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Home My WebLink AboutGallatin City-County Health Department Fiscal Year 2011 Budget TO: Honorable Mayor and City Commission FROM: Matt Kelley, MPH Health Officer Gallatin City-County Health Department SUBJECT: Gallatin City-County Health Department FY2011 Budget MEETING DATE: October 4, 2010 AGENDA ITEM TYPE: Special Presentation RECOMMENDATION: None BACKGROUND: The County Commission gave final approval to the FY2011 Budget for Gallatin City-County Health Department on August 31, 2010. A copy of the finalized budget is attached. Some of the highlights of this budget are as follows: · The County Commissioners decreased the maximum mil levy available to the Health Department from 5.01 for FY10, to 4.69 for FY11. This reduction decreased the amount available for the General Health Fund. · Personnel Changes: o The impact of the mil levy decrease, as well as, a decrease in the fees generated by the subdivision and public water system programs, which supports the Environmental Health division of the Health Department, was a reduction of staff by 1.0 FTE. o Due to increased grant revenue for the Human Services division, a 1.0 FTE Grant/Program Administrative Assistant was hired to support several special grants, which includes support towards the voluntary accreditation for the department. The WIC Program staff was increased by .76 FTE related to the expansion of WIC services to the Belgrade area and support for the grant that funds breast feeding training and promotion throughout the County. o County Employees salaries were frozen for FY10; the FY11 budget includes a 2% COLA increase 50 PUBLIC HEALTH CITY / COUNTY HEALTH FUND _______________________________________________________________ Fund Overview The City / County Health Fund was created by an Inter-local Agreement between Gallatin County and the City of Bozeman. The agreement sets forth the criteria for operation of the Fund, including authorization to levy taxes inside the City of Bozeman. The Fund had a mill levy of 5.01 from FY 2003 through FY 2010, but was reduced for FY 2011 to 4.69. The mill reduction amounted to a loss in revenue of approximately $73,936. This along with reduction in work loads and corresponding fees necessitated staffing reductions over the last two years. The Fund is separated into three activities: 1) Administration, 2) Human Services and 3) Environmental Health. These divisions are under the authority of the City/County Health Board and the City / County Health Officer is responsible for the day - to - day activity of the divisions. Risks to public health are assessed and monitored; appropriate policies, rules and regulations promulgated and enforced; and community based public health strategies created. The City / County Health Officer supervises the activities of the Human Services and Environmental Health divisions, along with all grants used by the Department. The Health Officer is charged with the responsibility to assure that the department complies with the requirements for each grant as set forth in individual contracts. Fund Goals • Prevent epidemics and the spread of disease. • Protect against environmental hazards. • Prevent injuries. • Promote and encourage healthy behaviors. • Respond to disasters and assist communities in recovery. • Assure the quality and accessibility of health services. • Support efforts to reduce risk of acute and chronic disease. ***************************************************** Recent Accomplishments • Successful deployment of resources and community outreach to address the H1N1 epidemic. • Establishment of the Gallatin Breastfeeding Coalition. • Revised Health Code Chapter 2 including a requirement that restaurants have a manager trained in food safety available during hours of operation. • Created Health Code Chapter 4 for local regulations for pools/spas, public accommodations and Body Art. • Established the Body Art inspection program. F-6 ADMINISTRATION 26% HUMAN SERVICES 28% ENVIRONMENTAL 46% City / County Health Fund FY 2011 51 PUBLIC HEALTH CITY / COUNTY HEALTH FUND _______________________________________________________________ Fund Budget Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 1,203,377$ 1,279,257$ 1,148,852$ 1,165,950$ 1,196,074$ 1,196,179$ Operations 182,156 197,667 155,569 190,354 195,632 195,632 Debt Service - 63,836 56,921 63,836 63,836 63,836 Capital Outlay - 107,107 409 104,082 104,082 140,484 Transfers Out - - - - - - Total 1,385,533$ 1,647,867$ 1,361,751$ 1,524,222$ 1,559,624$ 1,596,131$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 1,385,533 1,647,867 1,361,751 1,524,222 1,559,624 1,596,131 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 1,385,533$ 1,647,867$ 1,361,751$ 1,524,222$ 1,559,624$ 1,596,131$ Funding Sources Tax Revenues 1,063,881$ 1,118,411$ 1,077,709$ 1,025,621$ 1,046,523$ 1,082,925$ Non-Tax Revenues 393,676 341,330 389,244 365,529 365,529 330,541 Cash Reappropriated (72,024) 457,893 (105,202) 133,072 147,572 182,665 Total 1,385,533$ 1,917,634$ 1,361,751$ 1,524,222$ 1,559,624$ 1,596,131$ Fund Personnel No. of Positions FT/PT Title FTE (See individual activity pages for Breakdown of Personnel ) Total Fund 19.56 F-7 52 PUBLIC HEALTH HEALTH ADMINISTRATION _______________________________________________________________ Department Overview The Health Administration office oversees the fiscal, contractual and mandated regulatory responsibility of the Health Department. The staff administers the Public Health Emergency Preparedness (PHEP) grant and Public Health Promotion activities, and provides the critical administrative support necessary for other divisions in the department to carry out core public health initiatives such as immunization clinics, communicable disease surveillance, cancer screening programs, and public health home visitation. The overriding goal of the division is to support the Board of Health, and to maximize the capacities of the entire staff of the Gallatin City/County Health Department. Staff activities include assessing and monitoring the risks to public health; promulgating and enforcing policies, rules and regulations; and creating and implementing community-driven public health strategies. It is recognized that this goal is dependent on dedicated staff, an engaged public and stable funding. The Health Officer is the Department Head and supervises the activities of the Directors of Human Services and Environmental Health. The Health Officer is responsible to assure that the department complies with the requirements for each grant as set forth in individual contracts. ***************************************************** Department Goals • Prevent epidemics and the spread of disease. • Protect against environmental hazards. • Prevent injuries. • Promote and encourage healthy behaviors. • Respond to disasters and assist communities in recovery. • Assure the quality and accessibility of health services. • Support efforts to reduce risk of acute and chronic disease. ****************************************************** Recent Accomplishments • Managed the department’s successful response to the H1N1 flu epidemic. • Implemented a comprehensive electronic records system, allowing for better services, improved data gathering, and dramatic efficiency gains. • Implemented a new billing system, allowing GCCHD to directly bill insurers for services to residents of Gallatin County. • Assisted Board of Health in its effort to recruit and hire a new Health Officer. F-9 53 PUBLIC HEALTH HEALTH ADMINISTRATION _______________________________________________________________ Activity Budget Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 202,829$ 319,786$ 218,994$ 205,421$ 210,526$ 210,526$ Operations 21,865 27,812 25,176 30,257 30,257 30,257 Debt Service - 63,836 56,921 63,836 63,836 63,836 Capital Outlay - 73,085 24,689 70,060 70,060 106,462 Transfers Out - - - - - - Total 224,694$ 484,519$ 325,780$ 369,574$ 374,679$ 411,081$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 224,694$ 484,519$ 325,780$ 369,574$ 374,679$ 411,081$ Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 224,694$ 484,519$ 325,780$ 369,574$ 374,679$ 411,081$ Funding Sources Tax Revenues 201,417$ 212,018$ 207,778$ 188,696$ 193,801$ 278,196$ Non-Tax Revenues 37,454 21,268 21,693 19,766 25,500 15,559 Cash Reappropriated (14,177) 251,233 96,309 161,112 155,378 117,326 Total 224,694$ 484,519$ 325,780$ 369,574$ 374,679$ 411,081$ Department Personnel No. of Positions FT/PT Title FTE 1 Full‐Time Health Officer 1.00 1 Full‐Time Executive Admin Asst 1.00 1 Full‐Time Accounting Tech 1.00 3 Total Program 3.00 F-10 54 PUBLIC HEALTH HEALTH ADMINISTRATION _______________________________________________________________ F-11 2011 Budget Highlights Personnel • The FY 2011 budget reflects the recent hiring of a new Health Officer, eliminating the need for an interim Health Officer. Operations • The FY 2011 budget includes changes to account for various Fixed Costs, including liability insurance, technology and telecommunications, and facilities costs. Debt Service • Funding of loan on annex based on value of newly taxable property multiplied by mils. Capital • Capital reserves increased by newly taxable property for FY 2011 County Commission Goals/Division Response The County Commission established a set of overarching goals for the County government. Listed below are the County Commission’s goals, followed by the methods by which the Health Administration is striving to fulfill those goals. Exceptional Customer Service • Customer satisfaction and input is considered in the program evaluation process • New billing system allows the Department to directly bill insurers, reducing the financial burden and bureaucratic hassle for clients. Be Model for Excellence in Government • Implementation of an electronic records system enhances program efficiency, Department management, and data collection. • Response to public health emergencies improved through continuous planning, drills, and adjusting for improvement. • Facilitation of the Unified Health Command to build partnerships and bolster planning. • Comply with City, County and Federal standards and public health best practices. Improve Communications • Increased public knowledge of department – receive positive impression from public • Renovated website to provide more intuitive user experience. To be the Employer of Choice • Provide an employee-friendly and family-friendly work environment • Implement department-wide performance planning to provide employees better clarity on duties and evaluation criteria. 55 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Department Overview Human Services (HS) is the division of the Gallatin City-County Health Department that provides an array of core public health programs in every community (Belgrade, Bozeman, Manhattan, Three Forks and West Yellowstone) of the County. The division is staffed by Public Health Nurses (PHN) whose duties include public health home visitation, immunization clinics, disease surveillance, and administration of various disease screening and treatment programs. Each nurse is assigned a geographic area of the County to provide services, allowing a better understanding of community needs and priorities. The nurses also sit on a variety of community and school advisory groups. This interface between the Health Department and the community is fundamental to providing adequate, relevant, and timely services. The HS division carries out mandated communicable disease (CD) surveillance and investigation duties, allowing the Department to identify and react to health needs and threats. To prevent the spread of disease, nurses run adult and child immunization clinics in Bozeman, Belgrade, West Yellowstone, Three Forks and in schools. In addition, HS contracts with the State to provide services to HIV/AIDS and TB patients. PHN are involved in daycare inspections to assure compliance with regulations associated with communicable disease and immunizations. A variety of Federal preventive health grant programs are administered through HS. These include: the Women, Infant and Children (WIC) Nutrition Program; the Breast and Cervical Health program; the Colorectal Screening Program; the Nutrition and Physical Activity Grant; and a number of Maternal Child Health (MCH) Block Grant services. The MCH Block Grant supports school nursing services, home visitation programs that target high-risk pregnant women and children up to the age of 1 year, breastfeeding support, and prenatal and parenting classes. The HS staff works collaboratively with many organizations to create successful community-based programs including the Safe Kids, Safe Communities program; the DUI Task Force; and the Partnership to Strengthen Families, which provides child abuse and neglect prevention services. ****************************************************** Department Goals • Develop performance plans for all programs to track outcomes and data, and establish employee expectations and performance goals. • Increase the incidence of breastfeeding in Gallatin County through increased outreach, support groups, and classes. • Continue to prepare for voluntary national accreditation of local health departments. • Increase immunization rates among WIC clients through regular review of records. • Increase community awareness of the risks of low immunization rates and the benefits of utilizing vaccines. ******************************************************** Recent Accomplishments • Successful deployment of resources and community outreach to address the H1N1 epidemic. • Establishment of the Gallatin Breastfeeding Coalition. • Conversion of the immunization clinic to paperless record keeping. • Continued scrubbing of immunization data and transfer of internal records to the state immunization registry. F-13 56 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget - HHS Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 344,979$ 349,728$ 327,188$ 360,524$ 370,052$ 370,120$ Operations 87,773 78,453 53,460 62,287 67,565 67,565 Debt Service - - - - - - Capital Outlay - 16,722 - 16,722 16,722 16,722 Transfers Out - - - - - - Total 432,752$ 444,903$ 380,648$ 439,533$ 454,339$ 454,407$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 432,752 444,903 380,648 439,533 454,339 454,407 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 432,752$ 444,903$ 380,648$ 439,533$ 454,339$ 454,407$ Funding Sources Tax Revenues 317,903$ 334,635$ 327,942$ 303,709$ 313,261$ 396,765$ Non-Tax Revenues 52,588 50,338 50,841 48,700 81,035 28,334 Cash Reappropriated 62,261 59,930 1,864 87,124 60,043 29,309 Total 432,752$ 444,903$ 380,648$ 439,533$ 454,339$ 454,407$ Division Personnel No. of Positions FT/PT Title FTE 1 Full‐Time Human Service Director 1.00 1 Full‐Time Lead Data Mgmt Tech 1.00 2 Full‐Time Administrative Assistant 1.80 1 Part‐Time PHN Program Mgr .80 1 Part‐Time Public Health Nurse .70 2 Full‐Time Public Health Nurse 1.26 Total Program 6.56 F-14 57 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget – Maternal Child Health/School Nursing Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 163,452$ 148,787$ 146,370$ 141,317$ 152,765$ 140,090$ Operations 62,700 51,995 50,226 50,067 50,067 93,180 Debt Service - - - - - - Capital Outlay 4,530 8,069 8,069 8,069 8,069 8,069 Transfers Out - - - - - - Total 230,682$ 208,851$ 204,665$ 199,453$ 210,901$ 241,339$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ Special Revenue Funds 275,448 208,851 204,665 199,453 210,901 241,339 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 275,448$ 208,851$ 204,665$ 199,453$ 210,901$ 241,339$ Funding Sources Tax Revenues -$ -$ -$ -$ -$ -$ Non-Tax Revenues 208,871 182,698 197,847 182,698 182,698 220,432 Cash Reappropriated 66,577 26,153 6,818 16,755 28,203 20,907 Total 275,448$ 208,851$ 204,665$ 199,453$ 210,901$ 241,339$ Operating Reserve: $25,631 (10%) Division Personnel No. of Positions FT/PT Title FTE 4 Part‐Time Public Health Nurse 1.60 1 Part‐Time Lead Social Worker .80 Total Program 2.40 F-15 58 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget – Communicable Disease Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 113,658$ 162,814$ 131,732$ 171,498$ 166,522$ 170,053$ Operations 234,229 266,737 235,090 281,918 281,926 332,268 Debt Service - - - - - - Capital Outlay - 137,677 25,000 133,477 133,477 150,000 Transfers Out - - - - - - Total 347,887$ 567,228$ 391,822$ 586,893$ 581,925$ 652,321$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ Special Revenue Funds 587,416 567,228 391,822 586,893 581,925 652,321 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 587,416$ 567,228$ 391,822$ 586,893$ 581,925$ 652,321$ Funding Sources Tax Revenues -$ -$ -$ -$ -$ -$ Non-Tax Revenues 326,734 334,199 340,883 364,266 376,614 380,516 Cash Reappropriated 260,682 233,029 50,939 222,627 205,311 271,805 Total 587,416$ 567,228$ 391,822$ 586,893$ 581,925$ 652,321$ Operating Reserve: $61,566 (10%) Division Personnel No. of Positions FT/PT Title FTE 1 Part‐Time PHN Program Mgr .80 3 Full‐Time Public Health Nurses 1.55 1 Full‐Time Administrative Assistant 0.30 Total Program 2.65 F-16 59 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget – Women, Infants & Children Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 130,565$ 138,790$ 137,622$ 150,859$ 150,983$ 172,550$ Operations 45,202 52,383 50,159 58,975 58,332 56,662 Debt Service - - - - - - Capital Outlay - - - - - - Transfers Out - - - - - - Total 175,767$ 191,173$ 187,781$ 209,834$ 209,315$ 229,212$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 175,767 191,173 187,781 209,834 209,315 229,212 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 175,767$ 191,173$ 187,781$ 209,834$ 209,315$ 229,212$ Funding Sources Tax Revenues -$ -$ -$ -$ -$ -$ Non-Tax Revenues 185,296 185,503 176,228 204,163 204,163 225,050 Cash Reappropriated (9,529) 5,670 11,553 5,671 5,152 4,162 Total 175,767$ 191,173$ 187,781$ 209,834$ 209,315$ 229,212$ Division Personnel No. of Positions FT/PT Title FTE 1 Full‐Time WIC Program Manager 1.00 2 Full‐Time Nutrition Technician 2.00 1 Temporary Nutrition Aide Total Program 3.00 F-17 60 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget – Cancer Prevention Fund Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 85,338$ 77,463$ 104,383$ 110,515$ 81,580$ 103,907$ Operations 24,675 100,120 24,878 91,120 116,275 121,677 Debt Service - - - - - - Capital Outlay 1,981 17,345 - 15,000 15,000 45,000 Transfers Out - - - - - - Total 111,994$ 194,928$ 129,261$ 216,635$ 212,855$ 270,584$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ Special Revenue Funds 111,994 194,928 129,261 216,635 212,855 270,584 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 111,994$ 194,928$ 129,261$ 216,635$ 212,855$ 270,584$ Funding Sources Tax Revenues -$ -$ -$ -$ -$ -$ Non-Tax Revenues 127,458 123,615 123,615 161,772 161,772 146,980 Cash Reappropriated (15,464) 71,313 5,646 54,863 51,083 123,604 Total 111,994$ 194,928$ 129,261$ 216,635$ 212,855$ 270,584$ Operating Reserve: $21,208 (10%) Division Personnel No. of Positions FT/PT Title FTE 1 Part‐Time Health Program Coordinator .75 1 Part‐Time PHN Program Mgr .35 1 Full‐Time Billing Admin. Assistant .20 1 Full‐Time Support Staff 1.00 3 Total Program 2.30 F-18 61 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget – (PHEP) Health Preparedness & NACCHO Grant Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 74,736$ 65,239$ 124,767$ 80,015$ 80,239$ 80,173$ Operations 28,092 109,841 185,941 90,330 81,983 153,329 Debt Service - - - - - - Capital Outlay - 102,838 33,848 78,000 78,000 78,000 Transfers Out - - - - - - Total 102,828$ 277,918$ 344,556$ 248,345$ 240,222$ 311,502$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ Special Revenue Funds 195,890 277,918 344,556 248,345 240,222 311,502 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 195,890$ 277,918$ 344,556$ 248,345$ 240,222$ 311,502$ Funding Sources Tax Revenues -$ -$ -$ -$ -$ -$ Non-Tax Revenues 124,308 185,074 185,074 113,189 240,237 122,634 Cash Reappropriated 71,582 92,844 159,482 135,156 (15) 188,868 Total 195,890$ 277,918$ 344,556$ 248,345$ 240,222$ 311,502$ Operating Reserve: $3,451 Division Personnel No. of Positions FT/PT Title FTE 1 Part‐Time PHN Program Mgr .80 1 Part‐Time Public Health Promotion .35 Total Program 1.15 F-19 62 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ Division Budget – Grant Summary Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 567,749$ 593,093$ 644,874$ 654,204$ 632,089$ 666,773$ Operations 394,898 581,076 546,294 572,410 588,583 757,116 Debt Service - - - - - - Capital Outlay 6,511 265,929 66,917 234,546 234,546 281,069 Transfers Out - - - - - - Total 969,158$ 1,440,098$ 1,258,085$ 1,461,160$ 1,455,218$ 1,704,958$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 969,158 1,440,098 1,258,085 1,461,160 1,455,218 1,704,958 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 969,158$ 1,440,098$ 1,258,085$ 1,461,160$ 1,455,218$ 1,704,958$ Funding Sources Tax Revenues -$ -$ -$ -$ -$ -$ Non-Tax Revenues 972,667 1,011,089 1,023,647 1,026,088 1,165,484 1,095,612 Cash Reappropriated 373,848 429,009 234,438 435,072 289,734 609,346 Total 1,346,515$ 1,440,098$ 1,258,085$ 1,461,160$ 1,455,218$ 1,704,958$ Division Personnel No. of Positions FT/PT Title FTE 13 Total Program 11.50 F-20 63 PUBLIC HEALTH HEALTH HUMAN SERVICES (NURSING) ______________________________________________________________ F-21 2011 Budget Highlights Personnel • The FY 2011 budget would utilize Federal and State grant funding to fill one entry-level position to assist with the administration of cancer screening programs, to prepare for upcoming national accreditation of local health departments, and to work with the Health Officer on quality improvement and performance planning and assessment. Operations • The FY 2011 budget includes changes to account for various Fixed Costs, including liability insurance, technology and telecommunications, and facilities costs. Capital • Continue to build capital reserve County Commission Goals/Department Response The County Commission established a set of overarching goals for the County government. Listed below are the County Commission’s goals, followed by the methods by which the Health Human Services (Nursing) is striving to fulfill those goals. Exceptional Customer Service • Consistent communicable disease surveillance will help prevent and contain epidemics. • Data gathering allows better assessment of the community’s health. • Prevention services improve health outcomes and quality of life, while decreasing the financial impact of unnecessary illness and premature death. Model for Excellence in Government • Conversion to electronic record keeping and billing will improve patient experience and reduce the costs and hassle of services. • Expanding access to services, including a new Belgrade immunization clinic, brings resources to County residents. • Compliance with State and Federal grant requirements ensures continued funding into the future. Improve Communications • Provide health prevention messages, with significant emphasis on immunizations, will reduce risk of acute and chronic disease. • Improved web site will open new lines of communication. To be the Employer of Choice • Comprehensive performance planning will provide clarity and stability for employee expectations and evaluations. • Consistent and clear lines of communication will foster employee satisfactions. 64 Workload Indicators Actual Actual Estimate Projected Indicator FY 2008 FY 2009 FY 2010 FY 2011 1. Maternal Child Health - Caseload * Women of child-bearing age 637 815 748 800 * Pregnant women – Projected FY11 new contract requirements 123 76 92 172 * Infants (under age 1) – Large decrease due to HEP B shots given at BDH counted in prior years 1,085 422 102 200 * Children (1-22 years) 2,304 1,789 1,974 2,100 * Children with special health needs 337 239 183 200 2. School Nursing * Number of schools served 13 13 13 13 3. Communicable Disease (CD)/Immunizations * Total reportable communicable diseases 1,155 820 1,677 To Be determined * Number of persons seen in the clinic 5,548 5,095 3,271 3,500 * Number of child vaccinations given – Large decrease due to HEP B shots given at BDH counted in prior years 6,517 6,134 4,093 4,200 * Number of adult vaccinations given 3,226 2,991 3,140 3,200 4. Women Infant and Children * Total number of women seen 290 235 251 269 * Total number of children seen 803 787 842 901 5. Breast and Cervical Health * Number of women served 364 459 480 485 * Number of breast pre-cancerous diagnosed 1 4 3 3 * Number of cervical pre-cancerous diagnosed 13 15 10 10 * Number of invasive breast cancer 6 5 5 5 * Number of invasive cervical cancer 0 0 0 0 Performance Measures Actual Actual Actual Projected Measure FY 2008 FY 2009 FY 2010 FY 2011 1. Maternal child Health * % low birth weight (A) * % Prenatal Care-1st trimester (B) * % Teen births (C) * Infant Mortality Rate (D) See attached 2009 MT Kids Count - Gallatin County Statistics 2. Communicable Disease (CD)/Immunizations) * Cases followed-up within 24 hrs of report 100% 100% 100% 100% 3. Women Infant and Children * Increase the number of participants by 5%-Decrease in FY2009 due to staff changes & move to new annex location 1,093 (3% inc) 1,022 (7% dec) 1,093 (7% inc) 1,170 (7% inc) 4. Breast and Cervical Health * Increase participation by 1% 364-21% (E) 459 463 468 Comments A. Percent of all live births B. Percent of live births by month pre-natal care began C. Percent of live births to women 15-19 years D. Five year rates per 1,000 live births E. Decrease F-22 65 †…•‰¿‹–ﬁ›–«†‹§¿›»˙»¿ﬁ–«†‹§«ﬁﬁ»†‹˙»¿ﬁ˝‹¿‹»«ﬁﬁ»†‹˙»¿ﬁ˝¸˝»…•¿†‚–«›»‚–·…•†‰–‡»Ø–«†‹§«†»‡·–§‡»†‹ﬁ¿‹»Ł‚•·…ﬁ»†«†…»ﬁŁ •†–“»ﬁ‹§ł»·–'ß— Øł‡–†‹‚·§¿“»ﬁ¿„»˙––…˝‹¿‡ﬁ»‰••»†‹›–” ¿··¿„»› ł‡–†‹‚·§¿“»ﬁ¿„» ˙‚•·…ﬁ»†»†ﬁ–··»… •†—ﬁ»•†…»ﬁ„¿ﬁ‹»†‹‚ﬁ–«„‚‹‚„ﬁ¿…»»·•„•·»”–ﬁ”ﬁ»»æﬁ»…«‰»…ﬁ•‰»·«†‰‚ł¿‰¿…»‡•‰§»¿ﬁŁ˝¸˛†”¿†‹‡–ﬁ‹¿·•‹§ ł…»¿‹‚› »ﬁ ·•“»•ﬁ‹‚› Ł–'•ﬁ‹‚'»•„‚‹¿•»›ł º·›Ł–ƒ¿› »ﬁ‰»†‹–” ¿··•ﬁ‹‚› Ł•ﬁ‹‚› ‹– ‡–‹‚»ﬁ› ﬁ»‰»•“•†„ﬁ»†¿‹¿·‰¿ﬁ»›‹¿ﬁ‹•†„›‹‹ﬁ•‡»›‹»ﬁ ¿› »ﬁ‰»†‹–” ¿··•ﬁ‹‚›Ł•ﬁ‹‚› ‹– ‹»»†› ł¿„»› º¿› »ﬁ‰»†‹–”¿·· •ﬁ‹‚› Ł‚•·…ﬁ»†ł¿„»› Ø»†ﬁ–··»…•† »…•‰¿•… ł‡–†‹‚·§¿“»ﬁ¿„»˙‚•·…ﬁ»†ł¿„»› Ł»†ﬁ–··»…•†— ł‡–†‹‚·§ ¿“»ﬁ¿„» ˙¸–‹¿·«·•‰ﬁ•“¿‹» ¿†… ‚–‡» ›‰‚––·»†ﬁ–··‡»†‹ ł¿‰¿…»‡•‰§»¿ﬁŁ—«·•‰—ﬁ»•†…»ﬁ„¿ﬁ‹»†»†ﬁ–··‡»†‹ł¿‰¿…»‡•‰§»¿ﬁŁ˝»‰•¿·»…«‰¿‹•–†»†ﬁ–··‡»†‹ł¿‰¿…»‡•‰ §»¿ﬁŁ•„‚›‰‚––· »“»†‹…ﬁ––«‹ﬁ¿‹»ł¿‰¿…»‡•‰§»¿ﬁØŁ˝˙«“»†•·» ﬁ»”»ﬁﬁ¿·ﬁ¿‹» ł¿„»› Ø »ﬁ ¶«“»†•·»› Ł«“»†•·» ﬁ»”»ﬁﬁ¿·› ”–ﬁ¿··‰ﬁ•‡»›Ł˛»”»ﬁﬁ¿·› ”–ﬁ…ﬁ«„–””»†›»› ¿› »ﬁ‰»†‹–” ¿··ﬁ»”»ﬁﬁ¿·›˛»”»ﬁﬁ¿·› ”–ﬁ“•–·»†‹–””»†›»› ¿› »ﬁ‰»†‹–” ¿··ﬁ»”»ﬁﬁ¿·›–‹–ﬁ“»‚•‰·» ‰ﬁ¿›‚»› '•‹‚…ﬁ•“»ﬁ«†…»ﬁ¿„» ŁŁ˛˙‚•·…ﬁ»†¿ﬁ‹•‰•¿‹•†„•†‹‚» ¿§¿ﬁ»—ﬁ–„ﬁ¿‡ł‰‚•·…‰¿ﬁ»˙‡‡«†•ƒ¿‹•–† ﬁ¿‹» ”–ﬁ§»¿ﬁ–·…›'‚–¿ﬁ»›»»†§¿ ‚»¿·‹‚ ‰¿ﬁ»ﬁ–“•…»ﬁ Ł†…•‰¿‹–ﬁ›–«†‹§¿›»˙»¿ﬁ–«†‹§«ﬁﬁ»†‹˙»¿ﬁ˝‹¿‹»«ﬁﬁ»†‹˙»¿ﬁ˛—˝–‹¿· ‰–«†‹§–«·¿‹•–†Ł—»ﬁ‰»†‹–«·¿‹•–† ‰‚¿†„» Ł—–«·¿‹•–† «†…»ﬁ¿„»ŁŁ‚•·…ﬁ»†«†…»ﬁ¿„»º Ł‚•·…ﬁ»†¿„»›ºŁ‚•·…ﬁ»†¿„»›Ø Ł–«†‹§ –«·¿‹•–†«†…»ﬁ §ﬁ¿‰»æ»‹‚†•‰•‹§Ł‚•‹»¿·–†»‡»ﬁ•‰¿† †…•¿†æ ·¿›¿¿‹•“»¿·–†»•›¿†•‰æ¿‹•†–»…•¿† ¿„»•† §»¿ﬁ›Ł˝–«ﬁ‰»› ¸˝»†›«›«ﬁ»¿«ł'''‰»†›«›„–“—˝ ł'''…‚‚›‡‹„–“ «ﬁ»¿«–”‰–†–‡•‰ †¿·§›•› ł'''»¿„–“ –†‹¿†¿»¿ﬁ‹‡»†‹–”¿–ﬁ ¿†…†…«›‹ﬁ§ ł'''…·•‡‹„–“æŒØŁ ŁŁ ŒØßØßŁ Œ ºŁº ŒŁº ŒØºº º ŒŁŁº ººŒŁ Ł ŒØºº Łº ŁºØŁ ŒŁ ŁºØ ºº Œß Øß ºßºŁ ŁŁŁŒ ŒŁØ Ø ŁØØ ºŁºŒŒŒºßŒßØßŁØß Œß ŒºßŒßºßŁßØ ØŁ ŒŒººŒ ØŒºØ ºØººŁ ŒŁ º ØŒºßßºßæ ŒŒ ŁŒ ŁØŒßßŁßæß ßº Ø ºŒ Œ ØŁØŁØß Øß Œß66 PUBLIC HEALTH ENVIRONMENTAL HEALTH SERVICES _______________________________________________________________ Division Overview Environmental Health Services (EHS) is the division of the Gallatin County City / County Health Department that is most directly responsible for protection of state waters, drinking water supplies, air quality, and health conditions within restaurants and other public establishments. EHS enforces state laws and regulations, and County rules and Regulations in a wide array of settings, including new housing developments, public drinking water systems, food service establishments, hotels and other public accommodations, body art establishments, and public pools. EHS carries out these efforts in a variety of ways. Statutes require the Department to inspect and enforce regulations within food establishments, public accommodations (such as hotels or vacation homes), day care centers and trailer courts. EHS also issues permits and inspects septic systems within the County and assists other governmental agencies in the investigation and remediation of environmental health problems or issues. EHS performs site evaluations of proposed subdivisions to ensure compliance with the Sanitation in Subdivision Act and local septic regulations. In addition to these mandatory programs, EHS manages the local radon program and is under a contract with the State to inspect public water systems. EHS also maintains extensive GPS capabilities and GIS databases to track information of public health importance at a geographical level. ****************************************************** Department Goals: • Revise Chapter 3 of the Health Code. • Achieve 90% compliance rate for mandatory training for managers in restaurants. • Create a Recreational Waters Informational Program • Implement a Tourist Home Inspection Program as mandated by the State. • Explore opportunities to enhance the Human Services GIS capabilities. • Place septic permit records online and viewable by the public. • Obtain 50% compliance with the Communication Alert Network (CAN). • Input at least 90% of septic permits into scanning project. ****************************************************** Recent Accomplishments • Revised Health Code Chapter 2 including a requirement that restaurants have a manager trained in food safety available during hours of operation. • Created Health Code Chapter 4 for local regulations for Pools/spas, PA’s and Body Art. • Redesigned and updated the Department Webpage. • Revised the fee schedule in Chapter 3 of the Health Code. • Coordinated resources with Bozeman officials to test Bozeman Creek for harmful bacteria. • Established a Communication Alert Network for restaurants, public accommodations and other inspected entities. • Established the Body Art inspection program. • Assisted the Human Services Division with clinics during the Pandemic H1N1 season. • Completed the public system GIS database. F-24 67 PUBLIC HEALTH ENVIRONMENTAL HEALTH SERVICES _______________________________________________________________ Division Budget Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel 655,569$ 609,743$ 568,381$ 600,154$ 615,496$ 615,533$ Operations 72,518 91,402 75,705 97,810 97,810 97,810 Debt Service - - - - - - Capital Outlay - 17,300 1,778 17,300 17,300 17,300 Transfers Out - - - - - - Total 728,087$ 718,445$ 645,864$ 715,264$ 730,606$ 730,643$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 728,087 718,445 645,864 715,264 730,606 730,643 Debt Service Funds - - - - - - Capital Project Funds - - - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 728,087$ 718,445$ 645,864$ 715,264$ 730,606$ 730,643$ Funding Sources Tax Revenues 317,903$ 334,635$ 327,942$ 303,664$ 313,261$ 407,964$ Non-Tax Revenues 240,523 237,080 275,557 258,994 258,994 286,648 Cash Reappropriated 169,661 146,730 42,365 152,606 158,351 36,031 Total 728,087$ 718,445$ 645,864$ 715,264$ 730,606$ 730,643$ Division Personnel No. of Positions FT/PT Title FTE 1 Full‐Time EH Director 1.0 3 Full‐Time EH Program Lead 3.0 5 Full‐Time EH Specialist 4.0 1 Full‐Time Program Technical Asst 1.0 1 Full‐Time Program Assistant 1.0 Total Program 10.0 2011 Budget Highlights F-25 68 PUBLIC HEALTH ENVIRONMENTAL HEALTH SERVICES _______________________________________________________________ F-26 Personnel • The FY 2011 budget reduces EHS by 1 FTE to align staffing with resource constraints tied to reduction in the mill levy designated for public health services. Operations • The FY 2011 budget includes changes to account for various Fixed Costs, including liability insurance, technology and telecommunications, and facilities costs. Capital • Continue to build capital reserves County Commission Goals/Department Response The County Commission established a set of overarching goals for the County government. Listed below are the County Commission’s goals, followed by the methods by which the Environmental Health Services is striving to fulfill those goals. Exceptional Customer Service • Improved the electronic inspection capacity to include all inspection programs. • Completed or enhanced GIS databases. • Completed subdivision reviews, public water inspections and septic permitting within regulatory or contractual timelines. Be Model for Excellence in Government • Participated in Public Health Emergency Responses training. • Undertake performance planning for all EHS programs. Improve Communications • Perform semi-annual reviews of the Division Website to ensure accurate and timely access to public health information or Division programs. • Perform outreach and education to community leaders, establishment owners, and Gallatin County residents on issues of public health importance. To be the Employer of Choice • Continue program cross training for all EHS sanitarians. • Improve collaborative efforts with the Human Services Division. 69 PUBLIC HEALTH ENVIRONMENTAL HEALTH SERVICES _______________________________________________________________ WORKLOAD INDICATORS / PERFORMANCE MEASURES Workload Indicators Actual Actual Estimated Projected Indicator FY 2008 FY 2009 FY 2010 FY 2011 1. Number of septic applications processed 315 262 200 225 2. Number of sub applications processed (lots) 125(657) 82(198) 50(230) 50(210) 3. Number of food establishment inspections 977 1,116 1,170 1,000 4. Number of temporary food events inspected 205 293 200 250 5. Number of ServSafe class participants 108 80 125 80 6. Number of complaints investigated 234 240 175 175 7. Number of public accommodations inspected 58 51 75 270 8. Number of trailer courts inspected 69 67 64 40 9. Number of pools/spas inspected 122 158 240 225 10. Number of septic inspections 286 231 180 200 11. Number of site evaluations 191 171 110 120 12. Number of public water inspections 34 22 20 15 13. Number of Plan reviews 78 86 100 350 Performance Measures Actual Actual Actual Projected Measure FY 2008 FY 2009 FY 2010 FY 2011 1. Percent of septic permits scanned 59% 75% 80% 90% 2. Percent of site evaluations seen 62% 22% 28% 30% 3. Number of Health Code chapters updated N/A 2 1 1 Comments • The County has begun discussing the role of EHS in the permitting, review and oversight of public wastewater treatment systems in the County. The performance measures and workload estimates may be affected by the decision. • The Montana Department of Public Health and Human Services have initiatives involving the inspection of tourist homes which may affect workload estimates. Additionally, new regulations regarding the review of non-public water and wastewater systems may be implemented and affect EHS’s workload. F-27 70 PUBLIC HEALTH MENTAL HEALTH _______________________________________________________________ Department Overview Mental Health activities show expenses associated with the County’s compliance with State law on support for people needing support. The FY 03 Budget moved expenses for Mental Health from the City / County Health Fund to a separate fund, consistent with State laws. The Mental Health activities include $191,000 in support for the Western Montana Mental Health Services Association out of Missoula and $12,000 to Aware, Inc. for juvenile treatment. The Mental Health Local Advisory committee, appointed in FY 01 by the County Commission, continues to review the needs of the mental health community and make recommendations to the Commission. The Advisory Committee is supported through the County General Fund. The Committee meets on a monthly basis with a County Commissioner attending and Commission staff responsible for the administrative needs of the Committee. For the preliminary FY 2011 budget, the Commission maintains the FY 05 increase of $100,000. This funding is for crisis stabilization and weekend coverage as outlined in the 7/27/04 letter from the Western Mental Health Center. This included the starting of a Crisis Stabilization Center and weekend emergency support. The Commission finalized its commitment to borrow up to $1,000,000 for a new facility in FY 2010. The balance of construction costs came from Western Mental Health Associations revenue stream, grants and donations. The facility was constructed on a parcel owned by Bozeman Deaconess Hospital. ******************************************************** Department Goals • Continue assessment of community mental health needs • Improve the quality of life for individuals with behavioral health needs through quality services, consumer involvement, community collaboration and resource management • Provide a Crisis Stabilization Center • Provide weekend emergency support • Support Mental Health Advisory Council ******************************************************** Recent Accomplishments • Consumers and Providers in the community met with State AMDD (Addictive and Mental Disorder Division) to discuss their perceived needs • Received $500,000 grant from the Gilhousen Family Foundation to start a new psychiatric facility • 5 acre piece of land was donated by Bozeman Deaconess Hospital F-28 71 PUBLIC HEALTH MENTAL HEALTH _______________________________________________________________ Department Budget Object of Expenditure Actual Final Actual Request Preliminary Final FY 2009 FY 2010 FY 2010 FY 2011 FY 2011 FY 2011 Personnel -$ -$ -$ -$ -$ -$ Operations 203,409 203,409 203,409 227,876 203,876 203,876 Debt Service - 11,584 - 23,719 23,719 31,425 Capital Outlay - 1,012,602 1,012,602 7,706 7,706 - Transfers Out - - - - - - Total 203,409$ 1,227,595$ 1,216,011$ 259,301$ 235,301$ 235,301$ Budget by Fund Group General Fund -$ -$ -$ -$ -$ -$ Special Revenue Funds 203,409 227,595 1,216,011 259,301 235,301 235,301 Debt Service Funds - - - - - - Capital Project Funds - 1,000,000 - - - - Enterprise Funds - - - - - - Internal Service Funds - - - - - - Trust & Agency Funds - - - - - - Total 203,409$ 1,227,595$ 1,216,011$ 259,301$ 235,301$ 235,301$ Funding Sources Tax Revenues 200,494$ 219,296$ 212,717$ 219,067$ 206,694$ 219,197$ Non-Tax Revenues 625 1,000,800 625 800 800 800 Cash Reappropriated 2,290 7,499 1,002,669 39,434 27,807 15,304 Total 203,409$ 1,227,595$ 1,216,011$ 259,301$ 235,301$ 235,301$ Department Personnel No. of Positions FT/PT Title FTE Services provided through contracted services Total Program 0 F-29 72 PUBLIC HEALTH MENTAL HEALTH _______________________________________________________________ 2011 Budget Highlights Personnel • No County employees - professional services provided through contracts. Operations • A.W.A.R.E. requested an increase from $12,000 to $24,000, which was not approved by the County Commission. Capital • Reserve for future needs County Commission Goals/Department Response The County Commission established a set of overarching goals for the County government. Listed below are the County Commission’s goals, followed by the methods by which Mental Health is striving to fulfill those goals. Exceptional Customer Service • Allocate resources in an efficient and economical manner. Be Model for Excellence in Government • Formulate operational strategies and achieve facility objectives within planned budgets and time frames. • Conduct short and long-range planning to meet goals and objectives. Improve Communications • Increased public knowledge of department – receive positive impression from public. To be the Employer of Choice F-30 73 PUBLIC HEALTH MENTAL HEALTH _______________________________________________________________ F-31 WORKLOAD INDICATORS / PERFORMANCE MEASURES Workload Indicators Actual Actual Actual Projected Indicator FY 2008 FY 2009 FY 2010 FY 2011 1. Crisis Stabilization Activity 131 201 243 286 2. Crisis Response Team Activity 995 1,437 1,300 1,350 3. Therapy in Jail (days per week)-(total served) 2 2 2 – 160 2 - 300 4. AWARE – Total Budget 1,809,534 2,289,276 2,592,585 2,748,140 5. AWARE – Total Payroll 1,102,727 1,444,758 1,707,758 1,810,223 6. AWARE – Citizens Served 208 225 265 281 7. AWARE – FTE’s 22.5 43 52 56 Performance Measures Actual Actual Actual Projected Measure FY 2007 FY 2008 FY 2009 FY 2010 Comments 74