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Program Explanations

Introduction

The 2000 Adopted Budget for Health and Human Services reflects the County’s continuing commitment to providing the best possible services to residents of King County, especially those most vulnerable populations. Health and Human Service agencies are finding new and better ways of doing business while maximizing CX funds and leveraging additional revenues from other sources. The proposed program initiatives outlined below are designed to improve and expand upon current programs that assist those with mental health and/or substance abuse problems, provide access to health care for people who do not have adequate health insurance, and increase the quality of child care for children.

Assuring Quality Childcare. In recognition of the importance of quality child care, and as a way to improve its availability in the community, the Metropolitan King County Council passed a childcare wage ordinance in 1999 that seeks to increase the professionalism and retention of childcare workers through a wage incentive pilot program. The Adopted Budget contains $300,000 to administer this pilot project beginning in 2000 and continuing through 2004. Participating vendors who meet the ordinance requirements, and other program criteria, are eligible for a professionalization and retention subsidy of up to one dollar per hour per employee. In addition, training will be provided to childcare teachers and directors. The purpose of this pilot project is to assess the impacts of increasing salary and benefit levels on the quality of childcare in King County.

Developmental Disability Improvements. There are significant increases in the Developmental Disabilities budget including $500,000 of one-time funding to enhance services for children under 3 years of age with developmental disabilities; $200,000 to expand employment and recreational opportunities for disabled adults; and funding for currently unserved individuals who live with older parents.

Public Health Enhancements. The Public Health budget includes the following increases. $173,000 and 3 positions will be added to the communicable diseases section to help handle the increased workload due to population increases, increases in the number of cases of reportable disease, and also to enable the County to be more proactive in analyzing disease trends. Increases are also included for the laboratory handling outbreak situations as well as for prevention and counseling efforts to decrease the transmission of STD/HIV. $1.3 million has been awarded to Public Health who will be the prime contractor to provide breast and cervical health program services in King and Snohomish Counties. This grant will enable the department to increase its screening services. Finally, $1.28 million has been awarded to fund efforts to decrease infant mortality in the African American and Native American communities by linking them to prenatal and pediatric services. This grant will also be used to increase Medicaid outreach in order to increase the number of families with insurance coverage.

Maximizing Outside Revenues. In spite of a volatile health care environment with ever changing regulations and unstable revenue sources, Public Health-Seattle/King County (PHSKC) is committed to delivering top quality care and services. In order to maximize outside revenues and minimize reliance on local revenues, PHSKC has restructured its Primary Care division. This change is designed to increase revenues as well as the number of patients that providers can see. It is also a way in which PHSKC can cover the costs of uncompensated care for patients who do not have any or inadequate health insurance. The new program structure will provide centralized oversight for the financial and operational aspects of primary care service delivery. A central operations unit with expertise in financial management, managed care and clinical practice will work to ensure maximum efficiency and quality care. This program change is supported entirely by outside revenues.

Integrated Services. The Department of Community and Human Services (DCHS) is continuing to develop services that address chronic substance abuse and mental health problems in King County. In 1999, DCHS integrated the Division of Alcohol & Substance Abuse Services with the Mental Health Division to form the Mental Health Chemical Abuse and Dependency Services Division. This integration allows DCHS to better coordinate a continuum of mental health and substance abuse services. Providing comprehensive and integrated services also facilitates the identification and treatment of each individual’s needs. Clients with co-occurring substance abuse and mental health disorders can now receive previously unavailable coordinated care. The new system promotes stability and recovery regardless of whether an individual is experiencing a short-term crisis or a chronic condition that requires ongoing and intensive support services.

In addition, DCHS continues to prepare to assume responsibility from the State for inpatient mental health treatment. The County currently provides outpatient mental health services through the Prepaid Health Plan. Inpatient services are provided on a fee-for-service basis. In accordance with the State mandated integration of outpatient and inpatient mental health services, the County will assume the risk for both service categories in 2001.

 

 

 

 

Community & human services

Issues and Priorities

The 2000 Executive Adopted Budget for the Department of Community & Human Services (DCHS) reflects a continued focus on providing critical human services to the County’s most vulnerable populations. The road to achieving this focus continues to be challenging due to static or declining revenue streams. Despite this challenge, the County’s Community & Human Services agencies are committed to providing effective and efficient service in response to the demand.

DCHS Administration will receive two Community Corrections Analysts. This 2000 budget add supports a County effort to begin thoroughly assessing the status quo of community corrections processes as well as determine the appropriate populations to serve.

In July, 1999, the Metropolitan King County Council passed a child care wage ordinance that seeks to increase the professionalism and retention of child care workers through a wage incentive pilot program. Participating vendors who meet the ordinance requirements, and other program criteria, are eligible for a professionalization and retention subsidy of up to one dollar per hour per employee. The purpose of this pilot project is to assess what impact increasing salary and benefit levels has upon the quality of child care in King County. DCHS will administer this pilot project which begins in 2000 and continues through 2004.

Another program highlight for 2000 includes a Homeless and Human Services Planner position that will serve as the lead analyst in developing and implementing the Human Services Plan. This position will work with many County agencies to ensure better County coordination regarding human services. In addition, Developmental Disabilities is receiving a substantial, one-time revenue add for enhanced services for infants and toddlers under the age of three and their families to treat children with developmental delays.

The 2000 Adopted Budget for DCHS continues to reflect the County’s intent to better serve the needs of the people with mental illness and chronic substance abuse problems. This commitment is represented by two initiatives; the assumption of responsibility from the State of inpatient mental health treatment, and the integration of the Division of Alcohol & Substance Abuse Services with the Mental Health Division.

Currently the County provides outpatient mental health services through the Prepaid Health Plan, on a full risk assumption basis from the State. Inpatient services are provided on a fee-for-service basis. In accordance with the State mandated integration of outpatient and inpatient mental health services, the County will assume the risk for both service categories. Integral to the integrated service concept is a contract with an "Entity" which is a risk bearing outside business or not-for-profit organization that will maintain the provider network. The DCHS has begun a Request for Proposal (RFP) process, with an expectation to begin full service provision by January 2001.

In 1999, the DCHS integrated the Division of Alcohol & Substance Abuse Services with the Mental Health Division to form the Mental Health Chemical Abuse and Dependency Services Division (MHCADS). This integration allows DCHS to better coordinate a continuum of mental health and substance abuse services. The new system will promote stability and recovery regardless of whether an individual is experiencing a short-term crisis or a chronic condition that requires ongoing and intensive support services. Clients of these systems will benefit from services provided in a comprehensive and integrated fashion that facilitates the identification and treatment of the full spectrum of each individual’s needs. Those with either mental health or substance abuse treatment needs will continue to receive the same high quality of care through existing systems. Clients with co-occurring substance abuse and mental health disorders will receive previously unavailable coordinated care, tailored to the complex treatment needs of this population.

Program Highlights

DCHS Administration

Significant Program Additions

Homeless and Human Services Planner - $73,500/0.5 FTE. The Homelessness and Human Services Program Planner will serve as the lead analyst in developing and implementing the Human Services Plan, the homelessness planning process, and other major initiatives as directed by the department director. This position will better coordinate County human services among DCHS, Executive Office, Office of Regional Policy and Planning, Health Department, Parks and Recreation, and Department of Youth Services.

Community Corrections - $132,082/2 FTE. The two Program Analysts will manage a broad-based community participation effort to reach citizens at large and system stakeholders, find external funding, secure grants, support work groups by analyzing and presenting data and literature, and create recommendations for program change and implementation in regards to community corrections procedures.

Non-CX DCHS Admin. Rent Increases - $13,272. This item adds the non-CX proportionate share of the DCHS Admin. rent increases for DCHS. The rent increase is calculated by assuming the same square footage occupied in the Exchange Building (The DCHS Admin. new location for 2000) as is presently occupied in the Key Tower. The CX share of the rent increase was built into the 2000 status quo budget.

 

 

Technical Adjustments

Central Rate Changes - $82,152. Central Rate adjustments include CX overhead, rent, and ITS infrastructure.

Community Services Division

Significant Program Additions

Additional Unincorporated Area Council - $10,000. This add will provide administrative support for the Unincorporated Area Council in the Snoqualmie area.

Child Care Labor Subsidy - $197,869/0.79 FTE. This add funds the first year of a 5-year pilot project. The purpose of this pilot project is to assess what effect increasing salary and benefit levels has upon the quality of childcare in King County. This program will be administered by an Office Tech II (.29 FTE) and a Program Representative (.50 FTE). Seven South King County Childcare providers will be chosen as pilot program participants. In addition, the Children and Family Commission (CFC) will contribute $50,000 to fund an evaluation.

Children & Family Services - One-Time Funds – $222,716. CSD was presented with an opportunity for the use of one-time Children and Family Services Set Aside funds. The agency chose to provide: Enhanced Child Care Provider Training ($100,000), Domestic Violence Cross-Systems Coordination ($85,216), and Technology Upgrades ($37,500).

Technical Adjustments

Net Change in TLT, true-temps, & FTEs - $0/0.1 FTE. The net impact of a series of technical changes in personnel resulted in $0 adjustment and a 0.1 FTE addition. The .10 FTE is an office technician position that will be maintaining a permanent database. The City of Seattle will be partially funding this position.

Underexpenditure Contra – ($35,179). The Adopted 2000 Budget includes a 1% underexpenditure contra in each CX operating and CX transfer budget to directly budget for assumed underexpenditure levels. A remaining central contra of .75% is being held in the CX Financial Plan, for a total assumption of 1.75% underexpenditure for all CX operating and CX transfer budgets. While it is a change in that the contra is now directly placed in each budget, it is the same policy as in previous years. CX departments are asked to manage to a total underexpenditure requirement of 1.75%. The underexpenditure requirement for CSD was calculated on the administrative portion of its budget only.

Central Rate Changes - ($332,277). Central Rate adjustments include finance rates, rent, and Motor Pool.

Federal Housing & Community Development

Significant Program Additions

Housing Planner - $41,651/0.50 FTE. The Consortium’s Joint Recommendations Committee recommends this additional .5 FTE be paid from HOME funds to assist the lead Federal Housing & Community Development planner with implementing the Fair Housing Action Plan and other duties.

Significant Program Reductions

Program Reduction – ($1,282,233). The $1,283,233 reduction in this fund represents a 2000 forecasted reduction in recaptured funds (funds in excess of what is needed to perform a program or service) and in the Shelter Plus Care program. Of this decrease, $594,008 is associated with reduced income in the Shelter Plus Care program for homeless adults. The program will issue 100 fewer housing vouchers in 2000. The recaptured funds estimate will be reviewed and updated prior to passage of the 2000 appropriations ordinance.

Technical Adjustments

Central Rate Changes - $210,454. Central Rate adjustments include rent, finance rates, CX overhead, ITS infrastructure, and debt service.

Housing Opportunity Fund

Significant Program Additions

Planner II, HOF Project Manager - $0/1.0 FTE. The number of active HOF projects has grown to 30 requiring the conversion of a TLT to a FTE Career Service HOF project manager. The HOF funds housing development and preservation for low-income households with income below 50% of median. This proposal will increase efficiency and timelines of HOF project management, assisting clients served by the Division of Mental Health & Chemical Abuse Dependency and other County agencies.

Technical Adjustments

Underexpenditure Contra - ($32,950). The Adopted 2000 Budget includes a 1% underexpenditure contra in each CX operating and CX transfer budget to directly budget for assumed underexpenditure levels. A remaining central contra of .75% is being held in the CX Financial Plan, for a total assumption of 1.75% underexpenditure for all CX operating and CX transfer budgets. While it is a change in that the contra is now directly placed in each budget, it is the same policy as in previous years. CX departments are asked to manage to a total underexpenditure requirement of 1.75%.

Central Rate Changes - $37,651. Central Rate adjustments include rent and ITS infrastructure.

Transfer to Capital Fund - $69,269. HOF is budgeted in the capital fund. This adjustment represents an increase in the transfer amount.

Veterans Program

Technical Adjustments

Transitional and Treatment Housing - $25,000. This program supports the existing Incarcerated Veteran’s Project and the Veteran’s Administration Medical Center (VAMC) by providing additional housing for veterans coming out of in-patient alcohol treatment. The program’s goal is to break the of re-entrance into the criminal justice system for veterans that have underlying alcohol addiction and homelessness problems.

Expansion of Pro-Vet Application - $22,156. The Pro-Vet Application is a database that assists the Veterans Program in identifying veteran eligibility and Veterans Program usage patterns regarding financial cash assistance for King County veterans. Fund balance supports this request.

Other Adjustments - $11,726. This item increases funds for two purposes. The first is a Security Guard benefit rates increase for which the Veteran’s fund is accountable. The second is an increase in the Contra/Contingent account. This account increase allows Veterans Programs to carry forward 1999 COLA and benefit increases that did not get carried forward during the Proposed Status Quo budget phase.

Central Rate Changes - ($78,006). Central Rate adjustments include ITS O&M, finance rates, and CX overhead.

Work Training Program

Significant Program Reductions

Program Reduction – ($928,295). In 2000, the Federal Job Training Partnership Act will be superseded by the Workforce Investment Act (WIA). This change will result in a projected revenue decrease of 41%, or $802,438, in federal funding for youth employment programs for both in-school youth and dropouts. The balance of the decrease was needed changes and transfers associated with this loss.

Transfer Port Jobs to Economic Development – ($80,000). The Port Jobs contract will be transferred to Economic Development. Service will still be provided but will be sub-contracted by Economic Development.

Significant Program Additions

Transfer CX Day Camp Funding from CSD to WTP - $128,616. Funds formerly used to support summer reading day camps for elementary age children will be reprogrammed to serve low-income youth with serious risks of dropping out of school. The program is double budgeted in CSD and WTP.

New Start Program - $537,446. This project will provide community services, training, and employment opportunities to gang and criminal justice involved youth. This program is funded through the Private Industry Council.

CFS One-Time Funds - $100,000. DCHS was presented with an opportunity for the use of one-time Children and Family Services Set-Aside funds. The agency chose to provide Youth and Family Independence (YFIP) Enhancements plus $10,000 for technology improvements.

Technical Adjustments

Underexpenditure Contra – ($11,495). The Adopted 2000 Budget includes a 1% underexpenditure contra in each CX operating and CX transfer budget to directly budget for assumed underexpenditure levels. A remaining central contra of .75% is being held in the CX Financial Plan, for a total assumption of 1.75% underexpenditure for all CX operating and CX transfer budgets. While it is a change in that the contra is now directly placed in each budget, it is the same policy as in previous years. CX departments are asked to manage to a total underexpenditure requirement of 1.75%.

Central Rate Changes - $19,821. Central Rate adjustments include flex benefits, ITS O&M/infrastructure, and rent.

Developmental Disabilities

Significant Program Additions

Fiscal Staffing Support - $12,090/0.50 FTE. A Data Entry/Office Assistant position will be increased from half-time to full-time due to the volume of work.

Early Intervention Part C - $500,000. This program is a one-time revenue add for enhanced services for infants and toddlers and their families to treat children with developmental delays under 3 years of age.

Housing Technical Assistance - $50,000. Developmental Disabilities (DD) fund balance will be used to fund a technical assistance program based on a 1998 Housing Needs Assessment to assist individuals with DD in public and private housing funding.

Expand Opportunities for Individuals - $200,000. This program supports increasing social, employment, and recreational opportunities for adults with developmental disabilities.

Technical Adjustments

Program Increase - $1,873,269. An increase of $1.3 million in funding from the State Department of Social and Health Services (DSHS) will allow the Division to increase the number of adults in King County who receive employment and community access services. The major share of the new funding will be used, in accordance with Legislative directives, for specific target populations which include currently-unserved individuals who live with older parents. The other portion of the $1.3 million increase will be used to continue services for adults who started receiving services late in 1998 or during 1999. An additional $500,000 increase in Federal funds will be used to enhance infant/toddler early intervention services for children ages birth to 36 months and their families.

Underexpenditure Contra – ($5,167). The Adopted 2000 Budget includes a 1% underexpenditure contra in each CX operating and CX transfer budget to directly budget for assumed underexpenditure levels. A remaining central contra of .75% is being held in the CX Financial Plan, for a total assumption of 1.75% underexpenditure for all CX operating and CX transfer budgets. While it is a change in that the contra is now directly placed in each budget, it is the same policy as in previous years. CX departments are asked to manage to a total underexpenditure requirement of 1.75%.

Central Rate Changes – ($262,721). Central Rate adjustments include CX overhead, ITS new development/O&M, insurance, rent, and finance rates.

MHCADS – Mental Health Services Fund

Significant Program Reductions

ACCESS Demonstration – ($1,492,067/1.0 FTE). This federal pilot project is ending. The activities found to be of greatest value that were supported by the $1.5 million federal grant will be continued through a different program, Homeless Outreach, Stabilization, and Treatment program (see below).

Mentally Ill Offender – ($10,900/1.0FTE). This proposal reflects the reduction of $65,000 and 1.0 FTE from a state grant program for easing the transition into the community of released mentally ill offenders.

Significant Program Additions

Federal Child Initiative Grant – $483,280. This proposal annualizes the grant initially awarded in 1999 for enhancing and consolidating funding for children’s mental health programs. The goal is to consolidate the fragmented and categorical funding streams that target young people with mental illness to ensure accountability and effective care for this population.

Homeless Outreach, Stabilization, and Treatment (HOST) – $450,000. This proposal would restore some of the services from the federally funded ACCESS program. The HOST program will focus on the most needy of the mentally ill populations in King County: severely ill, homeless persons. The HOST contractor will engage this population with active outreach measures, attempt to stabilize acute conditions, obtain housing placement, and treatment. Although the $450,000 proposal would initially be funded from the Mental Health fund balance, State RSN resources will fund the program starting in 2001.

DYS Assessment Program $50,000. Funded by state RSN resources, this $50,000 program increase (to $150,000) would continue development of a juvenile mental health triage program. The program, modeled after the existing Crisis Triage Unit at Harborview, would be staffed in conjunction with Children’s Hospital, and located in the Upper Alder building. The MHCADS considers the current practice of seeing both adults and juveniles at the Crisis Triage Unit as not being in the best interests of the youth.

Integrated RSN/PHP Program – $8,381,423. Currently the County provides outpatient mental health services through the Prepaid Health Plan, on a full-risk-assumption basis from the State. Inpatient services are provided on a fee-for-service basis. This proposed increase for integration of Regional Service Network services and Prepaid Health Plan services includes funding for the State mandated integration of outpatient and inpatient mental health services. The budget proposal assumes that the County will start providing inpatient services in July 2000.

Administration of Integrated Services Entity $50,613/6.0 FTE. Integral to the integrated service concept is a contract with an "Entity" which is a risk bearing outside business or not-for-profit organization that will maintain the provider network. The MHCADS proposes 4.0 FTE (3.0 transferred from the Substance Abuse Fund) for IS support to the division, and 2.0 FTE to administer the Entity.

Technical Adjustments

Central Rate Changes – $158,418. Central rate adjustments include CX overhead, ITS, Finance, telecommunications, lease, and labor settlement rates.

Administrative Costs and Charge Back to Substance Abuse Fund – 18.0 FTE. The 2000 Adopted Budget will transfer 16.0 FTE from the Substance Abuse fund to the Mental Health fund. This is actually a net zero transaction to each fund as it also includes a charge back to the Substance Abuse fund for the administrative costs. An offsetting adjustment is included in the Substance Abuse fund proposal.

The department believes that this change will assist in accurately assessing each fund’s administrative costs. Due to the nature of the reorganization, many managers and administrative staff are providing services to both units. The Department is of the opinion that consolidating the expenditures and distributing them on a proportionate basis from one fund is simpler than the alternative.

Special Programs

Technical Adjustments

Fee Increases - $12,282. This item budgets membership fee increases for various associations with whom the County is involved. These organizations include: the Puget Sound Regional Council, the Washington State Association of Counties, and the Washington Association of County Officials.

Central Rate Changes - $618. Central Rate adjustments include finance rates.

 

Human Services/CJ

Significant Program Additions

COLA for Contracts – $16,728. This request provides Human Service/CJ Community Contracts a 4% COLA increase.

Technical Adjustments

Central Rate Changes - $23,480. Central Rate adjustments include finance rates.

MHCADS – Alcoholism and Substance Abuse Services Fund

Significant Program Reductions

Administration Reductions – ($157,797/1.0 FTE/2.0 TLT). This proposal will reduce administrative costs, and shift 1.0 FTE and 2.0 TLTs previously shown in Administration to the Mental Health fund. Information Services (IS) costs previously charged as administrative costs are allocated on a per workstation basis to direct cost centers to more accurately reflect the cost of service.

Contracted Services Reductions – ($261,854). This proposal reduces contracted chemical abuse and dependency treatment to youth and adults in King County due to a reduction in state funding. In addition, the spending of one-time fund balance in 1999 created a non-sustainable level of service (bow wave) in many programs. The department continues to work to find the best way of bringing programs to a sustainable level while minimizing the impact to current clients and treatment providers.

Transfer to Public Health – ($188,471). This proposal reduces chemical abuse and dependency prevention programs targeted at youth and adults in King County. The reduction is caused by a decrease in federal and state funding.

Cedar Hills Treatment Services Reduction – ($260,179). This proposal reduces residential chemical abuse and dependency treatment to youth and adults at the Cedar Hills treatment facility due to a reduction in state funding.

Significant Program Additions

Crisis Commitment Monitoring – $155,518/1.0 FTE. This proposal provides an increase in State funding and 1.0 FTE for a State required involuntary commitment monitor.

Sobering Services and Emergency Transportation – $90,297. This proposal provides an increase in State funding for ongoing sobering services.

CSAT Mobile Methadone – $610,208. The 2000 Adopted Budget includes the annualization of a 1999 federal grant for mobile methadone dispensing.

CHAT Medical Services –$275,000/4.0 FTE. The 2000 Adopted Budget contains an increase of $275,000 CX and 4.0 FTE to continue limited on-site medical services to Cedar Hill residents. Similar services were previously provided by the Seattle-King County Public Health Department. There is a corresponding decrease to the Seattle-King County Public Health CX transfer.

Cedar Hills Clerical Support – $34,735/1.0 FTE. The MHCADS is adding a 1.0 FTE Office Technician II to provide additional billing support.

Technical Adjustments

Central Rate Changes – ($291,336). Central rate adjustments include CX overhead, ITS, Finance, telecommunications, and lease rates.

Administrative Costs and Charge Back to Substance Abuse Fund – (16.0 FTE). The 2000 Adopted Budget will transfer 16.0 FTE from the Substance Abuse fund to the Mental Health fund. This is actually a net zero transaction to each fund as it also includes a charge back to the Substance Abuse fund for the administrative costs. An offsetting adjustment is included in the Mental Health fund proposal.

The Department believes that this change will assist in accurately assessing each fund’s administrative costs. Due to the nature of the reorganization, many managers and administrative staff are providing services to both units. The department is of the opinion that consolidating the expenditures and distributing them on a proportionate basis from one fund is simpler than the alternative.

Other Significant Additions

Children and Family Commission Reorganization. The 2000 Executive Adopted Budget includes the transfer of the Children and Family Commission from the Department of Community and Human Services to the Office of Regional Policy and Planning. This transfer was made during the Status Quo phase of the budget and equals $2,648,219 and 2 FTEs.

Council Adopted Budget

Community Services Division – $1,193,723. The changes from the Executive Proposed CSD budget include the following: A net ($200,000) service reduction for 2000 (the services to be reduced will be considered based on a RFP process conducted by DCHS during the first quarter of 2000), elimination of DV one-time program enhancements ($78,371), the addition of both RAYS West Hill Youth & Family Services ($75,000) and KSARC legal advocates ($54,000) program funds. Finally, CSD received a Council Initiatives roll-up of $1,343,094 of which $1,300,000 was originally budgeted in the Executive Proposed phase under Special Programs (0650).

Federal Housing & Community Development - $2,539,012/.67 FTE. This expenditure adjustment brings FHCDs’ expenditures in line with revenues. $1,915,585 of this revenue increase is the result of a Federal Homeless Grant awarded to FHCD at the close of the Executive Proposed Budget phase. The remainder of the revenue increase is the net of other FHCD program revenues that accumulated during the budget review period.

Housing Opportunity Fund – ($73,970). Following the passage of I-695, operational and management efficiencies were implemented resulting in a reduction of $73,970 from the Housing Opportunity Fund.

Work Training Program – ($90,000). Following the passage of I-695, operational and management efficiencies were implemented resulting in a reduction of $90,000 from the Work Training Program.

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Updated: June 28, 2000


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