because they are less likely to be reunified and are reunified more slowly—This will be a focus of efforts next year

– Wake County children are less likely to reenter care – Wake County children’s foster placements are more stable

Racial disparities have been documented. Wake County in general has pretty significant racial disparities compared to the rest of the state. Over the last dozen years over 80% of the children in foster care were African American. It’s now about 60%, but is still way out of proportion to the percentage of African American children in the community. Nationally there has been a shift over the last several years saying to child welfare that they are doing better with have fewer kids in foster care and better with safety, but have they shown that their wellbeing improves? (Cont.)

No. 1704

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

(Cont.) Studies have shown that children who are abused and neglected do very poorly. They are doing poorly when they are first seen by the system and are doing poorly years later. This is not just foster children, but also other children who are reported in the system. They have to start measuring how their kids are doing. They must do this in a consistent, reliable way. Wake County is currently working with Duke Endowment and the Annie E. Casey Foundation to highlight a way of measuring the wellbeing of foster kids. Measuring Wellbeing:

• Use a highly researched checklist developed to match clients to mental health providers

• Key persons involved with youth will complete the checklist at regular intervals

• Children’s progress in key wellbeing domains will be tracked as children progress through services and placements

Mr. Ludwig spoke about the Making It Happen event. A year ago they had an event at the Double Tree Hotel where more than 150 people attended. The focus was strengthening families and building a community of hope. They wanted that to be an event that galvanized the community. There has been a lot of activity since that time. The follow up is as follows:

• Steering Committee, Racial Disparities break out group, and Hispanic break out group have continued to meet

• Educational outreach to Hispanic community has taken place through Spanish language media

• John Rex has funded community wide implementation of Triple P for Raleigh

• United Way is making a focused effort to support youth transitioning from foster care.

• Will show film to families Hoping to announce a follow up breakfast event on May 29. Child welfare in North Carolina is under some increased scrutiny. There has been State pressure from the legislature and media interest. It is challenging working with youth that have been severely abused and neglected. Another issue this year is that the federal government is beginning round three of the Child and Family Services Review. It now looks like it will begin in 2015. North Carolina will be one of the first states and Wake County, Mecklenburg, and probably Scotland County will be the counties that are visited. (Cont.)

No. 1705

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

(Cont.) It is a tough review that they will be taking very seriously. Next month they will be going to Atlanta to hear from the federal government how they’ve changed the review. Ms. Margaret Raynor asked if it made a big difference when they take the kids out of the home. She posited that the earlier they took the child out of the home the better it would be for them if they were put in a stable place. Mr. Ludwig said this was both a good and difficult issue. He said that he thought it was important for government to be very cautious when taking a child away from family. Foster care itself is an additional trauma to the children on top of what they’ve already experienced. Having said that he thinks there have been times when they have moved too slowly. He said it was a case by case question. Ms. Raynor asked if the children did better when they went to live with family members. Mr. Ludwig said once again this was a case by case thing. He said it is believed it was less traumatic with family. There are some national studies that at least suggest that kids do at least as well with kin, on average. That doesn’t mean that some children aren’t placed in the wrong kinship homes. Mr. Julian Smith asked if even anecdotally or subjectively if the kids are more likely or less likely or the same to go from the environments they’re in into the criminal justice system. Mr. Ludwig said irrespective of foster care, there is a lot of data that shows that children who have been abused or neglected are much more likely to go into the criminal justice system. Also with foster youth there are issues of homelessness, poverty, and a cycle of maltreatment continuing into the next generation. Ms. Horna-Guerra spoke about undocumented new immigrant populations and random raids where children were taken out of the care of their family members. She said the placement of the child with no input from the parents who have been whisked away to be deported is unjust. She wanted to know what Wake was doing to address how they treat children who fall in that category. Mr. Ludwig said there were several things. First they did have a Hispanic outreach that was featured at the Making It Happen even last year. From that there has been a Hispanic focus group that has been providing them with feedback. Also, they know they need to hire more Spanish speaking staff. Also they have looked at the question as to how many children are in foster care just because the parents were arrested. At the time the answer was zero. They are required to reach out to parents even if they are in prison. Even with ICE. They are not always successful. They believe that those parents need to be involved in the planning for their children.(Cont.)

No. 1706

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

(Cont.) Ms. Horna-Guerra asked if those procedures were written up somewhere. Mr. Ludwig said they were federal procedures. Ms. Horna-Guerra discussed the undocumented experience was not limited to the Hispanic/Latino population. She wanted to make sure there was something that goes on within these departments with cultural sensitivity. Mr. McKinley Wooten stated that one of the things they talked about from the Making It Happen group was looking at the reporter. These reports come from schools, etc. So the same type of sensitivity training has to happen with teachers and social workers, and all of those people who are considered reporters. Ms. Horna-Guerra said that was why it needed to be part of our procedures and hiring processes. Chair Escobar officially accepted the report. Mr. Rojano said that this was linked to their budget request for more child services social workers.

Chair Escobar officially accepted the report on Child Welfare.

No. 1707

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

IX. Board Committee Chairs’ Report Dr. Sharon Foster Ms. Angie Welsh

The Board was shown the video of Dr. Foster’s presentation to the Board of Commissioners. The Board stood up during the video to promote Healthy Behaviors. Dr. Foster gave her report. She said that they are continuing to vet and give people things they need to follow up on. Dr. Foster’s passion is decreasing the infant mortality rate. They have an advocate and fliers that will be going up in every Wake County bathroom on the seven things young women can do to improve their health. Once they become pregnant they need to get into prenatal care very quickly. In the private sector women call for prenatal care within one to two weeks. According to Ms. Ida Dawson that 25% of lower income women receive their prenatal care through the Wake County Health Department and there is an 8 week waiting list. 48 hours ago she got a call from the president of Wake Med Physicians who is an OBGYN. She has met with Dr. Kimberly McDonald and with Ms. Dawson and they are going to try and improve staffing hours. When she presented this data to the County Commissioners she spoke about funding requests so they could get more money for extra hours and staff. Ms. Angie Welsh referred to the work plan objectives. Their major objective was Human Capital Development and they have 3 objectives within that. She requested that the Social Services Committee have about 10 minutes at the next Board meeting to give a little bit more detail about what they’re doing.

No. 1708

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

X. Chair’s Report Mr. Pablo Escobar

Chair Escobar said he would like to discuss 3 things. The first was to follow up with the retreat and the commitments that they made. The second was the plan for public comments at the June 2 Board of Commissioners sessions. The third thing is a letter to the Commissioners that Chair Escobar drafted and shared with the Board. It is something that is required by their rules but is timely considering they are in the middle of their budget season. On the first issue he asked the Committee Chairs to follow up on the commitments that they put down on paper and up on the walls at the retreat and how they are handling that. What is the plan for taking advantage of that goodwill? Dr. Foster said it was very helpful because people put their money down where they were willing to help and she has solicited those people and assigned people different areas to work. Dr. Paul Scruggs commended Dr. Foster on her work and follow up with this. Ms. Welch said their subcommittees were hard at work and they had a list of where people said they wanted to commit. She said they had an effective plan on how to pull people in. Mr. John Myhre and Ms. Regina Petteway told a story about a Committee member who left them real money. The second issue was assigning expansion items for the public comments on June 2. Each one of them would take one of the expansion items and make a short comment at one of the sessions. He asked the Board if this was a good plan. There were 13 expansion items so they need 13 volunteers to get to know the expansion item and make a brief statement about it at the session. The time is 2:30pm on June 2 at the Justice Center, and again at 7pm at the Commons. Ms. Denise Foreman said they could do the 2:30pm or the 7pm; they did not have to do both. They get 3 minutes. The Board said that they approved this plan. Chair Escobar asked that they pick one of the expansion items that they had thoughts or ideas on and send the Chair a note saying which item. If there is any that do not have a champion he will call and ask a member to take it on. The last issue is the letter that the Chair sent out in draft form. He asked for comments. Mr. McKinley Wooten asked about the word initiative appearing twice in one sentence. Ms. Horna-Guerra made a comment about the section speaking about “productive and responsive citizens”. Ms. Margaret Raynor motioned, seconded by Dr. James Smith, to approve with changes and send the letter. Motion passed unanimously.

The Board approved the letter to the Board of Commissioners.

No. 1709

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

XI. Environmental Services Director’s Report Mr. Joseph Threadcraft

Mr. Threadcraft presented the Environmental Services Budget and Expansion requests from an executive summary. This pertains to administrative positions, environmental health and safety and water quality. For the department budget they anticipate $2.4 million in revenue, $8.5 million in expenses, and a head count of 105. This does not include solid waste. Overall they have 13 expansion requests. 8 of these were recommended by the budget analysts, 2 were partially recommended by the budget analysts, and 3 were not recommended. In admin they are requesting a copier due to expansion in staff and office space. The software allocation was county wide. There is also a recommendation for a tier certification for Water Quality and Environmental Health and Safety. The reason for the tier certification is that at times they are not able to find qualified people and they hire them at a lower rate. Andre’s group requested 4 additional staff for inspection; the budget analyst is only recommending 2. That is connected to restaurant coverage. He also requested 9 temporary pool inspectors. The benefit being they do not have to reallocate personnel to conduct those inspections. Another expansion item is sustainable funding for Meth Lab functions. Most of the meth labs that they have had to evaluate were in homes. Now they are finding mobile meth labs. Mr. Britt Stoddard’s group is requesting 8 additional staff for septic permitting. He is also requesting lab equipment, lab supplies, and an increase in dues for the Upper River Basin Association. Additional items are a customer service representative for the call center, a public health educator for the contaminated ground water program, and temporary staff support for Andre’s group. Dr. Foster stated that Environmental Services decreased their budget during the budget contraction process. She asked if this budget and these expansion items were bringing them back on par. Mr. Threadcraft said that when Mr. Stoddard requested 8 new positions the goal was to get back to the pre-recession staffing level. When Mr. Andre Peirce requested 4 people that was due to required minimum coverage due to the increase in the amount of restaurants to be inspected. Dr. Foster said there was not fat in their budget. Mr. Threadcraft said Environmental Services is extremely lean. There are no wasted dollars. Chair Escobar asked about the budget office making their recommendations based on the requests and if there was a way to appeal their recommendations to the County Manager. Mr. Threadcraft said that when they made their budget presentation they respectfully disagreed with the budget office’s position. They will hear the County Manager’s final decision within the next two weeks. (Cont.)

No. 1710

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

XI.

(Cont.) Chair Escobar asked if there was anything that the Board could or should do. Mr. Paul Gross said that May 19 was when the County Manager presented his recommended budget. Chair Escobar asked if there was anything they could do before May 19. Even though Environmental Services was no longer part of the Board name, the things they covered were Public Health Issues. Mr. Rojano said Mr. Threadcraft was a deputized health director of the health department. That’s why he’s on the Board to talk about the Environmental Health portions of Public Health. Part of his budget is in the interest of Human Services. After they endorse the Human Services Budget they can see how it all fits together and decide how they want to advocate. Ms. Leila Goodwin said that many of the Board’s public health responsibilities fell under the Environmental Services department. She asked about the septic permitting positions.

XII. Human Services Director’s Report Mr. Ramon Rojano

Mr. Rojano went over the Human Services budget summary (attached). Mr. Gross has been presenting these budget issues to the Board for the past 6 month. This document has the total number of FTEs, etc. Also looking for an expansion of $6 million. That includes $3 million that they have already appropriated and was passed by the Board of Commissioner is March. They still have additional requests regarding NC FAST. They have a request in Child Welfare for additional positions. There are also expansion requests for administration in the call center. Ms. Horna-Guerra asked if the Human Capital Development funds were in there. Mr. Rojano said yes. Chair Escobar said he would send out a reminder with a list of all of the expansion items. Chair Escobar called to questions endorsing the budget and requests of both the Environmental Services and Human Services department. Dr. Foster motioned, seconded by Dr. Smith. The motion passed unanimously. Mr. Rojano went over the newly approved the Board of Commissioner Goals and how they synergized and reflected and aligned with the Human Services Board Goals. They talk about Human Capital, Healthy Lifestyles, and the Healthiest Capital County Initiative.

The Board endorsed the budget and expansion requests for Environmental Services and Human Services. [PH Accreditation Benchmark #39.3]

No. 1711

Agenda Item

Discussion, Conclusions, Recommendations Action, Follow-up Responsible Party

Due Date

Lastly Mr. Rojano said they were alive and well in the Healthiest Capital County Initiative. June 12 at the Commons they will be launching the Initiative inside Wake County Human Services. The Board is invited. It will be from 1pm-4pm.

XIII. Participation in Community Events/ Public Comments

Ms. Regina Petteway talked about the planned Bus Tour. It was decided that they best day of the week for this would be a Friday morning. Members should tell Ms. Petteway which Friday in May would be the best. They should be finished by noon.

XIII. Adjournment With no other business, the Board meeting was adjourned at 10:09 a.m. Board Chair Approval Pablo J. Escobar, Chair

1 of 2 5/21/2014

WCHS BUDGET ANALYSIS FY2014 - FY2015As of April 14, 2015

Division Section FY 2014 Adopted Budget

FY 2014 FTEs

FY 2015 Dept Base Budget

FY 2015 FTEs

FY 2015 Expansion

4615 ESS DIVISION ESS B&O 1,387,311 19.90 1,388,088 19.90 250,248 ESS Reserve (643,080) 0.00 (643,080) 0.00 - Medicaid 5,812,032 123.55 5,030,931 123.55 3,526,476 Food Stamps 4,326,214 72.97 3,970,561 72.97 - Energy Assistance 3,611,014 11.24 3,539,204 11.24 - Work First 4,746,225 62.24 4,480,520 62.24 - Child Day Care 35,514,075 25.50 34,592,317 25.50 - Work First 50,000 0.00 50,000 0.00 - Employment 587,354 5.50 592,398 5.50 - Child Support 4,609,299 72.00 4,654,663 72.00 - Adult Services 11,783,165 87.00 11,392,997 87.00 177,627

4615 ESS DIVISION Total 71,783,609 479.90 69,048,599 479.90 3,954,351 4625 CHILD WELFARE Child Welfare B&O 326,031 3.00 332,174 3.00 -

CW Reserve (388,820) 0.00 (388,820) 0.00 - Child Welfare 21,634,943 230.50 22,562,119 230.50 374,796

4625 CHILD WELFARE Total 21,572,154 233.50 22,505,473 233.50 374,796 4635 CYF DIVISION Children Youth and Family B&O 581,032 6.00 578,202 6.00 -

CYF Reserve (522,240) 0.00 (522,240) 0.00 - WIC 3,952,931 72.50 3,986,313 72.50 - Maternal Health 3,584,890 49.26 3,580,562 49.26 - Child Day Care - 0.00 - 0.00 - Early Childhood 2,108,967 27.59 2,146,387 27.59 - Youth Services 2,345,421 29.50 2,266,480 29.50 - School Nursing 4,651,925 62.31 4,602,865 62.31 727,098

4635 CYF DIVISION Total 16,702,926 247.16 16,638,569 247.16 727,098 4645 PUBLIC HEALTH Public Health B&0 1,123,093 4.35 1,096,544 4.35 -

PH Reserve (441,820) 0.00 (441,820) 0.00 - Health Promotion 731,256 10.00 878,363 10.00 27,544 HIV/STD Community Outreach 1,599,622 23.00 1,658,677 23.00 70,741 Epidemiology Surveillance 2,083,805 26.04 2,113,366 26.04 50,000 Public Health Emergency 200,017 2.15 174,314 2.15 - School Nursing - 0.00 - 0.00 -

4645 PUBLIC HEALTH Total 5,295,973 65.54 5,479,444 65.54 148,285 4655 HEALTH CLINICS Health Clinics B&O 465,727 5.55 484,762 5.55 -

HC Reserve (769,940) 0.00 (769,940) 0.00 - MCH Clinics 7,996,809 82.37 7,772,382 82.37 167,364 Communicable Disease Clinics 3,750,972 34.44 4,553,363 34.44 36,883 Dental 1,371,668 15.05 1,354,453 15.05 - Pharmacy 1,828,561 9.00 1,796,271 9.00 18,312 Lab 1,418,915 15.45 1,401,017 15.45 -

4655 HEALTH CLINICS Total 16,062,712 161.86 16,592,307 161.86 222,559 4665 BH DIVISION Behavioral Health B&O 633,228 1.00 - 1.00 -

BH Reserve - 0.00 - 0.00 - Behavioral Health - 0.00 - 0.00 - Behavioral Health MCO - 0.00 - 0.00 -

4665 BH DIVISION Total 633,228 1.00 - 1.00 - 4675 ADMINISTRATION HS Administration B&O 8,012,006 64.20 8,186,681 64.20 709,578

HS Reserve 126,900 0.00 126,900 0.00 - Housing 5,126,691 52.00 5,209,443 52.00 - Transportation 6,218,241 9.50 7,157,884 9.50 - Finance/Budget 2,782,663 43.50 2,972,277 43.50 - Community Affairs 1,069,991 13.00 1,094,464 13.00 54,972 Regional Networks of Care 2,562,172 33.75 2,563,419 33.75 -

4675 ADMINISTRATION Total 25,898,664 215.95 27,311,068 215.95 764,550 4685 BH MCO Behavioral Health MCO B&O - 0.00 185,696 0.00 75,000

Behavioral Health MCO 25,202,558 0.00 25,204,732 0.00 -

WCHS FINANCIAL COMPARISON FY 2014 - FY 2015

2 of 2 5/21/2014

WCHS BUDGET ANALYSIS FY2014 - FY2015As of April 14, 2015

Division Section FY 2014 Adopted Budget

FY 2014 FTEs

FY 2015 Dept Base Budget

FY 2015 FTEs

FY 2015 Expansion

WCHS FINANCIAL COMPARISON FY 2014 - FY 2015

4685 BH MCO Total 25,202,558 0.00 25,390,428 0.00 75,000 Grand Total 183,151,824 1404.91 182,965,888 1404.91 6,266,639