* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.
          [00:00:45]
          CAN'T REMEMBER WHAT HIS FIRST NAME WAS. 
          MAYBE DAVID DANIEL JUST, JUST GRADUATED FROM THE, I DON'T, I DON'T, UM, I'M NOT CONVERSANT WITH THE FAMILY. 
          SO WE'RE DONE. 
          GOOD AFTERNOON. 
          WE'LL CALL THIS, UH, MEETING TO ORDER THE HEALTH AND HUMAN SERVICES MEETING OF AUGUST 28TH. 
          UH, ROLL CALL. 
          WE HAVE CHRIS ON ZOOM, EVERYONE. 
          I THINK ANN IS COMING IN ANY MINUTE. 
          UH, EVERYONE ELSE IS HERE. 
          THE AFFIDAVIT OF POSTING WAS POSTED ACCURATELY. 
          LET'S RISE FOR A MOMENT OF SILENT PRAYER AND THE PLEDGE OF ALLEGIANCE. 
          I PLEDGE ALLEGIANCE TO THE PLAY OF THE UNITED STATES OF AMERICA AND TO THE REPUBLIC FOR WHICH IT STANDS, ONE NATION UNDER GOD, INDIVISIBLE, WITH LIBERTY AND JUSTICE FOR ALL. 
          JODY. 
          OKAY. 
          ALRIGHT, THERE'S ANN. 
          ALL RIGHT, WELCOME ANNE. 
          ALL RIGHT, OUR, UM, I'M GOING TO SWITCH UP THE ORDER A LITTLE BIT, BUT UH, JUST BEFORE WE GO THERE, THE MINUTES, ANY QUESTIONS OR ANY COMMENTS, ANY CHANGES WITH THE MINUTES? OKAY. 
          THEREFORE, THEY WILL BE APPROVED. 
          UM, AND I'M GONNA MOVE THE FAMILY CENTERED TREATMENT PRESENTATION UP INTO THE FIRST POSITION. 
          SO I THINK WE'RE LOOKING FOR CORAL AND KELLY TO HELP US WITH THAT. 
          WELL, WELCOME. 
          HELLO. 
          HELLO. 
          GOOD AFTERNOON. 
          YES. 
          UM, I'M CORAL KLEIN AND I'M THE CHILDREN AND FAMILIES DIVISION MANAGER. 
          [d. Family Centered Treatment Presentation]
AND I AM KELLY BELL. 
          I AM THE ASSISTANT SUPERVISOR OF YOUTH TREATMENT, AND I SUPERVISE, UH, FAMILY-CENTERED TREATMENT. 
          UM, THIS AFTERNOON WE ARE GONNA BE, OH, THAT IS NOT MOVE THESE SLIDES. 
          JUST KIDDING. 
          HOLD ON A SECOND. 
          . 
          PERFECT. 
          HERE WE GO. 
          UH, THIS MORNING WE'RE GONNA BE TALKING ABOUT, UH, FAMILY-CENTERED TREATMENT. 
          UH, WE'RE GOING TO TELL YOU WHAT FAMILY-CENTERED TREATMENT IS. 
          WE'RE GONNA TALK ABOUT WHY WE NEED IT HERE IN WASHINGTON COUNTY AND, AND WHO IT SERVES AND WHAT ITS GOALS ARE. 
          WE'RE GONNA TALK ABOUT HOW IT'S BEEN FUNDED AND HOW IT'S CURRENTLY FUNDED AND HOW WE HOPE TO FUND IT. 
          UM, AND REALLY THE FUTURE STATE OF, OF THE PROGRAM AND HOW IT'S GONNA INTERFACE, UH, BETWEEN MULTIPLE PROGRAMS AND MULTIPLE DEPARTMENTS IN WASHINGTON COUNTY. 
          WHY DO I KEEP DOING THAT? OKAY. 
          SO WHY DID WE PURSUE, UM, FAMILY-CENTERED TREATMENT? UM, WE FIRST STARTED THIS ENDEAVOR BACK IN 2020, UM, WHEN THE CHILDREN AND FAMILIES DIVISION HAD AROUND 12 TO 15 KIDS IN RESIDENTIAL TREATMENT AT EVERY GIVEN TIME, UH, WITH AN AVERAGE LENGTH OF STAY OF ABOUT 16 TO 18 MONTHS. 
          UM, THAT IS A SIGNIFICANT COST, UM, TO THE COUNTY. 
          UM, PARENTS DO PAY A PORTION OF THAT, UM, BACK THROUGH CHILD SUPPORT, BUT THE COUNTY BEARS ALL THOSE UPFRONT COSTS, UM, FOR AUTOHOME PLACEMENTS. 
          AND THOSE OUT HOME PLACEMENTS ARE ANYWHERE FROM, I WOULD SAY, 300 TO $500 A DAY, GIVE OR TAKE. 
          IT'S KIND OF A WIDE RANGE OF, UM, RATES. 
          AND THOSE PROGRAMS ALSO HAVE LIMITATIONS. 
          UM, THE RESIDENTIAL TREATMENT MODEL HAS LIMITATIONS WHERE KIDS ARE HOUSED SOMEWHERE AND THEIR FAMILY UNIT IS AT HOME. 
          UM, SO THE KIDS ARE RECEIVING THOSE TREATMENT. 
          PARENTS AND FAMILY UNIT MAY BE RECEIVING A SMALL AMOUNT OF FAMILY THERAPY. 
          UM, BUT THERE'S REALLY LIMITED FAMILY INVOLVEMENT OR ABILITY TO PRACTICE NEW SKILLS, UM, WITH EACH OTHER, WHETHER THE, THE CHILD IS TRYING TO TRY SOME NEW COPING SKILLS IN THE FAMILY ENVIRONMENT AND THE PARENT'S ABILITY, UM, TO PARENT THEM. 
          AS YOU MIGHT IMAGINE, UM, WE WERE SEEING SOME POOR OUTCOMES, UM, POST-TREATMENT. 
          UM, KIDS WERE BEING REINTRODUCED INTO THE HOME AFTER A PERIOD OF TIME IN RESIDENTIAL TREATMENT, THERE'S CONTINUED FAMILY DISCOURSE. 
          UM, AGAIN, IF THAT ENVIRONMENT DOESN'T CHANGE, KIDS OFTEN DO NOT DO WELL WHEN THEY RETURN HOME. 
          [00:05:01]
UM, AND WE ALSO WERE SEEING KIDS CYCLE THROUGH MULTIPLE PLACEMENTS. 
          SO WE'D GO THROUGH TO ONE RESIDENTIAL PROGRAM. 
          A CHILD MAY COMPLETE THAT PROGRAM, GO HOME, THINGS WEREN'T GOING WELL. 
          UM, AND A CHILD WAS REMOVED AGAIN FROM THE HOME AND PLACED IN ANOTHER, UM, OUT OF HOME PLACEMENT, WHETHER THAT'S ANOTHER RESIDENTIAL OR ANOTHER, UM, HIGHER LEVEL OF CARE. 
          UM, SO WE STARTED THINKING ABOUT WHAT WE COULD DO DIFFERENT FOR OUR KIDS. 
          UM, AND AT THE SAME TIME, THE CCS PROGRAM WAS BUILDING THEIR SERVICE ARRAY. 
          AND WE WERE TALKING BACK IN, UM, 2020 NOW, SO THIS IS QUITE SOME TIME AGO. 
          THEY WERE BUILDING THEIR SERVICE ARRAY, UM, BECAUSE IT WASN'T QUITE ROBUST ENOUGH FOR THE COMPLEXITIES OF THE KIDS THAT WE WERE SEEING THAT WERE RISING TO THE LEVEL OF BEING PLACED OUTSIDE THE HOME. 
          SO IN THOSE CONVERSATIONS, UM, MYSELF AND DOUG AND KELLY AND SARAH AND JULIE, WE REALLY STARTED TO LOOK AT HOW WE CAN INTEGRATE OUR TWO DIVISIONS TO REALLY PROVIDE A DIFFERENT SOLUTION FOR CHILDREN AND FAMILIES IN WASHINGTON COUNTY. 
          AND THAT WAS COUPLED WITH THE FACT THAT DCF LAUNCHED THIS YOUTH JUSTICE INNOVATION GRANT, WHICH IS REALLY LOOKING AT KIDS IN THE YOUTH JUSTICE SYSTEM, HOW TO, UM, MATCH SERVICES TO NEEDS, HOW TO REDUCE RECIDIVISM, AND HOW TO KEEP, UH, KIDS IN THEIR COMMUNITIES. 
          UM, SO THROUGH THAT, SO THROUGH THAT PROCESS, WE STARTED LOOKING AT A NUMBER OF PROGRAMS. UM, WE LOOKED AT, UH, OH MY GOSH, WE LOOKED AT, UH, FAMILY-CENTERED TREATMENT AND FAMILY FUNCTIONAL TREATMENT. 
          UH, DOUG AND I HAD MULTIPLE CONVERSATIONS WITH COUNTIES ACROSS WISCONSIN ABOUT WHAT WORKED BEST FOR THEIR KIDS, UM, WHAT THE, WHAT THE DOLLAR AMOUNT WAS ON THE TRAINING, WHAT THE COMMITMENTS WERE, HOW TO DO THIS PROGRAM TO, TO FIDELITY AND FIGURING OUT A WAY THAT WE COULD PICK A PROGRAM THAT WE COULD NOT ONLY DO, BUT SUSTAIN ON THE LONG TERM THROUGH, THROUGH FUNDING AND REIMBURSEMENT. 
          SO WE GOT TO FAMILY CENTERED TREATMENT AND I MIGHT CONTINUE TO PICK THE WRONG BUTTON THIS WHOLE TIME. 
          SO SOME INITIAL GOALS, AND I WOULD SAY THEY WERE OUR INITIAL GOALS, BUT CONTINUE TO BE, UM, OUR GOALS FOR THIS PROGRAM. 
          UM, THIS PROGRAM STARTED OFF ALMOST EXCLUSIVELY SERVING KIDS IN THE YOUTH JUSTICE SYSTEM 'CAUSE IT WAS A YOUTH JUSTICE GRANT. 
          UM, SO WE'RE REALLY LOOKING AT REDUCING KIDS, UM, ENTERING OUT OF HOME CARE, UM, AND ALSO SUPPORTING FAMILIES, THE POST RESIDENTIAL TREATMENT. 
          SO THOSE KIDS THAT DO HAVE TO BE PLACED OUTSIDE THE HOME, WHEN THEY DO COME HOME, HOW CAN WE WRAP AROUND THE ENTIRE FAMILY AND PUT IN SUPPORTS, YOU KNOW, NAVIGATE THOSE STRUGGLES, HELP THEM REINTEGRATE AND PROVIDE THOSE, UM, BETTER INCOME, UH, BETTER OUTCOMES. 
          UM, AND THOSE ARE REALLY AROUND FAMILY COMMUNICATION, RELATIONSHIP, UH, AND QUITE FRANKLY, GIVING PARENTS THE SKILLS TO PARENT KIDS WITH DIFFICULT BEHAVIORS, UM, AND BEING ABLE TO DO THAT TOGETHER AS A FAMILY UNIT. 
          AND I'M GONNA TURN OVER TO KELLY AND HIT THE WRONG BUTTON FOR THE FOURTH TIME. 
          THERE YOU GO. 
          ALRIGHT. 
          SO, UM, I'M GONNA TALK A LITTLE BIT ABOUT WHAT FAMILY CENTER TREATMENT IS AND HOW WE DO IT, AND THEN WHAT IT'S LOOKED LIKE FOR US IN WASHINGTON COUNTY. 
          UM, SO FAMILY-CENTERED TREATMENT, IT IS EVIDENCE-BASED, UM, AND IT IS IN-HOME TREATMENT. 
          UM, WE WORK WITH THE ENTIRE FAMILY UNIT, ALTHOUGH WE HAVE AN IDENTIFIED CLIENT, UM, FOR BILLING PURPOSES, WE REALLY CONSIDER THE ENTIRE FAMILY THE CLIENT, AND WE ALLOW THE FAMILY SOME, UM, FREEDOM IN IDENTIFYING WHO THAT IS FOR SURE, EVERYBODY THAT LIVES IN THE HOME. 
          BUT IF GRANDMA IS OFTEN A CAREGIVER, THEN MAYBE GRANDMA'S LOOPED INTO TREATMENT. 
          WHOEVER REALLY HAS A BIG PART OF THAT. 
          UM, WE REALLY DON'T WANT TO CHASE BEHAVIORS OR CHASE CRISES, UM, OR SOLVE LIKE THE ISSUE OF THE WEEK. 
          WE WANT TO GET AT THE UNDERLYING ROOT CAUSES OF THE BEHAVIORS AND REALLY REORGANIZE HOW THE FAMILY IS STRUCTURED SO THAT WE CAN REDUCE THOSE BEHAVIORS LONG TERM INSTEAD OF JUST PUTTING A BANDAID OVER IT. 
          UM, THROUGHOUT FCT, THERE IS ALSO A SYSTEMIC TRAUMA TREATMENT. 
          UM, AND YOU'LL SEE THAT ON THE NEXT SLIDE, BUT WE, WE REALLY WANT TO BE TREATING THE TRAUMA THROUGHOUT THE ENTIRETY OF THE TREATMENT THAT IS BEING PROVIDED. 
          UM, WE DO SOME VARIOUS STAGES OF, OF ASSESSMENT, WHICH I'LL GET INTO IN A LITTLE BIT AS WELL. 
          SO THE TYPICAL LENGTH OF TREATMENT FOR FCT IS ABOUT SIX TO NINE MONTHS, AND IT IS FOUR TO SIX HOURS OF IN-HOME FAMILY THERAPY. 
          SO IT IS A BIG COMMITMENT. 
          UM, BUT WE TRY TO DO TWO SESSIONS FOR TWO HOURS A WEEK WITH THE ENTIRE FAMILY. 
          UM, SO THESE ARE THE FOUR STAGES OF TREATMENT THAT FCT GOES THROUGH. 
          THAT FIRST PHASE IS GETTING TO KNOW THE FAMILY, DOING ASSESSMENTS, AND REALLY IDENTIFYING WHAT IS THE CAUSE OF THE 
          [00:10:01]
ISSUES. 
          UM, SO WE'RE NOT DOING A LOT OF TREATMENT IN THAT FIRST MONTH. 
          IT'S A LOT OF ASSESSMENT, A LOT OF, UM, RAPPORT BUILDING AND GAINING TRUST WITH ALL THE FAMILY MEMBERS. 
          THE SECOND STAGE IS RESTRUCTURING. 
          THAT IS THE MEAT OF FCT. 
          UM, FCT IS NOT A TALK THERAPY MODEL. 
          WE DO MORE EXPERIENTIAL TYPE THERAPY. 
          SO, UM, IF A FAMILY HAS DIFFICULTY WITH COMMUNICATION, UM, ONE OF THE ACTIVITIES WE MIGHT DO WITH A FAMILY IS CALLED, UM, ALLEGO. 
          ALLEGO BUILD. 
          SO YOU HAVE ONE PERSON BE HAVE THE INSTRUCTIONS, ONE PERSON BE THE RUNNER, AND ONE PERSON BE THE BUILDER, AND YOU WORK THROUGH WITH THE PRACTITIONER, OKAY, WHAT WENT WRONG? WHAT WAS REALLY HARD? WHAT, WHAT COMMITMENTS ARE YOU READY TO DO MOVING FORWARD OVER THE NEXT WEEK? AND MAYBE DAD IS LIKE, YOU KNOW, I JUST GOT SO FRUSTRATED I SHUT DOWN AND SO OVER THE NEXT WEEK, I AM GOING TO VOICE MY FRUSTRATIONS. 
          SO THINGS LIKE THAT. 
          WE USE DIFFERENT ACTIVITIES TO PRACTICE DIFFERENT SKILLS SO THAT, UM, THE FAMILY CAN START SHIFTING THOSE DYNAMICS. 
          VALUE CHANGE IS WHEN, UM, SOME OF THOSE CHANGES ARE STARTING TO BE SEEN, UM, AND FAMILY PARENTS ARE STARTING TO KIND OF TAKE OVER, UM, IN A GOOD WAY. 
          MAYBE PARENTS ARE LEADING THE ACTIVITIES. 
          UM, WHAT I REALLY LIKE TO SAY IS BY THE TIME WE GET TO VALUE CHANGE, THE PARENTS WILL BE CALLING THE PRACTITIONER AND SAYING, HEY, THIS HAPPENED. 
          THIS IS WHAT I'M GONNA DO ABOUT IT. 
          WHEREAS EARLY ON WE GET CALLS SAYING, OH MY GOSH, THIS HAPPENED. 
          WHAT DO I DO? I'M FREAKING OUT. 
          SO WE START SEEING THAT SHIFT TO PARENTS REALLY TAKING ON THAT OWNERSHIP GENERALIZATION. 
          UM, THAT'S PROBABLY THE LAST MONTH. 
          UM, THAT'S WHERE WE REALLY EMPOWER THE FAMILY THAT YOU GUYS HAVE DONE THIS, YOU'VE DONE THE WORK, WE'VE GIVEN YOU THE TOOLS AND YOU'VE ACCOMPLISHED IT. 
          HOW ARE WE GONNA MAINTAIN THIS PROGRESS? WHAT ARE WE GONNA DO TO MAKE SURE THAT THAT THINGS DON'T BACKSLIDE OR THINGS DON'T FALL? UM, SO THE FIVE PILLARS OF FCT TREATING FAMILIES WITH DIGNITY AND RESPECT, HONOR THE FUNCTION OF THE BEHAVIOR. 
          SO WE'RE REALLY LOOKING AT, UM, INSTEAD OF DISCIPLINING THE BEHAVIOR WISE, THE BEHAVIOR EXISTING AND ADDRESSING THAT CONCERN. 
          UM, WE WANT TREATMENT TO BE RELEVANT AND USEFUL TO THE FAMILY, AND WE WANT IT TO BE INTERNALIZED AND ONGOING INSTEAD OF COMPLIANCE BASED. 
          SO, UM, ESPECIALLY WITH SOME OF OUR TEENAGERS THAT WE GET HERE, THEY DO IT BECAUSE THEY KNOW THEY HAVE TO. 
          UM, OUR GOAL IS TO REALLY INTERNALIZE SOME OF THE CHANGES WITH EVERYBODY IN THE FAMILY. 
          SO IT COMES SECOND NATURE INSTEAD OF I'M DOING IT BECAUSE, AND THEN THE POWER OF GIVING AND RESTORING SELF-WORTH. 
          UM, A BIG ASPECT OF FCT IS THAT, UM, AT THE END OF TREATMENT YOU DO, THE FAMILY WILL DO A GIVE BACK PROJECT, UM, SHOWING THEM THAT THEY, THEY'RE WORTHY, THEY HAVE SOMETHING TO GIVE BACK TO THE COMMUNITY AND WE EMPOWER THEM TO DO THAT. 
          UM, ALL RIGHT, SO THESE ARE THE FCT GUARANTEES. 
          UM, THIS IS JUST KIND OF IDENTIFYING, UH, WHAT WE TELL THE FAMILY WHEN WE WALK IN THE DOOR. 
          WE ARE GIVING DIRECT AND HONEST FEEDBACK. 
          WE WANNA RECEIVE DIRECT AND HONEST FEEDBACK. 
          WE TAKE RESPONSIBILITY FOR OUR MISTAKES. 
          EVERYBODY MAKES MISTAKES, INCLUDING CLINICIANS. 
          UM, THE PARENT IS THE EXPERT IN THE FAMILY, AND WE ARE PROVIDING THEM TOOLS TO, TO AMP UP THEIR ABILITIES. 
          WE ARE ASKING PERMISSION BEFORE WE ARE DOING ACTIVITIES WITH THE, WITH THEIR CHILDREN, UM, AND WE ARE BEING TRANSPARENT. 
          WE ARE GONNA, AT THE END OF ACTIVITIES, SAY, HEY, I FELT LIKE THAT DIDN'T GO GREAT TODAY. 
          WHAT DO YOU GUYS THINK? AND WE WANT HONEST FEEDBACK FROM FAMILIES WITH THAT. 
          UM, THIS IS JUST A LITTLE MAP OF THE PLACES THAT ARE OFFERING FCT RIGHT NOW. 
          UM, SO IT IS EXPANDING. 
          IT IS GETTING MUCH BIGGER. 
          UM, AND THERE ARE SEVERAL COUNTIES IN WASHINGTON COUNTY, OR I'M SORRY IN WISCONSIN THAT ARE IMPLEMENTING FCT. 
          SO OUR MEASURES OF SUCCESS, UM, WE DO A TRAUMA SCREENER AT THE BEGINNING, MIDDLE, AND END OF TREATMENT. 
          UM, AND THAT IS DONE BY THE CHILD, OR IF THEY'RE YOUNGER THAN 11, THE PARENT WILL DO THAT FOR THE CHILD. 
          UM, THIS IS KIND OF HOW WE MEASURE HOW THE FAMILY IS PROGRESSING IN TREATMENT. 
          THE NEXT ONE IS CALLED A FAMILY ASSESSMENT DEVICE OR A FAD. 
          UM, WITH THAT IT IS LOOKING AT, UH, A QUESTIONNAIRE THAT EVERYBODY IN THE FAMILY COMPLETES, AGAIN AT THE BEGINNING, MIDDLE, AND END. 
          UM, AND IT, IT GIVES, IT SPITS OUT A NUMBER OF WHERE THE DEFICITS ARE, WHETHER IT'S COMMUNICATION, EFFECTIVE INVOLVEMENT ROLES, BEHAVIOR CONTROL, AND THAT IS HOW WE IDENTIFY WHAT WE'RE TARGETING IN TREATMENT. 
          AND THEN WE CAN MEASURE THAT ALONG THE WAY TO SEE IF IT'S GETTING BETTER. 
          THROUGH EACH TRANSITION BETWEEN THOSE FOUR PHASES 
          [00:15:01]
I SHOWED YOU, THERE'S ALSO A FAMILY REPORT. 
          THEY FILL OUT A QUESTIONNAIRE EVERY TIME TO INDICATE WHAT HAS GONE WELL AND WHAT HAS NOT. 
          UM, THIS IS OUR CURRENT IMPLEMENTATION STATUS. 
          UM, SO WITH THE FCT FOUNDATION, THEY ARE HEAVILY INVOLVED. 
          UM, AND WE ARE CURRENTLY 71% IMPLEMENTED AT WASHINGTON COUNTY. 
          UM, AND THAT IS FROM APRIL OF THIS YEAR. 
          AND WE CURRENTLY DON'T HAVE ANYTHING THAT'S NOT IN PLACE. 
          SO THIS IS A BIG ACCOMPLISHMENT FOR US AS AN AGENCY TO COME THAT FAR, UM, IN IMPLEMENTATION OF THIS EVIDENCE-BASED TREATMENT. 
          AND HERE IS SOME DATA, UM, IN GRAPH FORM THAT I WANTED TO PROVIDE TODAY. 
          UM, I WILL ADD A DISCLAIMER THAT WE RECENTLY CHANGED ELECTRONIC HEALTH RECORDS WITH THE FOUNDATION. 
          SO THE ONLY DATA THAT I HAVE HERE IS FOR CLIENTS THAT HAVE OPENED AND CLOSED IN 2024. 
          THAT IS A VERY SMALL SAMPLE SIZE DUE TO HOW LONG TREATMENT IS, BUT IT GIVES YOU AN IDEA. 
          UM, SO THIS IS THAT TRAUMA SCREENER. 
          AS YOU CAN SEE AT THE BEGINNING OF TREATMENT, THE NUMBERS ARE MUCH HIGHER. 
          UM, THERE IS A DIP IN THE MIDDLE AND, UM, WE DON'T HAVE ENOUGH DATA TO FULLY SAY YET WHAT THAT MEANS. 
          UM, BUT MY INCLINATION IS THAT'S IN THE MIDDLE OF RESTRUCTURING WHEN THERE IS LIKE SUPER HIGH, UM, SUPPORT, SUPER HIGH TREATMENT WITH THE PROVIDER. 
          AND ALTHOUGH IT GOES BACK UP, IT'S MUCH LOWER THAN IT ORIGINALLY STARTED. 
          UM, SO WE HAVE LAID A, A POSITIVE FOUNDATION FOR THE CHILDREN TO BE ABLE TO WORK THROUGH THEIR TRAUMA AND MOVE ON TO INDIVIDUAL THERAPY TO REALLY DIG IN AND PROCESS THAT TRAUMA NOW THAT THE FAMILY DYNAMIC IS ESTABLISHED. 
          UM, SAME THING HERE. 
          THIS IS SKEWED TO ONLY 20, 24 KIDS WHO HAVE OPENED AND CLOSED. 
          UM, BUT THIS IS THAT FAMILY ASSESSMENT DEVICE I TALKED ABOUT. 
          UM, THESE NUMBERS, WE SEE THEM M VERY HIGH IN THE BEGINNING. 
          WE OFTEN ACTUALLY SEE THEM SPIKE MID TREATMENT, UM, BECAUSE THAT'S WHEN WE'RE REALLY GETTING, UM, A LOT OF THE ELEPHANTS IN THE ROOM OUT. 
          WE'RE REALLY DIGGING INTO THE ISSUES AND THEN BY THE END WE SEE THOSE NUMBERS GO DOWN. 
          SO THAT IS THE COMMON TREND. 
          AGAIN, WE DON'T HAVE ENOUGH, UM, OF A SAMPLE SIZE TO REALLY SAY FOR SURE QUITE YET. 
          AND THEN I INDICATED SOME TREATMENT SUCCESS. 
          SO THIS IS A FAMILY REPORT. 
          UM, WE HAD EIGHT OUT OF 10 IN 2024 THAT SUCCESSFULLY COMPLETED TREATMENT AND REMAINED IN THE HOME. 
          UM, AND WE HAD, UH, EIGHT OUTTA 10 MAINTAIN PLACEMENT WITH FAMILY OF ORIGIN. 
          AND THESE ARE FAMILY REPORTS OF THEIR SATISFACTION OF FCT AND, UM, IMPROVEMENT OF THOSE AREA FAMILY FUNCTIONING LIKE COMMUNICATION AND THINGS LIKE THAT. 
          SO OVERALL, VERY POSITIVE FEEDBACK FOR FAMILIES THAT WE'VE SERVED THIS YEAR. 
          UM, AGAIN, WE CREATED MORE SAFETY IN OUR FAMILY DURING FCT MUCH. 
          UM, AS YOU CAN SEE, IT'S A LOT OF POSITIVE FEEDBACK AND THAT OUT OF SEVEN, EVERYBODY EITHER AGREED OR STRONGLY AGREED THAT, UM, FCT HAS IMPROVED THEIR FAMILY LIFE. 
          GREAT. 
          , IT'S MY TURN, MIKE. 
          UM, SO GREAT. 
          SO THANKS TO KELLY AND CORAL FOR PRESENTING THAT. 
          SO, YOU KNOW, I GET TO DO THE, UM, THE PLEASURE OF TALKING ABOUT THE DOLLARS AND CENTS OF THE PROGRAM. 
          AND SO, YOU KNOW, AS CORAL INDICATED AT THE BEGINNING OF THE PRESENTATION, YOU KNOW, AND, AND WHAT WE'LL TALK ABOUT LATER IN TODAY'S MEETING IS THAT THE HIGH DRIVER OF, UM, THE HUMAN SERVICES BUDGET IS OUR OUT-OF-HOME CARE, UM, UH, BUDGET. 
          AND, AND AS WE'VE BEEN SEEING THAT EXPONENTIALLY GROW, KNOWING AND KNOWING THAT WE'RE NOT GETTING THE OUTCOMES THAT, THAT WE WANT WITH KIDS AND FAMILIES, YOU KNOW, WE'VE BEEN TALKING ABOUT WHAT CAN WE DO TO CHANGE THAT? UM, AND SO, BUT TO INVEST MONEY, UM, TO IMPACT SOMETHING THAT'S AT THE DEEP END OF THE POOL, UM, WITHOUT REALLY KNOWING A HUNDRED PERCENT IF IT WILL IMPACT THE DEEP END OF THE POOL IS, IS SORT OF A HARD THING, UM, I THINK TO ASK FOR AND PRESENT. 
          UM, AND SO WE HAD THIS OPPORTUNITY TO APPLY FOR YOUTH JUSTICE INNOVATION GRANT TO ESSENTIALLY GIVE US THE SEED MONEY AND THE TIME TO IMPLEMENT THIS PROGRAM AND PILOT IT TO SEE IF IT WAS GONNA START HAVING THE SUCCESS THAT WE HOPED THAT IT WOULD BE. 
          AND ALSO, UH, YOU KNOW, THE BIG QUESTION OF WOULD IT WOULD OR COULD IT PAY FOR ITSELF OR COULD WE DRAW DOWN REIMBURSING REIMBURSABLE DOLLARS, UM, TO SUPPORT THE PROGRAM LONG TERM? UM, BECAUSE, YOU KNOW, IT'S A DIFFERENT CONVERSATION IF IT DOESN'T. 
          AND, UM, WE 
          [00:20:01]
HAVE TO COME, YOU KNOW, FORWARD AND ASK FOR TAX LEVY, UM, FOR THAT PROGRAM. 
          SO THIS WAS, UH, THIS JUST SHOWS YOU WHAT THE DOLLAR AMOUNT WE GOT FOR OUR YOUTH JUSTICE INNOVATION GRANT. 
          SO THE FIRST, UM, YEAR WE ESSENTIALLY GOT, UM, ENOUGH MONEY TO PAY FOR, UM, THE WHOLE PROGRAM. 
          AND THEN THE DOLLARS HAVE HAVE REDUCED EVERY YEAR THEREAFTER, UM, AS WE'VE BEEN GOING THROUGH IMPLEMENTATION. 
          AND WHEN WE DID OUR 2024 AND 2025, UM, BIENNIUM BUDGET, UM, WE THEN DID IMPLEMENT, UM, SOME TAX LEVY DOLLARS TO COVER THE COST OF THE PROGRAM BECAUSE WE WERE CONTINUING TO, UM, DETERMINE IF THIS PROGRAM COULD BE SELF-SUSTAINING OR NOT. 
          THE NEXT SLIDE. 
          SO THIS NEXT SLIDE, UM, JUST SORT OF DETAILS FOR YOU THE CURRENT SCENARIO AND, AND WHAT WE THINK COULD BE, UM, A FUTURE SCENARIO THAT WE'RE CURRENTLY ANALYZING. 
          ONE OF THE STRATEGIES THAT THE HUMAN SERVICES DEPARTMENT USES, UM, IN PROVIDING SERVICES TO THE COMMUNITY IS A USE OF CONTRACTED PARTNERS. 
          UM, CONTRACTED PARTNERS CAN BE VERY BENEFICIAL BECAUSE, UM, THEY CAN HELP US DO WORK THAT MAYBE WE CAN'T DO OR THEY CAN REACH THE COMMUNITY IN A WAY THAT WE CAN'T, BUT THEY ALSO ALLOW US TO BE MORE FLEXIBLE IN GROWING AND REDUCING PROGRAMS WITHOUT HAVING TO ADD COUNTY EMPLOYEES, UM, ESPECIALLY IF WE'RE TRYING TO PILOT SOMETHING OR GROW SOMETHING VERY QUICKLY. 
          SO WE APPROACHED THIS PROGRAM WITH, WITH THAT IN MIND, THAT WE KNEW WE COULD RELY ON ONE OF OUR CONTRACTED PARTNERS THAT WE'VE BEEN WORKING WITH FOR A LONG TIME, AND THEY WOULD HELP US TO SET UP THIS PROGRAM AND WE COULD UTILIZE THE GRANT FUNDS TO, TO PAY FOR THAT, UM, WITH THE IDEA THAT WE COULD PROJECT OUT MEDICAID REIMBURSEMENT IN THE FUTURE. 
          SO IF YOU LOOK AT THE CURRENT SCENARIO, WE CURRENTLY, UM, HAVE A CONTRACTED THERAPIST THAT'S THE COST OF THEIR CONTRACTED THERAPIST, AND THEN WE DO HAVE A COUNTY THERAPIST OR COUNTY EMPLOYEE WHO'S A THERAPIST IN THE PROGRAM THAT WE PUT IN THE BUDGET IN 2024. 
          UM, YOU'LL PROBABLY ASK YOURSELF WHY THAT COST IS DIFFERENT. 
          UM, AND SO ONE OF THE THINGS THAT WE'RE SEEING WITH CONTRACTED PARTNERS IS IT'S STARTING NOT TO BE, UM, ECONOMICALLY, UM, ADVANTAGEOUS FOR US AS IT USED TO BE, UH, FIVE TO 10 YEARS AGO. 
          UM, IT USED TO COST US A LOT LESS TO HAVE A CONTRACT THAN IT DOES NOW, UM, FOR A NUMBER OF REASONS. 
          WELL, EVERYBODY'S COSTS ARE RISING. 
          UM, THEY WANT TO ATTRACT AND RETAIN, UM, STAFF AS WELL, SO THEY NEED TO, TO PAY THOSE STAFF. 
          UM, YOU'RE ESSENTIALLY PAYING DOUBLE OVERHEAD BECAUSE YOU'RE HAVING, YOU KNOW, THEY HAVE THEIR OWN OVERHEAD. 
          UM, AND THEN THEY ARE HAVE AN ALLOWABLE 5%, UM, PROFIT, UM, WITH MEDICAID REIMBURSEMENT. 
          SO THERE'S A PROFIT THAT'S, THAT'S IN THERE AS WELL AS THEIR COVERING, YOU KNOW, THEIR OVERHEAD COVERS PERCENTAGE TIME OF THEIR SUPERVISORS AND THEIR DIRECTORS AND, AND THAT TYPE OF THING. 
          SO THAT, UM, COST OF THAT THERAPIST INCLUDES ALL OF ALL OF THOSE DIFFERENT, UM, BUDGET LINE ITEMS. SO THIS YEAR WE BUDGETED THAT CONTRACT WITH SOME TAX LEVY, UM, AND THEN SOME GRANT MONEY. 
          AND THEN WE PROJECTED OUT, UM, $75,000 OF MEDICAID REIMBURSEMENT. 
          AND IN OUR ANALYSIS OF 23 AND 24 AND THE PROJECTION FOR THE REST OF THE YEAR, UM, THAT THERAPIST REVENUE WILL BE $150,000. 
          SO, UM, 2023 AND YOU KNOW, I WOULD SAY HALF OF 2023 AND ALL OF 2024, WE'VE BEEN AT A PLACE WHERE THEY'RE FULL CASE LOADED AND WE'RE FULLY, UM, BILLING MEDICAID. 
          AND SO THAT WAS A REALLY EXCITING THING TO SEE THAT THE MEDICAID REVENUE, UM, WAS BEING GENERATED TO SUPPORT THE PROGRAM. 
          SO RIGHT NOW WE'RE PROJECTING A REVENUE OVER, UM, A REVENUE OVER, UM, OF ABOUT $75,000. 
          CONVERSELY, FOR THE COUNTY THERAPIST, WE, UM, WE ALLOCATED MORE TAX LEVY TO THAT POSITION AND LESS MEDICAID BECAUSE WE ANTICIPATED THAT THE COUNTY EMPLOYEE WOULD SERVICE THE INDIVIDUALS THAT WE COULD NOT BILL FOR. 
          SO FAMILIES WHO DON'T HAVE MEDICAID, UM, AND WE COULDN'T BILL. 
          BUT WHAT WE'RE SEEING IS THAT IS JUST SIMPLY NOT THE CASE. 
          THE THE NUMBERS ARE NOT THERE OF, OF CLIENTS OR FAMILIES THAT WE CAN'T BILL FOR. 
          AND SO, UM, OUR COUNTY EMPLOYEES REVENUE PROJECTION, UM, ALSO EXCEEDS WHAT THEIR CURRENT COST IS, SO THAT RIGHT NOW WE'RE IN THE STATE OF ANALYSIS AND, AND TRYING TO DETERMINE A, WILL IT BE MORE COST EFFECTIVE FOR THE COUNTY TO BRING ON BOTH OF THOSE THERAPISTS AS COUNTY EMPLOYEES BECAUSE WE ALSO KNOW THAT WE ALSO HAVE A LITTLE BIT MORE CONTROL AND OVERSIGHT OF AN EMPLOYEE WHEN THERE ARES, UM, OUR CONTRACTED PROVIDERS 
          [00:25:01]
AND ARE GREAT PARTNERS TO US, AND THEY WORK VERY CLOSELY WITH US. 
          BUT THERE IS A DIFFERENCE WHEN YOU HAVE A DOTTED LINE SUPERVISION AND A DIRECT LINE OF SUPERVISION, UM, TO AN INDIVIDUAL. 
          AND IF YOU ASK MY STAFF, THEY ASK ME EVERY DAY IF WE CAN JUST HAVE COUNTY EMPLOYEES. 
          AND SO THIS IS THE PART OF THE ANALYSIS THAT WE'RE DOING. 
          UM, RIGHT NOW THE NUMBERS SAY TO ME THAT, UM, NOT ONLY WILL THIS PROGRAM PAY FOR ITSELF, BUT WE'LL ALSO SAVE TAX LEVY IN THE END. 
          UM, AND THAT WILL HELP US IN OUR NEXT BIENNIUM BUDGET. 
          UM, WHEN WE'RE PREPPING THIS, UM, PLANNING FOR, UM, THE FUNDING OF THIS PROGRAM. 
          ONE OF THE BENEFITS, HOWEVER, OF CONTINUING TO KEEP OUR PARTNERSHIP IS IF WE WANNA GROW THIS PROGRAM, UM, THEN WE CAN CONTINUE TO ASK OUR COMMUNITY PARTNER TO BRING ON ANOTHER STAFF PERSON, UM, AND GROW THE PROGRAM TO SORT OF DO A LITTLE BIT OF THAT EBB AND FLOW OF, WELL, HOW MANY THERAPISTS IS ENOUGH THERAPISTS TO MEET THE COMMUNITY NEED. 
          UM, THE CASELOAD'S VERY SMALL BECAUSE OF THE INTENSITY, SO IT'S ABOUT FIVE. 
          IS THAT ACCURATE? YEAH. 
          UM, AND SO, UM, YOU KNOW, RIGHT NOW THE STAFF IS SAYING, I THINK WE'RE OKAY, UM, BUT MAYBE IN A YEAR WE MIGHT WANNA ADD ANOTHER POSITION. 
          UM, AND SO FOR ME THAT'S A GOOD TIMING, I THINK FOR THE BIENNIUM BUDGET TO SORT OF FIGURE OUT IF, IF WE'RE GONNA GROW THE PROGRAM, UM, WE WOULD DO IT IN THAT TIMEFRAME. 
          BUT RIGHT NOW WE'RE IN THE DECISION MAKING AROUND WHETHER WE'LL BE COMING FORWARD TO THIS COMMITTEE AND ASKING TO BRING THAT POSITION IN-HOUSE AS A COUNTY POSITION, UM, AND SHOW YOU, UM, HOW WE'RE ABLE TO FUND IT. 
          SO, UM, I'M GONNA STOP THERE. 
          AND THEN DID YOU WANNA SHOW YOUR, SO THAT ONE THAT I HAD ANOTHER SLIDE, BUT WE HAD TWO SEPARATE ONES. 
          OH YEAH, THAT'S RIGHT. 
          BUT I CAN SHARE A LITTLE BIT OF INFORMATION. 
          SO, UM, I HAD A PICTURE OF A, OF A FAMILY WHO WAS ONE OF OUR FIRST FCT CLIENTS AND, UM, THEY GRADUATED PROBABLY ABOUT A YEAR AGO. 
          UM, AND THEY SENT THEIR FCT PRACTITIONER A PICTURE OF THEM GRADUATING HIGH SCHOOL. 
          UM, AND I ACTUALLY JUST GOT AN UPDATE YESTERDAY THAT THE SAME CLIENT JUST GOT HER LICENSE. 
          SO JUST A LOT OF POSITIVE FEEDBACK. 
          WE'VE HAD, UM, A COUPLE KIDS AT RISK OF BEING ON THE SEX OFFENDER REGISTRY, UM, DUE TO THINGS THAT THEY DID THAT WERE NOT GREAT, UM, BUT THEY PARTICIPATED IN TREATMENT AND THEY WERE ABLE TO RECOVER THROUGH THE, THROUGH FCT AND SOME OTHER TREATMENTS AND THEY ARE DOING WELL AS WELL. 
          UM, WE ALSO, ONE OF OUR THERAPISTS, JAN DREXLER KATZ, UM, SHE WAS NOMINATED BY SARAH WHITTY AND MYSELF FOR PRACTITIONER OF THE YEAR, AND SHE WON THAT. 
          SO, UM, AT OUR FCT FOUNDATION, UH, CONFERENCE, WHICH WAS ALL, ALL THOSE STATES, YOU SAW EVERYBODY WAS THERE. 
          UM, OUT OF ALL OF THOSE PEOPLE, OUR THERAPIST GOT AWARDED THAT, WHICH IS A REALLY COOL THING AND WE'RE REALLY PROUD OF HER FOR THAT. 
          DID SHE GET AWARDED BASED ON A CASE STUDY EXAMPLE OR, UM, CAN YOU EXPAND ON IT? IT WAS BASED ON NOMINATIONS, SO OKAY. 
          SUPERVISORS COULD NOMINATE WHOEVER THEY FELT WAS APPROPRIATE FOR IT. 
          UM, AND THEN THE FOUNDATION HAD A COMMITTEE THAT CHOSE BASED ON THE NOMINATIONS WHO WAS THE WINNER, AND SHE WAS AWARDED THAT. 
          EXCELLENT. 
          GREAT. 
          I HAVE A A ONE QUESTION. 
          UM, IT WAS SLIDE, IT WAS ABOUT THE 71% IMPLEMENTED YES. 
          UM, ON SLIDE 11 I THINK IT WAS. 
          CAN YOU EXPAND ON THAT? I'M, I'M NOT FOLLOWING YOU. 
          MADE IT SEEM POSITIVE. 
          YES. 
          UM, THAT THAT'S A GOOD NUMBER. 
          AND SO I GUESS I NEED SOME HELP UNDERSTANDING THAT. 
          SURE, OF COURSE. 
          SO, UM, WITH IMPLEMENTATION WITH THE FOUNDATION, IT IS MEANT TO BE LIKE A THREE, FOUR YEAR PROCESS. 
          IT IS NOT MEANT TO BE QUICK. 
          UM, AND THEY HAVE THESE DIFFERENT IMPLEMENTATION DRIVERS THAT TWICE A YEAR WE GO THROUGH WITH OUR CONSULTANT WITH THE FOUNDATION AND IDENTIFY, UM, WHAT IS IN PROGRESS, WHAT IS IMPLEMENTED, AND WHAT IS YET TO BE DONE. 
          UM, SO THE FEEDBACK WE'VE GOTTEN FROM OUR CONSULTANT IS THAT WE HAVE, WE HAVE MOVED FROM EMER INTERMEDIATE IMPLEMENTATION, SORRY, TO EMERGENT IMPLEMENTATION, WHICH MEANS I WOULD ANTICIPATE BY NEXT YEAR WHEN WE DO THIS AGAIN, WE WILL BE FULLY IMPLEMENTED IS THE PLAN. 
          UM, EMERGENT IS RIGHT BEFORE FULLY IMPLEMENTED. 
          SO WE ARE RIGHT WHERE WE'RE SUPPOSED TO BE, IF NOT AHEAD OF THE GAME. 
          EXCELLENT. 
          THANK YOU FOR CLARIFYING. 
          YEAH, ABSOLUTELY. 
          AND IF I COULD, UM, ADD TO THAT AS WELL, UM, THE, THE INTENSITY OF TRAINING IN THIS PROGRAM IS, IS, IS VERY SIGNIFICANT. 
          UM, AND THE INITIAL THERAPIST WENT THROUGH TRAINING WITH THE FOUNDATION, BUT PART OF THE LONG-TERM SUSTAINABILITY IS NOW KELLY IS A TRAIN THE TRAINER, UM, SO THAT WE CAN HAVE THAT EXPERTISE IN HOUSE AND WE DON'T HAVE TO CONTINUE TO PAY THE FOUNDATION, 
          [00:30:01]
UM, FOR THEIR TRAINING. 
          UM, AND SO THAT IS PART OF, OF THE SUSTAINABILITY OF THAT. 
          AND I THINK THE OTHER POINT OF ANALYSIS FOR US OF HAVING, YOU KNOW, IN-HOUSE COUNTY EMPLOYEES IS THAT WE CAN ALSO THEN HAVE THEM BECOME, TRAIN THE TRAINERS AS WELL. 
          MM-HMM, . 
          EXCELLENT. 
          ANY QUESTIONS, COMMENTS, THOUGHTS? I DO. 
          OH, OKAY. 
          SUPERVISOR GALL. 
          LET'S LET MR. GALLS GO FIRST. 
          OKAY, THANKS. 
          THANK YOU. 
          UH, CHAIR SCHULTE'S. 
          SO THE TREATMENT SUCCESS, UM, HOW DOES THAT COMPARE? THAT'S IN-HOUSE, RIGHT? THAT'S OUR THREE YEARS RUNNING NOW. 
          YES. 
          UM, HOW DOES THAT WELL, THREE YEARS, BUT THE DATA I HAVE HERE IS ONLY FOR 2024 'CAUSE OF THE CHANGE IN EHRS. 
          GOT IT. 
          SO THEN, SO THE LIFETIME FCT WITH 13 SUCCESS, YOU GOT M UM, SAMPLE SIZE IS 10 FOR 2024. 
          SO WHAT'S THEN LIFETIME FCT OF 13? UM, YES. 
          GOTCHA. 
          SO, UM, THE LIFETIME THAT WE HAVE CALCULATED IS 13 SUCCESSFULLY GRADUATED FAMILIES. 
          NOW KEEP IN MIND THAT FIRST YEAR WE PROBABLY GRADUATED MAYBE ONE OR TWO CLIENTS THE SECOND YEAR. 
          IT SLOWLY GREW FROM THERE. 
          SO, UM, THE DATA, AND WE JUST IMPLEMENTED THIS NEW SYSTEM PROBABLY IN THE SPRING. 
          AND I DON'T KNOW THAT ALL THIS, WE'RE STILL WORKING OUT KINKS. 
          OKAY. 
          SO BASED ON MY CALCULATIONS, NOT THE SYSTEMS CALCULATIONS, THE LIFETIME OF FCT, WE'VE GRADUATED 13 CLIENTS SUCCESSFULLY, WHICH IS A 65% COMPLETION RATE. 
          THE GRAPHS LOOK REALLY PRETTY, WHICH IS GREAT, BUT I DON'T KNOW THAT THE DATA IS QUITE UP TO PAR YET BECAUSE OF THOSE KINKS. 
          UM, I MEAN THAT, THAT'S GOOD TO KNOW BECAUSE WE'RE LIMITED TO JUST 2024 AND IT'S A GROWING PROCESS. 
          BUT PRESUMABLY THAT COULD BE EXTRAPOLATED THAT SUCCESS WOULD CONTINUE AT A 80% OR HIGHER CLIP. 
          IS THAT THE EXPECTATION? YES, THAT IS, THAT IS THE HOPE. 
          THAT IS THE HOPE THAT WE'RE GONNA KEEP, UM, BULKING UP. 
          OUR PRACTITIONERS KEEP BULKING UP, UM, OUR SKILLS AND OUR PROGRAM, UM, TO GET TO A PLACE WHERE WE'RE MORE EFFECTIVE. 
          UM, IT'S SOME OF THE SKILLS THAT YOU DO IN FCT, YOU DO IT ONCE FOR A FAMILY. 
          SO TO BECOME AN EXPERT IN THAT SKILL WITH A FAMILY, IT TAKES A WHILE 'CAUSE YOU'RE ONLY DOING IT ONE TIME FOR EVERY FAMILY, AND THEN YOU GET ANOTHER FAMILY THREE, FOUR MONTHS DOWN THE ROAD. 
          SO, UM, AS WE CONTINUE TO GET MORE EFFICIENT, I THINK OUR NUMBERS WILL CONTINUE TO GROW DIFFERENT SCENARIO, DIFFERENT SOLUTIONS, ET CETERA. 
          EXACTLY. 
          UM, HOW DOES THAT DATA THAT YOU SHOWED HERE FOR 2024 SUCCESS RATE COMPARE TO OUT OF HOME SERVICE SERVICES, WHICH YOU STARTED THE PRESENTATION OFF WITH? I DON'T KNOW IF YOU HAVE THAT INFORMATION. 
          I DON'T. 
          UM, CAN YOU JUST CLARIFY YOUR QUESTION? SO YOU'RE SAYING THE TREATMENT SUCCESS HERE IS BASED ON 2024 AND THIS IS IN HOME TREATMENT, RIGHT? RIGHT. 
          AT THE BEGINNING OF THE PRESENTATION YOU HAD MENTIONED WE PREVIOUSLY HAD OUT OF HOME SERVICES. 
          SO I'M JUST CURIOUS, HOW DOES THE SUCCESS RATE OF IN-HOME SERVICES COMPARE TO OUT OF HOME SERVICES? SO YOU'RE WANTING TO CONNECT IT TO LIKE OUT-OF-HOME CARE? I MEAN, BECAUSE YOU'RE PROVIDING COUNSEL. 
          I'M NOT SURE IT'S THAT FOR INDIVIDUALS, RIGHT? YEAH, I'M NOT, WHETHER IT BE IN-HOUSE OR OUT OF HOUSE, I'M NOT SURE IT CAN BE THAT CLEANLY COMPARED, ALTHOUGH I WOULD SAY WE'VE HAD HOW MANY OF MY KIDS, 'CAUSE THEY'RE ALSO ON ALL MY KIDS. 
          RIGHT. 
          SO YEAH, I MEAN OVER HALF ARE YOUR YEAH. 
          DIRECTLY YOURS OR HEADED TO YOU, UM, IN THE PROCESS. 
          I THINK THE TRICKY PART WITH THAT QUESTION IS, UM, IT'S DEPENDENT ON THAT OUT-OF-HOME PLACEMENT MEASURE OF SUCCESS. 
          SO EVERY PLACEMENT RESIDENTIAL HOSPITAL, THEY HAVE DIFFERENT MEASURES OF SUCCESS. 
          SO WE CAN'T TOTALLY, YOU KNOW, COMPARE IT. 
          UM, BUT I THINK INTERNALLY WE CAN, AT SOME POINT, CORAL AND I HAVE TALKED ABOUT GETTING NUMBERS OF YEAH. 
          UM, HOW MANY TIMES DID THEY REENTER TREATMENT WITHOUT FCT VERSUS HOW MANY MAINTAINED AT HOME WITH FCT AND ALSO THOSE THAT COMPLETED, WHAT'S THE POST DISCHARGE OR POST-COMPLETION OF FCT? WHAT WAS NEXT FOR THEM? DID THEY GO INTO ADDITIONAL PLACEMENT OR NOT? RIGHT. 
          UM, BECAUSE I, I'M JUST TRYING TO WRAP MY HEAD AROUND MAINLY THE, THE ALT ALTRUISTIC AND, AND THE VALUE TO THE WASHINGTON COUNTY AND RESIDENTS IS THAT THIS TREATMENT IS SUCCESSFUL, RIGHT. 
          SO OUR RESIDENTS ARE RECEIVING THE CARE THAT THEY NEED. 
          UM, AND IT MAY BE AT A BETTER RATE OF SUCCESS THAN IF THEY'RE NOT IN A HOME. 
          UM, AND ALL THE OTHER FACTORS YOU TALKED ABOUT, THE FAMILY 
          [00:35:01]
LEARNS FROM IT VERSUS JUST THE KIDS. 
          SOME CHILD THAT'S OFF OVER HERE YEAH. 
          VERSUS NOW THEY'RE, THEY'RE, THEY'RE IN THAT FAMILY SETTING, THEY CAN ALL LEARN FROM IT. 
          RIGHT. 
          AND PRESUMABLY, YOU KNOW, THEY, THEY WON'T REPEAT, UH, BEHAVIORS ONE WAY OR THE OTHER. 
          UM, WHICH KIND OF LEADS INTO THE NEXT PIECE ABOUT THE, THE SUSTAINABILITY AND FUTURE PART OF IT IS, UM, YOU KNOW, WITH TWO STAFF MEMBERS PROJECTED HOW MANY INDIVIDUALS, UH, CAN BE TREATED REASONABLY. 
          UM, YOU KNOW, IN A PREVIOUS PRESENTATION WE HAD A LITTLE BIT OF CAPACITY, UM, WITH STAFFING, BUT, AND I'M SURE THERE'S, IT'S GONNA CHANGE FROM YEAR TO YEAR BASED UPON NEED OR DEMAND OR QUALIFICATIONS OR WHATEVER TERM YOU WANT TO CALL IT. 
          CASELOAD. 
          YEAH. 
          YEAH. 
          AND, AND I SUSPECT IN SOME CASES, YOU KNOW, USE WILL BE, I GUESS FORCED TO HAVE TREATMENT. 
          IS THAT A TERM? I MEAN, I KNOW WE HAVE CUSTODIAL PLACEMENT AND THINGS LIKE THAT, BUT IS IT ALL VOLUNTARY OR, OR IS IT INVOLUNTARY TREATMENT? AND, AND AGAIN, THAT JUST GOES TO THE CAPACITY OF STAFF. 
          SO IF WE HAVE TWO TODAY AND WE THINK THAT THE PROGRAM MAY EXPAND, IS THAT BECAUSE THERE'S NEEDS THAT CURRENTLY CAN'T BE SERVED? OR ARE WE SEEING AN INCREASE IN, YOU KNOW, WHAT WAS THE TERM I SAW HERE? SOMETHING ABOUT, I DON'T KNOW, INAPPROPRIATE BEHAVIOR OR WHATEVER THAT WOULD REQUIRE TREATMENT? I'M JUST TRYING TO GET A GRASP OF HOW DO WE PROJECT WHAT FUTURE NEEDS WOULD BE BECAUSE MM-HMM, , WHEN YOU LOOK AT FUNDING, CREATING A A BIANNUAL BUDGET, YOU, WHAT DO YOU BASE IT ON? ARE YOU BA BASE IT ON PAST HISTORIC TRENDS OF CLIENTS SERVE? OR WHAT MIGHT BE HAPPENING IN IN THE COMMUNITY OR, I, I, I'M JUST, YEAH, WE KIND OF LOOK AT PAST HISTORICAL TRENDS. 
          WHAT NUMBER OF KIDS ARE CURRENTLY NUMBER OF KIDS CURRENTLY OUT PLACED OUTSIDE THE HOME THAT MAY MEET LIKE MAYBE THE TARGET AUDIENCE FOR THIS TYPE OF PROGRAM. 
          UM, AND RIGHT NOW, I WOULD SAY THE KIDS, WE ONLY HAVE, UM, EIGHT KIDS IN OUTSIDE THE HOME IN RESIDENTIAL TREATMENT. 
          THAT'S NOT ALL RESIDENTIAL. 
          UM, BUT NOT ALL OF THEM MAY BE APPROPRIATE FOR THIS PROGRAM. 
          AND EVEN THOUGH WE COURT ORDER MENTAL HEALTH SERVICES ALL THE TIME, WHETHER IT'S ON A JUVENILE ORDER OR A PARENTAL ORDER THROUGH CHILD PROTECTIVE SERVICES, THIS IS A REALLY BIG COMMITMENT. 
          SO PARENTS STILL HAVE TO HAVE AMOUNT OF BUY-IN WITH, IS IT SIX, SIX HOURS A WEEK? THAT'S FOUR TO SIX HOURS A WEEK. 
          UM, AND NOT EVERY FAMILY, WE'VE REFERRED LOTS OF FAMILIES WHO HAVE SAID, THANK YOU, BUT NO THANK YOU. 
          THIS IS TOO MUCH FOR US. 
          AND WE'VE THEN HAD TO STEER THEM INTO ANOTHER TYPE OF PROGRAM. 
          AND I WILL SAY TOO, UM, TO ANSWER YOUR QUESTION ABOUT FUTURE, UM, GROWTH, NOW THAT FC T'S KIND OF GOTTEN OUT THERE, I AM GETTING A LOT OF REFERRALS FROM LIKE CCS FAMILIES FROM, UM, I MEAN CPS, WHICH WASN'T ORIGINALLY IN THAT CORRECT COHORT THAT WE WERE LOOKING AT AS WELL AS SCHOOLS. 
          I MEAN, I'M, AND THESE ARE KIDS THAT AREN'T IN THE YJ SYSTEM, UM, BUT SOME OF THEM HAVE A LOT OF POLICE CONTACT OR HAVE GOTTEN A LOT OF TICKETS OR ARE AT HIGH RISK. 
          WE HAVE A LOT OF FAMILIES RIGHT NOW WHERE THEY WOULD BE WITH CORAL'S GROUP, UM, IF PARENTS CALLED THE POLICE, BUT PARENTS DON'T. 
          THEY JUST DEAL WITH IT AND ALLOW THE HOUSE TO GET DESTROYED OR GET HURT BECAUSE OF IT, BECAUSE THEY DON'T WANT THEIR KID IN THE SYSTEM. 
          SO WE ARE IDENTIFYING SOME OF THOSE PREVENTATIVE FAMILIES IN HOPES THAT THEY DON'T MAKE IT TO CORAL'S TEAM. 
          AND THAT, TO KELLY'S POINT, THAT WAS ALWAYS ONE OF THE GOALS OF THIS IMPLEMENTING THIS PROGRAM WAS, OR SO THAT, UM, FAMILIES CAN COME THROUGH KELLY'S DOOR AND GET THESE SERVICES VOLUNTARILY TO DO THIS PREVENTATIVE WORK SO THEY DON'T HAVE TO ENTER THE SYSTEM, WHICH WOULD THEN NOW HAVE A, OBVIOUSLY A POSITIVE EFFECT ON THE, ON THE OTHER THINGS THAT I TALKED ABOUT OUT OF HOME CARE DOLLARS AND ALL OF THOSE THINGS. 
          SO WE WOULD JUST BE LIKE DIVERTING THOSE FAMILIES WHO MIGHT OTHERWISE COME TO US WITHOUT AMPLE RESOURCES TO, TO CHANGE THEIR FAMILY'S, UH, SITUATION AND DYNAMIC. 
          SURE. 
          UM, SORRY, JUST ONE LAST, UH, QUESTION REGARDING, UH, JULIE AND THE, THE FUNDING. 
          UM, SO IT'S ANTICIPATED THAT T 19, I'M ASSUMING EQUATES TO MEDICAID MM-HMM. 
           THAT'S CORRECT. 
          YES. 
          UM, THAT, THAT WE WOULD GET AS MUCH REIMBURSEMENT AS WE COULD. 
          BUT WHAT IF, WHAT IF THERE'S A SHORTFALL? YOU SAID THAT NOT ALL FAMILIES QUALIFY MM-HMM. 
          . 
          SO, UH, IS THAT THEN, IS THERE A POOL OF FUNDS THAT HAVE BEEN, UM, ALLOCATED SO THAT, THAT COULD OFFSET THAT, UM, OR OUR FAMILIES CHARGED? BUT YOU SAID NOT AT A FULL A HUNDRED PERCENT OF THE COST. 
          SO I'M JUST TRYING TO UNDERSTAND IF THERE IS A SHORTFALL SOMEWHERE THERE, HOW IS THAT, UM, HOW IS THAT ACCOUNTED FOR? YEAH, SO TYPICALLY, UM, AND THAT IS ONE OF THE REASONS THAT WE DO DO CONTRACTS WITH OUTSIDE VENDORS. 
          'CAUSE WE DO FEE FOR SERVICE AND THEY, WHATEVER THEY BILL THEY GET, 
          [00:40:01]
AND THE HIRING AND STAFFING IS, IS THEIR RESPONSIBILITY. 
          WHEN WE DO OUR BUDGET FOR ANY OF OUR CASE MANAGERS THAT BILL CCS, WE DO A PROJECTION BASED ON PRODUCTIVITY EXPECTATIONS. 
          BUT WE DON'T, I WOULD NEVER HAVE BUDGET THIS WAY WHERE I WOULD SAY, I'M GONNA PAY FOR SOMEBODY A HUNDRED PERCENT BECAUSE YOU'RE, YOU CAN NEVER GUARANTEE A HUNDRED PERCENT PERCENT BECAUSE THE COUNTY IS RESPONSIBLE FOR SERVICING ALL INDIVIDUALS REGARDLESS OF ABILITY OF INSURANCE. 
          AND SO, UM, WHEN WE DO BUDGETING FOR STAFF, UM, THERE'S ALWAYS A SORT OF A BLENDED OR BRAIDED FUNDING STRATEGY TO IT. 
          SO I MIGHT TAKE MY TAX LEVY THEN I, YOU KNOW, ALLOCATED, AND THEN I DIVIDE IT, YOU KNOW, AMONGST SOME OF THE STAFFING COSTS. 
          AND THEN I PLUG IN WHAT THE MEDICAID PROJECTION IS. 
          UM, AND SO THAT WAY WE'RE NEVER RELIANT ON, UM, A HUNDRED PERCENT MEDICAID BECAUSE WE KNOW THAT WE HAVE THE TAX LEVY THERE. 
          BUT I THINK THAT STRATEGY HAS ALSO BEEN ONE OF THE REASONS WHY OUR BUDGET HAS BEEN SUCCESSFUL, BECAUSE WE HAVE DONE A REALLY GREAT JOB IN, UM, IN DRAWING DOWN THE REVENUE FROM INSURANCE AND MEDICAID THAT'S AVAILABLE. 
          UM, AND SO I MEAN, IN MY TENURE HERE, UM, YOU KNOW, WE'VE ALWAYS HAD A POSITIVE BUDGET AT THE END OF THE YEAR AND, AND ACTUALLY BEEN ABLE TO, UM, SEND SOME MONEY BACK TO THE, THE GENERAL FUND. 
          AND SO THAT'S TYPICALLY THE STRATEGY THAT I TAKE. 
          BUT I AM ALWAYS ALSO LOOKING AT IF WE HAVE THE PRODUCTIVITY MEASURES AND EXPECTATIONS THERE, COULD THIS PROGRAM FUND ITSELF? UM, AND SO AS I LOOK AT THIS PROGRAM NOW, IT, IT CAN FUND ITSELF, UM, BUT I WOULD NEVER, UH, TOTALLY ERASE ALL THE TAX LEVY THAT'S ALLOCATED TO THOSE POSITIONS JUST BECAUSE WE ALSO WANNA MAKE SURE THAT WE'RE SERVICING INDIVIDUALS THAT DON'T HAVE INSURANCE. 
          AND THEN I THINK AS WE START SEEING THE LANDSCAPE OF THIS PROGRAM CHANGE AND WHO'S BEING REFERRED TO THE PROGRAM, UM, THAT, YOU KNOW, THAT MIGHT ALSO CHANGE THE INSURANCE CAPABILITIES, WHICH WE HAVE TO ANALYZE AS WELL. 
          UM, BUT ONE OF THE THINGS THAT I, THAT GETS EVEN MORE COMPLICATED AND, AND THE TEAM ACTUALLY HAS MORE EXPERTISE IN THIS THAN I DO, IS, UH, MENTAL HEALTH IS A, UM, IS A DIAGNOSIS THAT DOES MAKE, UH, FAMILIES WHO HAVE HIGHER INCOMES CHILDREN ELIGIBLE FOR PROGRAMS LIKE KATIE BECKETT, UM, WHICH IS AN, A MEDICAID FUNDABLE SERVICE. 
          YEP. 
          SO I, I WORK REALLY CLOSELY WITH KATIE BECKETT WHEN I SCREEN KIDS FOR CCS, UM, AND IF THEY ARE ELIGIBLE FOR KATIE BECKETT, THEN WE CAN GET THEM THAT MEDICAID SOURCE DESPITE THEIR INCOME. 
          THANK YOU. 
          CHAIR . 
          THANK YOU, ADAM. 
          CHAIRMAN. 
          UM, MY QUESTIONS WERE PRETTY MUCH ALONG THE SAME LINES AS SUPERVISOR GALL, UH, ABOUT THE FUTURE AND LIKE, I GUESS THE POTENTIAL FUTURE CLIENTS OR TREATMENTS. 
          UM, BUT I WILL SAY I, MY QUESTION'S BEEN ANSWERED, BUT, UH, UM, KUDOS TO YOU FOR THIS INNOVATIVE SOLUTION. 
          I, IT SOUNDS LIKE IT'S WORKING AND I HOPE IT CONTINUES TO BE SUCCESSFUL AND IT'S A WHOLE LOT CHEAPER THAN THE OUT OF HOME TREATMENTS AND MORE EFFECTIVE THE WAY IT SOUNDS. 
          SO GOOD. 
          GOOD. 
          THANK YOU. 
          THANK YOU. 
          THANK YOU. 
          AND I'LL JUST KIND OF HOPEFULLY CLOSE OUT THE QUESTIONS UNLESS ANYONE ELSE HAS ANY, WITH JUST THE MEDICAID REIMBURSEMENTS, ARE THEY COVERING A HUNDRED PERCENT ARE HOW ARE THEY ACTUALLY, 'CAUSE HAVING DEALT WITH THE SAMARITAN AND THAT KIND OF MM-HMM. 
           MEDICAID REIMBURSEMENT, YOU KNOW, THIS IS, UH, NOT THE SAME. 
          AND SO IT SOUNDS LIKE THE REIMBURSEMENTS ARE PRETTY GOOD. 
          SO IT'S ABOUT, UM, PRODUCTIVITY AND SO BE, I THINK BECAUSE THIS PROGRAM HAS SUCH INTENSITY TO IT, THEN THE PRODUCTIVITY IS THERE. 
          OKAY. 
          UM, AND SO BECAUSE THEY'RE DOING FOUR TO SIX HOURS FOR A FAMILY, YOU KNOW, THAT IS ALL TIME THAT THEY CAN BILL, IF THAT PERSON HAS THE ELIGIBLE INSURANCE, UM, YOU KNOW, TO BE, YOU KNOW, COMPLETELY HONEST, THE, THE RATE HASN'T CHANGED IN A VERY LONG TIME. 
          UM, AND SO, UM, AS WE CONTINUE TO HAVE SAF COSTS RISE, RIGHT? AND THE RATE STAYS THE SAME, I, I'M NOT, YOU KNOW, THERE COULD BE A POINT WHERE WE'RE SEEING THAT THAT DOESN'T COVER. 
          UM, BUT, BUT RIGHT NOW, UM, THE RATE, YOU KNOW, DOES FAR AND EXCEED, YOU KNOW, IF, IF THE PRODUCTIVITY IS THERE, IF FAR AND EXCEEDS THEN WHAT THE, OUR COSTS ARE. 
          BUT YOU KNOW, THAT'S, YOU KNOW, OUR, OUR SALARIES INCREASE, OUR INSURANCE INCREASES AND MM-HMM. 
          , YOU KNOW, EVENTUALLY YOU HAVE THAT, THAT TIPPING POINT. 
          AND, AND DO WE AS A COUNTY DO ANYTHING ON A SLIDING FEE SCALE OR IS IT MEDICAID OR NOT? WE TYPICALLY DO, UM, IN OUR OUTPATIENT CLINIC FOR FOLKS WHO ARE UNINSURED. 
          I THINK AT THIS 
          [00:45:01]
POINT WE'RE STILL IN A PILOT, UM, PHASE OF THIS PROGRAM. 
          AND SO WE'VE NOT SET UP A REQUIREMENT THAT FAMILIES PAY. 
          UM, IF THEY DON'T HAVE INSURANCE, IT'S STILL AN, UH, PROGRAM OR PROGRAM THAT WE OFFER TO THEM. 
          AND WE REALLY TRY TO GET FAMILIES INTO COMPREHENSIVE COMMUNITY SERVICES, CCS, UM, AND THEN THOSE ARE COVERED BY MEDICAID FULLY. 
          UM, AND THEN THAT ALSO GIVES THEM A STEP DOWN ONCE FC ENDS, THEY STILL HAVE A CASE MANAGER, THEY STILL HAVE A TEAM THAT CAN SLOWLY, UM, REDUCE SERVICES. 
          SO IT'S NOT ALL THERE. 
          AND THEN ONE DAY IT'S ALL GONE. 
          RIGHT. 
          WELL, THANK YOU. 
          VERY COMPREHENSIVE. 
          YES. 
          ANNE, JUST ONE QUESTION. 
          UM, ARE THERE, IS THERE LIKE A WAITING LIST FOR PEOPLE WHO WANNA GET IN THE PROGRAM? UM, CURRENTLY THERE IS, UM, IT'S ABOUT FIVE. 
          WE ALSO HAVE ONE PRACTITIONER THAT'S ON MEDICAL LEAVE RIGHT NOW. 
          SO THAT'S A BIG CONTRIBUTOR, CONTRIBUTOR TO THAT. 
          UM, SO WE EXPECT WHEN SHE GETS BACK THE WAIT LIST SHOULD BE GO AWAY 'CAUSE OF CASELOAD OF FIVE. 
          SO, AND I WOULD JUST, SO I THINK I MENTIONED THIS, BUT ONE OF THE BENEFITS OF OUR CONTRACTED PROVIDER IS THEIR ABILITY TO, UM, BRING ON STAFFING QUICK, MUCH QUICKER THAN WE CAN. 
          SO WE HAD BROUGHT ON A THIRD, UM, POSITION, UM, BUT UNFORTUNATELY AS KELLY SAID, SHE WENT ON MEDICAL LEAVE. 
          SO RIGHT NOW WE'RE STILL OPERATING AT THE ORIGINAL TWO. 
          I'M SORRY, I DO HAVE ONE MORE I'M THINKING ABOUT, THIS IS FAIRLY NEW TO ME. 
          UM, I DON'T KNOW, I DIDN'T KNOW IT WAS COVERED IN THE NATION AS WELL, AND NOT ALL STATES ARE PARTICIPATING, BUT THERE ARE SEVERAL THAT ARE, AND I'M JUST WONDERING, UM, IS IS THIS SOMETHING THAT WE'VE DONE ANY PUBLIC SERVICE ANNOUNCEMENTS ABOUT IT OR, OR MARKETED SO TO SPEAK? UH, NOT BROADLY , JUST 'CAUSE WE DON'T, I MEAN, WE DO ONLY HAVE THREE PEOPLE. 
          SO I EXPECT IF WE WERE TO, UM, BROADLY MARKET THAT I WOULD GET MANY, MANY MORE REFERRALS VERY QUICKLY. 
          UM, BUT I HAVE SLOWLY STARTED TO TALK ABOUT IT. 
          I OFTEN GO TO LIKE WEST BEND SCHOOL DISTRICT AND SLINGER AND DO A LOT OF TALKS WITH THEM ABOUT THE TREATMENT WE OFFER AT WASHINGTON COUNTY. 
          AND THIS IS SOMETHING I DO BRING UP TO THEM. 
          OKAY. 
          SO I'VE STARTED SMALL, UM, AND WHICH IS WHERE ADDITIONAL REFERRALS HAVE COME IN, BUT I THINK IF WE EVENTUALLY WE CAN BE BROAD, WE JUST DON'T HAVE THE CAPACITY TO HANDLE THAT AMOUNT. 
          SURE. 
          UNDERSTAND. 
          YEAH. 
          YEAH. 
          YEAH. 
          OKAY. 
          WELL THANK YOU VERY MUCH. 
          IT WAS A GREAT PRESENTATION. 
          APPRECIATE IT. 
          THANK YOU. 
          THANK YOU. 
          THANK YOU. 
          ALL RIGHT. 
          WE'LL GO BACK TO THE TOP OF OUR AGENDA ORDER AND WE'LL HAVE THE, UH, ADMINISTRATION QUARTERLY REPORT, LEE AND ANITA. 
          HELLO. 
          HELLO THERE. 
          UM, I'M ANITA. 
          I'M THE BILLING SUPERVISOR FOR HUMAN SERVICES AND 
          [a. HSD Administration Quarterly Report]
THE INITIATIVE I'VE BEEN WORKING ON THIS YEAR IS TO, AND IN ENHANCE ACCURACY AND STREAMLINE THE BILLING PROCESS TO IMPROVE EFFICIENCY. 
          SO THE FIRST PART OF MY GOAL IS, IS KIND OF COMPLETE, BUT I JUST WANTED TO KIND OF RECAP IT. 
          SO, UM, THE GOAL WAS TO REVIEW MY EXISTING PRACTICES AND POLICIES, LOOKING AT WAYS TO IMPROVE FINANCIAL PERFORMANCE, REDUCE COSTS ASSOCIATED WITH CLAIMS PROCESSING AND ENHANCE PATIENT COLLECTIONS. 
          AS PART OF THIS INITIATIVE I CONDUCTED THROUGH AUDIT OF OUR CURRENT BILLING AND COLLECTIONS PROCESSES, I ANALYZED DATA METRICS FROM OUR CLEARING HOUSE TO IDENTIFY ERROR TRENDS, FOCUSING ON PREVENTABLE ERRORS SUCH AS INVALID MEMBER ID, THAT CAUSES, YOU KNOW, THE CLAIM TO BE REJECTED, WHICH REWORKING AND, UH, RESUBMISSION, WHICH CAUSES COSTS. 
          UM, ANOTHER AREA IS THE PATIENT COLLECTIONS FOR EOS. 
          AND EARLIER THIS YEAR, HUMAN SERVICES PARTNERED WITH WAUKESHA COUNTY, UH, FOR MANAGING OUR DELINQUENT ACCOUNTS. 
          AND AFTER OUR FORMER COLLECTION AGENCY CLOSED THEIR DOORS AND WE PARTNERED WITH THEM IN LATE FEBRUARY, AND TO DATE, WE'VE SUCCESSFULLY COLLECTED OVER $23,000 IN PATIENT COLLECTIONS. 
          UM, AND THE SECOND PART OF MY GOAL THAT ISN'T COMPLETED YET, UM, I'M WORKING ON CENTERED AROUND MEASURING AND MONITORING THE REVENUE, UH, WHICH ACTUALLY ALIGNS WITH ONE OF DOUG BRI'S GOALS. 
          UM, DOUG AND I HAD A COUPLE OF MEETINGS TO DETERMINE LIKE WHAT METRICS TO FOCUS ON AND WITH OBVIOUS, UH, LONG-TERM GOAL OF REVENUE GROWTH KIND OF WORK. 
          PERFECT. 
          WHAT WE WERE TALKING ABOUT,  A SO WE'RE CURRENTLY FOCUSED ON PRODUCTIVITY, UM, AND I REPORT MONTHLY, UM, THROUGH THAT DATA. 
          UM, AND I THINK AS HSD CONTINUES TO GROW AND THERE'S THAT CONTINUAL NEED FOR SERVICES, IT'S IMPORTANT THAT MY UNIT, UM, MAINTAINS THE ROBUST BILLING PROCESS, UM, BECAUSE IT'S ESSENTIAL TO SUSTAIN 
          [00:50:01]
POSITIVE REVENUE FLOW TO HSD. 
          SO I'M ON TRACK TO GREAT. 
          SO GREAT. 
          YEAH. 
          VERY GOOD. 
          ALRIGHT, ANY QUESTIONS? ANY QUESTIONS FOR LEE? I, I DID HAVE ONE IN NOT INTENDED TO GET INTO THE, THE DETAILS IS THAT, NOT THE INTENT OF THIS, BUT, UM, YOU HAD MENTIONED ABOUT, UH, MAYBE SOME BILLING PRACTICES AND MISSED DATA THAT CAUSES PUSHBACKS, ET CETERA. 
          UM, DID YOU DETERMINE IF THAT WAS IN RANGE EXCESSIVE, UH, ANYTHING TO BE CONCERNED ABOUT? PUT, PUT NEW PRACTICES IN PLAY? NOT REALLY ANYTHING TO, TO BE CONCERNED ABOUT. 
          IT'S JUST, I THINK WE'RE HUMAN AND SO WE LOOK AT SOMETHING AND IT GETS ENTERED INCORRECTLY IN THE SYSTEM. 
          SO WE JUST PUT, UM, A COUPLE OF EXTRA CHECKS IN PLACE TO ENSURE THAT WHAT'S BEING SUBMITTED IS BEING SUBMITTED CORRECTLY THE FIRST TIME TO PREVENT ERRORS. 
          SO TO GIVE YOU, TO KIND OF GIVE YOU AN OVERVIEW, IN 2023, WE SUBMITTED OVER 40,000 CLAIMS, UM, FOR BILLING AND WE BROUGHT IN OVER $4 MILLION. 
          AND FROM THE METRICS OFF THE CLEARINGHOUSE, WE HAD LIKE A 5% ERROR RATE. 
          SO WE DON'T HAVE A VERY BIG ERROR, BUT THOSE ERRORS CAUSE UM, COST HSD BECAUSE WE GET CHARGED EVERY TIME WE SUBMIT A CLAIM. 
          SO THAT OPPORTUNITY, COST, DIRECT COSTS, ET CETERA. 
          UM, JUST CURIOUS, YOU KNOW, AS WE'VE TALKED AT BOARD MEETINGS AND, AND OTHERS ABOUT AI AND IMPROVEMENTS IN, YOU KNOW, DATA TRANSFER FROM ONE SYSTEM TO ANOTHER. 
          I, I KNOW WE'VE, I BELIEVE IN MY TENURE, THE THE COUNTY HAS, UH, ADOPTED DIFFERENT SOFTWARE APPLICATIONS IN OTHER AREAS THAT WAS TO IMPROVE BILLING EFFICIENCIES, ET CETERA. 
          SO, UH, I MEAN, EVERY TIME YOU DO DATA ENTRY, THERE'S AN OPPORTUNITY FOR AN ERROR TO YOUR POINT. 
          SO IF THAT 5% CAN BE REDUCED TO 2.5 AND THE JUICE IS WORTH THE SQUEEZE, YOU KNOW, EXTRA TIME EFFORT OR, OR, OR A PROCESS PROCEDURE, WELL THEN YOU REDUCED IT BY 50% AND WE JUST IMPLEMENTED, UH, AVATAR. 
          SO THAT'S A NEW EHR. 
          SO, AND WE JUST DID A WHOLE NEW REVAMP AND WE WENT LIVE WITH THAT IN MAY. 
          SO. 
          OKAY. 
          YEAH, IT'LL BE INTERESTING TO SEE AS YOU LOOK AT METRIC FOR 2024 MM-HMM. 
           IN PART AND IN 2025 IN FULL, HOW THAT COMPARES TO THE 2023 MM-HMM. 
          , THANK YOU. 
          SURE. 
          THANK YOU. 
          AND NELLIE OKAY. 
          YEAH, I WAS LIKE, SHE IS NOT HERE. 
          OKAY. 
          HELLO, I'M LEE SANDERSON, I'M THE OFFICE MANAGER. 
          UM, I WANTED TO GIVE YOU A COUPLE UPDATES ON MY INITIATIVES THAT I'VE BEEN WORKING ON. 
          UH, ONE OF THE ONES THAT I'VE BEEN SPENDING A LOT OF TIME ON IS IMPROVING OUR BILLING PROCESS FOR OUR EXTERNAL PROVIDERS. 
          SO, AS JULIE MENTIONED IN OTHER PRESENTATION, WE DO CONTRACT WITH SEVERAL, UH, EXTERNAL PARTNERS THAT PROVIDE SERVICES TO OUR CLIENTS. 
          AND MY UNIT IS IN CHARGE OF PROCESSING THAT BILLING. 
          SO IT HAS BEEN A VERY CLUNKY PROCESS OVER THE YEARS AND WE'VE IMPROVED IT HERE AND THERE. 
          AND SO THIS INITIATIVE THAT I'VE BEEN WORKING ON WAS TO, TO CONTINUE TO IMPROVE IT AND ALSO MOVE AWAY FROM A PLATFORM WE WERE USING CALLED SHAREFILE TO A NEW PLATFORM THAT, UM, IT PREFERS US TO USE IS SHAREPOINT. 
          SO IT'S MORE EFFICIENT, IT'S HIPAA COMPLIANT, AND IT'S ALSO VERY EASY, EASY TO USE. 
          SO I COMPLETED THE GOAL. 
          UM, I'VE TRANSITIONED, UM, I WANNA SAY ABOUT 30 PROVIDERS ONTO SHAREPOINT AND THEY'RE ALL VERY HAPPY WITH IT. 
          WE'VE GOTTEN A LOT OF POSITIVE FEEDBACK FROM THE PROCESS THAT I CREATED. 
          UM, SINCE THAT'S BEEN COMPLETED, THE END OF JUNE, WHICH DID MEET MY TARGET DATE, I'VE REACHED OUT TO SOME OF THE, UH, SUPERVISORS AND MANAGERS IN WITHIN HUMAN SERVICES THAT PROCESS, OTHER TYPES OF INVOICES, AND WE'RE TRANSITIONING SOME OF THAT ONTO SHAREPOINT AS WELL. 
          SO IT'S KIND OF A, WE'RE JUST TAKING A LITTLE STEP FURTHER AND, AND MAXIMIZING OUR USE OF SHAREPOINT. 
          SO IT'S A GOOD SYSTEM. 
          SO IT'S, THAT'S DONE. 
          ANY QUESTIONS ON THAT? OKAY. 
          THE SECOND INITIATIVE, UM, IT'S IMPROVED PROCESS FOR REPORTING WISCONSIN MEDICAID COST REPORTING AND WHAT, WHAT WISCONSIN MEDICAID COST REPORTING. 
          WE, WE REFER TO THAT AS WIM KER IN OUR DEPARTMENT. 
          IT'S AN ANNUAL REPORT THAT WE COMPILE. 
          [00:55:01]
UM, AND I HANDLE THE EXTERNAL PARTNERS. 
          SO ALL THE PROVIDERS THAT PROVIDE SERVICES THROUGH THESE PARTNERSHIPS, WE HAVE TO REPORT THE HOURS OF SERVICE THAT THEY PROVIDED TO THAT, THAT WE, THEY PROVIDE IT, WE BILL IT TO MEDICAID AND WE HAVE TO REPORT THAT TO MEDICAID. 
          SO IT ALL HAS TO BALANCE OUT. 
          UM, SO I HAVE TO PAY WHAT ANITA BILLS, YOU KNOW, WE HAVE TO MATCH. 
          UM, SO WE HAVE TO RECONCILE THAT WE ARE RECONCILING IT MONTHLY, BUT IT'S ALL LABOR, IT'S ALL, UM, I SHOULD SAY MANUAL LABOR. 
          SO WE DON'T REALLY HAVE AN ELECTRONIC WAY TO DO THAT, WHICH IS WHAT THIS GOAL WAS CREATED FROM. 
          SO IT'S TO TRY TO GET AN ELECTRONIC PROCESS GOING AND SOMETHING THAT'S MORE EFFICIENT. 
          SO WE HAD TO PUT THAT ON HOLD A LITTLE BIT. 
          AS ANITA MENTIONED, WE DID A RE-IMPLEMENTATION OF OUR ELECTRONIC HEALTH RECORD. 
          AND THAT STARTED, OR THAT WAS DONE IN MAY OF THIS YEAR. 
          AND DREXEL IS THE COMPANY WE'RE WORKING WITH, AND THEY ARE FINISHING UP OTHER PROJECTS RIGHT NOW. 
          SO WE HAVEN'T RESTARTED TO WORK WITH THEM ON THIS INITIATIVE. 
          BUT WHAT WE HAVE DONE IS I'VE MET WITH FINANCE, I'VE MET WITH, UM, LET'S SEE, FINANCE AND DOUG, WERE YOU IN THERE? I DON'T EVEN REMEMBER. 
          UM, WE, HE, WE ALL MET TO SEE IF WE COULD DO SOMETHING INTERNALLY WHILE WE'RE WAITING FOR JSEL TO COME ON BOARD WITH THIS INITIATIVE. 
          SO WE JUST STARTED THAT LAST WEEK ACTUALLY, AND WE HAVE SOME GOOD, UH, BULLET POINTS ON THE TABLE THAT WE CAN ACT ON TO GET THE BALL ROLLING AND START IMPROVING SOME OF THE PROCESS OF THAT. 
          SO, AND WE WILL BRING JSEL IN ONCE THEY'RE DONE, BUT WE JUST NEED TO KEEP MOVING ON IT AND NOT HAVE IT JUST SIT THERE. 
          SO WE WE'RE ON TARGET STILL, WE JUST, WE'RE JUST STILL WORKING ON IT. 
          SO. 
          AND IF I COULD ADD THE IMPORTANCE OF THE WIM KER REPORTING IS NOT, NOT JUST THAT IT'S A REPORT, IT ALSO BRINGS IN SIGNIFICANT REVENUE TO THE DEPARTMENT. 
          UM, BECAUSE FOR COMPREHENSIVE COMMUNITY SERVICES SPECIFICALLY, IT'S TO MAKE US WHOLE. 
          AND SO WHAT THAT MEANS IS TO COVER THE COSTS OF ALL THE FOLKS WHO DO THE WORK, WHO YOU CAN'T BILL FOR. 
          UM, AND SO LAST YEAR WE BROUGHT IN $1.8 MILLION IN WIM KER AND IT'S A VERY SIGNIFICANT IMPACT TO OUR BUDGET. 
          UM, AND IT'S A VERY COMPLEX AND, UH, PROBABLY A HAIR PULLING, UM, PROCESS THAT THE TEAM HAS BEEN WORKING ON. 
          AND SO, UM, I CAN TELL YOU, I ALWAYS LIKE TO TELL THIS STORY. 
          I DON'T KNOW WHY 'CAUSE IT'S NOT A GOOD ONE, BUT, UH, SEVEN YEARS AGO WHEN I CAME HERE, WE WERE NOT SUBMITTING A WIM KER REPORT, WHICH MEANS WE WERE LEAVING LOTS OF MONEY ON THE TABLE. 
          UM, AND SO THE TEAM HAS BEEN DOING ALL OF THIS WORK ALL OF THESE YEARS TO JUST CONTINUALLY TO DO A QUALITY AND PROCESS IMPROVEMENT BECAUSE IT IS NOT AN EASY TASK, BUT IT'S VERY IMPORTANT. 
          SWEET. 
          ANY QUESTIONS? NO. 
          NO. 
          OKAY. 
          THANK YOU. 
          OKAY, CHRIS. 
          OKAY. 
          ALRIGHT. 
          THANK YOU LEE. 
          UM, THE NEXT ITEM IS FOR DOUG, THE BEHAVIORAL HEALTH QUARTERLY REPORT. 
          YES. 
          HELLO, I AM DOUG BRYAN, THE BEHAVIORAL HEALTH DIVISION MANAGER. 
          I'M REPORTING TO YOU ON THREE OF MY INITIATIVES. 
          UM, THE FIRST ONE WAS, 
          [b. HSD Behavioral Health Quarterly Report]
UH, IMPROVING THE QUALITY OF SERVICES IN THE BEHAVIORAL HEALTH DIVISION. 
          UM, IN DOING THAT WE UM, IMPLEMENTED, UH, ONBOARDING CHECKLISTS FOR THE SUPERVISORS TO ENSURE STAFF ARE TRAINED IN ALL THE STATUTES AND WHERE THERE'S A FORMAL POLICY FORTHCOMING ON THAT. 
          AS PART OF THAT PROCESS, I CONFIRMED THAT ALL OF THE SUPERVISORS ARE USING CHART AUDITS AS A WAY TO ENSURE THAT THERE ARE NOT MISTAKES MADE, WHICH DIRECT RELATE DIRECTLY BACK TO BILLING PRACTICES THAT WOULD EITHER FORCE US TO PAY MONEY BACK OR NOT ALLOW US TO BILL FOR SERVICES. 
          UM, SOME OF THE THINGS THAT THOSE ONBOARDING CHECKLISTS, UM, AFFORDS US IS IT ASSISTS WITH CONSISTENCY, UM, ACROSS THE BOARD. 
          SO WHEN THE CASE MANAGERS ARE ONBOARDED, THEY ALL HEAR THE SAME THING, UM, ON THEIR ONBOARDING PROCESS FROM THE SUPERVISOR. 
          IT ALLOWS US TO REDUCE MISTAKES IN THE WORK THAT THEY DO, WHICH IS OBVIOUSLY IMPORTANT. 
          UM, AND ANOTHER THING IT DOES IS IT HOLD STAFF, HOLD THE STAFF ACCOUNTABLE, UM, BY BEING ABLE TO REFER BACK TO THAT CHECKLIST IF THERE'S ANY KIND OF PERFORMANCE ISSUE. 
          MM-HMM,  THAT RELATES BACK TO THAT, THAT WE'VE CHECKED OFF LIKE, WELL WE DID TALK ABOUT THIS AT YOUR ONBOARDING AND THAT'S A REALLY IMPORTANT PIECE OF YOUR JOB AND HOW THAT CAN RELATE TO HELPING US SUPPORT PEOPLE TO IMPROVE. 
          UM, CHART AUDITING IS SOMETHING THAT GOES ON BY THE, THE SUPERVISORS DO THEY ALL HAVE A SLIGHTLY DIFFERENT PROCESS 
          [01:00:01]
DEPENDING UPON THEIR TEAM'S, UM, JOB DUTIES? UM, IT OBVIOUSLY HEADS OFF MISTAKES. 
          UH, WE CHECK, FIND A MISTAKE IN SOMEONE'S CHART IF THE MISTAKES ARE MORE EXTENSIVE, THAT WILL LEAD TO A MORE EXTENSIVE CHART REVIEW, PERHAPS THE WHOLE CASE CASELOAD FOR THAT STAFF PERSON IS REVIEWED. 
          UM, IT ALSO ALLOWS US TO IDENTIFY SOMETHING THAT IS MAYBE BEING BILLED OUT THAT SHOULDN'T BE. 
          SO WE CAN QUICKLY CORRECT THAT PROBLEM. 
          WE MIGHT HAVE TO SEND SOME MONEY BACK TO MEDICAID, WHICH IS APPROPRIATE TO DO IF WE FOUND A MISTAKE AND THEN CORRECT THAT ERROR. 
          SO IT KEEPS US, UM, ON TOP OF THAT PROCESS SO WE DON'T FIND OUR OURSELF DOWN THE ROAD A YEAR IN, UM, LOOKING AT A WHOLE BUNCH OF ERRORS THAT REQUIRE A LARGE PAYBACK. 
          UM, THE SECOND ONE IS RELATED TO ANITA'S THAT SHE TALKED ABOUT, UM, WHICH WAS ABOUT MAXIMIZING OUR REVENUE. 
          UM, AND WHAT WE'VE DONE IN THOSE MEETINGS IS DETERMINE, UM, LOOKED AT 20, 21, 22 AND 23 IN TERMS OF OUR REVENUE. 
          AND ANITA LOOKS AT THAT JUST BASED ON WHAT IS POSTED INTO THE SYSTEM. 
          SO IT'S NOT PARSED OUT BY EACH TEAM OR EVEN BY A CLINICIAN AT THIS POINT, BUT IT IS, DOES SHOW US THE YEAR END, UM, BILLABLE AND RECEIVABLE DOLLARS FOR REIMBURSEMENT. 
          UM, THE PLAN FOR THIS GOING FORWARD IS TO CONTINUE TO GET QUARTERLY REPORTS FROM FINANCE. 
          WE CAN IDENTIFY TRENDS RATHER THAN WAIT UNTIL THE END OF THE YEAR. 
          UM, AND THEN AT THE END OF THE YEAR, THE, THE FIRST QUARTER OF THE NEXT YEAR, WE'LL BE ABLE TO LOOK AT THE FINAL, UM, OUTCOME FOR THAT YEAR AND THEN JUST IDENTIFY TRENDS, LOOK AT AREAS FOR IMPROVEMENT. 
          AND BY THAT TIME WE'LL HAVE BE, BE ABLE TO DRILL DOWN MORE TO SPECIFIC TEAMS WHAT THEIR REIMBURSEMENT WAS AND EVENTUALLY MOVE TO WHAT KIND OF CLAIMS WERE REJECTED. 
          MM-HMM. 
          . 
          AND WHY WERE THEY REJECTED AND WHAT DID WE MISS? UM, WHICH ALL TIES IN WITH ONE OF, UM, ANITA'S STAFF WHO DOES CODING FOR US. 
          MM-HMM. 
          , BECAUSE WE WANNA MAXIMIZE OUR DOLLARS, ESPECIALLY FOR OUR PRESCRIBERS WHO OBVIOUSLY HAVE THE HIGHEST REIMBURSEMENT RATES IN THE CLINIC. 
          AND SO HAVING SOMEONE IN TO MAKE SURE THAT WE'RE NOT UNDERCOATING IS REALLY IMPORTANT, BUT IT'S ALSO IMPORTANT NOT TO OVER CODE, BECAUSE THEN THAT MONEY HAS TO GO BACK. 
          SO THOSE ARE ALL TIED INTO THESE GOALS FOR REVENUE. 
          A QUESTION, SO I'M LOOKING AT THIS, RIGHT? IS THIS INCREASE BHD REVENUE BY 10%? YES. 
          Q1, Q4, 2024. 
          UM, BASED UPON WHAT YOU JUST DESCRIBED, AND YES. 
          MAKE SURE IT'S ACCURATE, BUT, BUT ALSO NOT INACCURATE. 
          RIGHT? SO YOU'RE NOT DOING THESE AND YOU'RE HERE IS 10% AGGRESSIVE. 
          WELL, WHAT'S INTERESTING IS I DID, SORRY, I I FINISH THAT QUESTION. 
          OH, GO AHEAD. 
          SURE. 
          I'M SORRY. 
          WHAT, WHAT I TOOK OUT OF THE DESCRIPTOR IS RELATIVE TO ALL FUNDING STREAMS. SO PART OF MY MIND SAYING, WELL, ARE THERE OTHER FUNDING STREAMS TO, UM, MS. DRISCOLL'S COMMENT ABOUT 78 YEARS AGO, WE MISSED A REVENUE STREAM. 
          WELL, ARE THERE, ARE YOU IMPLYING THAT THERE ARE POTENTIALLY OTHER REVENUE STREAMS, OR IS IT JUST ENSURING OUR, OUR PROCESSES ARE, ARE MAKING SURE THAT WE'RE LEVELING THAT WE'RE NOT DOING THIS? YES, IT WOULD BE FOR ALL THE KNOWN REVENUE STREAMS. SO I, I'M ALWAYS WANTING TO MAKE SURE THERE'S NOT ANOTHER STREAM OUT THERE THAT WE'RE NOT DIPPING INTO. 
          YOU KNOW, SO COMMERCIAL INSURANCE IS A MUCH LOWER, UM, METRIC FOR OUR SERVICES BECAUSE COMMUNITY MENTAL HEALTH TYPICALLY DOESN'T SERVE THAT POPULATION. 
          WE'RE HERE FOR THE UNDERINSURED. 
          BUT ON THE OCCASION, WHEN WE DO HAVE COMMERCIALLY INSURED PEOPLE IN THE CLINIC, FOR WHATEVER REASON, ACUITY, UM, NO OTHER PROVIDERS IN THEIR NETWORK, WHATEVER IT MIGHT BE, WE WANNA MAKE SURE THAT WE ARE TAPPING INTO THOSE, THOSE DOLLARS BECAUSE WE SHOULD, WE SHOULD BE ABLE TO GET REIMBURSED BY COMMERCIAL, UM, INSURANCE PROVIDERS. 
          SO OUR BIGGEST REVENUE STREAM IN TERMS OF REIMBURSEMENT WOULD BE MEDICAID, MEDICARE, COMMERCIAL INSURANCE, AND THEN PRIVATE PAY. 
          MM-HMM. 
          SO FOR PEOPLE WHO HAVE NO COVERAGE, UM, THEY GO THROUGH AN ABILITY TO PAY PROCESS. 
          AND AS ANITA MENTIONED, NOW WE ARE ACTUALLY, YOU KNOW, COLLECTING ON THOSE, UH, WE WANNA MAKE SURE THAT, THAT WE DON'T LEAVE THAT MONEY ON THE TABLE EITHER. 
          MM-HMM. 
          . 
          SO WE WILL WORK WITH PEOPLE. 
          UM, THEIR ABILITY TO PAY MIGHT BE REALLY LOW, WHICH IS A PROCESS THEY GO THROUGH BASED ON THE FEDERAL POVERTY GUIDELINES. 
          BUT WE STILL WORK WITH THEM ON WHAT KIND OF PAYMENT CAN YOU MAKE FOR YOUR SERVICES. 
          SO EVEN IF IT'S $5 A MONTH WHEN YOU COME IN, CAN YOU PAY $5? SO WE'LL CONTINUE TO COLLECT THAT. 
          SO THAT'S ANOTHER REVENUE STREAM THAT I ALWAYS WANNA MAKE SURE THAT WE'RE, WE'RE NOT JUST WRITING THAT OFF AND THAT WE ARE COLLECTING JUST LIKE ANY OTHER PROVIDER WOULD DO. 
          OKAY. 
          EXCELLENT. 
          UM, AND I MEAN, FOR WHAT IT'S WORTH TOO, THE, I DID HAVE SOME NUMBERS HERE. 
          THE, THE, UM, WE HAD A 16% INCREASE, UM, IN TOTAL REVENUE FROM 21 TO 22. 
          UM, AND FROM 22 TO 23 WAS 11%. 
          SO AGAIN, THERE'S SOME SOMETHING ELSE IN THAT DATA THAT MAKES ME WANNA GO BACK AND LOOK AND SEE WHERE WAS 16 TO 11? WAS 
          [01:05:01]
IT NUMBERS? WAS IT NUMBER OF PEOPLE? WAS IT A CODING PERSON? DID WE CATCH AN ERROR? DO WE HAVE A PAYBACK? I MEAN, THERE'S, THERE'S SO MANY OTHER VARIABLES TO THAT, BUT THAT'S THE BEGINNING OF THIS PROCESS. 
          THAT'S GREAT. 
          THANK YOU AGAIN. 
          TO YOUR REMARK EARLIER ABOUT AI, I DO HAVE A TRAINING NEXT WEEK, UM, THAT THE, UM, BEHAVIORAL HEALTH TRAINING PARTNERSHIP STEERING COMMITTEE IS SPONSORING, AND THERE IS A PRESENTATION ABOUT HUMAN SERVICES AND USING ARTIFICIAL INTELLIGENCE AND HOW IT CAN BE USEFUL FOR COUNTY GOVERNMENT AND COUNTY MENTAL HEALTH. 
          SO MORE TO COME. 
          MM-HMM, . 
          ALRIGHT. 
          UM, IN THE LAST GOAL I'M GONNA REPORT ON IS, UM, THE EXPANSION OF SUBSTANCE ABUSE SERVICES IN WASHINGTON COUNTY, WHICH WAS, OF COURSE, AS YOU KNOW, OUR, UM, PLAN TO GET AN RFP OUT FOR A SOBER LIVING, UH, FACILITY. 
          SO WE ARE ON TRACK FOR THAT. 
          THE FINAL, UM, RFP, UM, IS WITH BILL KERR FOR PURCHASING MANAGER TO MAKE SURE THAT IT'S CONSISTENT WITH OUR PRACTICES AND WHAT WE'RE ASKING FOR. 
          AND WHAT WE'RE LOOKING FOR IS CONSISTENT WITH WHAT IT SHOULD BE AND MAKE SURE IT'S WRITTEN WELL. 
          UM, IT'S BEING REVIEWED AND EDITED AS NEEDED, AND WE ARE ON TRACK TO HAVE THAT COMPLETED. 
          THEN THE RFP IS SLATED TO GO OUT LATER THIS YEAR. 
          NICE. 
          GREAT. 
          ANY OTHER QUESTIONS? THANKS, DOUG. 
          YEP. 
          THANK YOU. 
          YOU HAVE BACK TO BACK REPORTS ON THE CHILDREN AND FAMILY QUARTERLY REPORT, OR IS THAT CORAL OKAY, . 
          I DID JUST WANNA COMMENT THIS. 
          I GUESS THIS IS WHAT WE GET FOR CANCELING JULY'S. 
          MEETING . 
          OH, WELL, HELLO AGAIN. 
          HELLO. 
          I AM HERE, UH, NOW TO DISCUSS THE TWO, UH, INITIATIVES OUTTA 
          [c. HSD Children and Families Quarterly Report]
THE CHILDREN AND FAMILIES DIVISION. 
          UM, THE FIRST ONE WAS IMPROVING THE QUALITY AND CONSISTENCY OF ACCESS TO COMMUNITY SERVICES. 
          UM, YOU MAY REMEMBER THAT WE HAD APPLIED, UM, FOR A, UM, GUIDED PROCESS THROUGH THE CHILD WELFARE TRAINING PARTNERSHIP, UM, THAT ENCOMPASSES BOTH CHILD WELFARE PROGRAMS AND BEHAVIORAL HEALTH AND STREAMLINING, UM, THOSE SERVICES, UM, TOGETHER BETWEEN THOSE, UM, TWO TYPES OF PROGRAMS AND THAT WE WERE ACCEPTED FOR THAT PROGRAM. 
          UM, THE PROGRAM LASTS RIGHT NOW. 
          UH, IT JUST STARTED ACTUALLY AUGUST, SO IT'S AUGUST OF 2024 THROUGH MAY OF 2025. 
          UM, AND THE TEAM CONSISTS OF, UM, MYSELF AND, AND DOUG. 
          UM, THE THREE SUPERVISORS ARE SARAH WHITTY, UH, CHRISTIE. 
          SO SARAH WHITTY IS A YOUTH SERVICES, UM, SUPERVISOR. 
          UM, CHRISTIE IS THE OUTPATIENT CLINIC SUPERVISOR. 
          AND THEN JEN WILKINS IS THE ONGOING CPS SUPERVISOR FROM MY TEAM. 
          SO THERE'S TWO MANAGERS, THREE SUPERVISORS, AND THEN THREE DIRECT LINE STAFF. 
          SO THIS IS QUITE A, UM, ROBUST MULTIDISCIPLINARY TEAM TACKLING THIS. 
          UM, WE WILL HAVE FOUR IN-PERSON TRAININGS UP IN WASAW. 
          WE WILL HAVE, UM, MULTIPLE TEAMS OR ZOOM, UM, CHECK-IN MEETINGS. 
          AND THEN OF COURSE WE WILL HAVE INTERNAL, UH, MEETINGS REGARDING THE WORK THAT WE WILL BE DOING. 
          WE MET LAST WEEK, WE SET SOME, UH, PRELIMINARY GOALS OR DIRECTION FOR OUR, OUR PROCESS, WHICH IS REALLY AROUND, UM, STRATEGIES TO IMPROVE INTERNAL COMMUNICATION AND SERVICE COORDINATION, UM, FOR FAMILIES IN MULTIPLE SYSTEMS. I THINK THAT'S AN OVERARCHING THEME THAT YOU'VE HEARD, UH, TONIGHT, THAT WE TRY TO DO THAT THE BEST THAT WE CAN. 
          UM, AND REALLY IT'S SPECIFIC TO HELPING CLIENTS, OF COURSE, UH, WHICH IS OUR MAIN FUNCTION, BUT ALSO TO IMPROVING, UH, SUPPORT TO OUR STAFF WHO ARE WORKING, UM, TOGETHER, UM, WITH COMPLEX FAMILIES. 
          SO, UM, AGAIN, THAT, THAT JUST STARTED, WE'RE ABOUT TO GET ROLLING, UH, THE SECOND WEEK OF SEPTEMBER WITH OUR FIRST, UH, IN-PERSON KICKOFF MEETING UP IN WASAW WITH THE, WITH THE TRAINING PARTNERSHIP AND THE OTHER COUNTIES THAT ARE PARTICIPATING. 
          SO SUBSEQUENT UPDATES, UH, ON THIS PARTICULAR INITIATIVE WILL BE KIND OF FOLLOWING THE WORK THAT WE, UH, ARE DOING MYSELF AND DOUG AND OUR TEAMS ARE DOING ON THIS PARTICULAR INITIATIVE. 
          SO STAY TUNED. 
          YES, IT'S EXCITING. 
          THE SECOND INITIATIVE IS ANALYZING THE STRUCTURE AND SUSTAINABILITY OF FAMILY COURT SERVICES. 
          UM, WE HAVE FINISHED REALLY THE RESEARCH FROM, UM, THE OTHER COUNTIES AND OTHER FAMILY COURT SERVICES PROGRAMS. UM, REALLY LOOKING AT, I THINK WE LOOKED AT SIX COUNTIES, WHICH ARE SIMILAR IN SIZE AND SCOPE TO WASHINGTON, OF COURSE. 
          UM, AND OUR PRELIMINARY FINDING IS THAT THE WASHINGTON COUNTY MODEL, UM, WHICH IS HAVING TWO SOCIAL WORKERS REALLY IN HUMAN SERVICES, UM, DO THESE CUSTODY AND PLACEMENT STUDIES IS NOT HOW MOST OTHER PROGRAMS ARE STRUCTURED. 
          UM, AND IT SEEMS THAT MOST OF THE OTHER PROGRAMS LIVE REALLY WITH THE COURT. 
          SO THE NEXT STEP WITH THIS IS TO, UM, BY END OF SEPTEMBER IS TO SORT OF COMPILE ALL OF THE INFORMATION THAT WE HAVE AND START ANALYZING, 
          [01:10:01]
UM, AND ASSESSING THE INFORMATION, UM, AND PRESENT IT OBVIOUSLY TO JULIE AND START THOSE INITIAL CONVERSATIONS AS WELL AS THE FAMILY COURT SERVICES CO-DIRECTOR, WHO'S ACTUALLY JULIE MALL, WHO, UM, IS ALSO THE FAMILY COURT COMMISSIONER. 
          SO, UM, THAT WILL BE BROUGHT, I'M, I AM SURE THAT'LL BE BROUGHT BEFORE THIS COMMITTEE. 
          ONCE WE HAVE OUR INFORMATION. 
          WE'VE ASSESSED THAT, AND THEN THE TWO DIRECTORS HAVE HAD CONVERSATIONS. 
          AND THEN I REALLY SHOULD HAVE PUT A SECOND GOAL UNDER HERE, UM, BECAUSE THE NEXT PHASE OF THIS IN IS AFTER WE'VE ASSESSED THE INFORMATION, THEN WE NEED TO BE REALLY DISCUSSING THE SUSTAINABILITY, UM, WHICH WILL BE THROUGHOUT THE END OF, UM, 2024. 
          OKAY. 
          ANY QUESTIONS? ALL RIGHT. 
          THANK YOU MUCH FOR THE UPDATE. 
          THANK YOU. 
          UM, NEXT WE HAVE, UH, VETERANS' MENTAL HEALTH UPDATE. 
          YEAH. 
          SO, UM, I JUST WANTED TO BRING THIS TO THIS COMMITTEE'S ATTENTION. 
          UM, AS YOU MAY RECALL, WE RECEIVED, UH, A GRANT IN THE AMOUNT OF $30,000 LAST OCTOBER. 
          UM, AND THEN SUBSEQUENTLY, WE, UM, WERE MADE AWARE THAT WE, WE RECEIVED ANOTHER $150,000, UM, 
          [e. Veteran Mental Health Update]
FROM, UM, THE VETERANS ADMINISTRATION. 
          UM, OUR ORIGINAL, UM, PROPOSAL WITH THE $30,000 WAS WE WANTED TO BE ABLE TO START, UM, OFFERING MENTAL HEALTH SERVICES IN OUR CLINIC TO VETERANS IN WASHINGTON COUNTY. 
          EXCUSE ME. 
          UM, PREVIOUSLY, UM, THE VA, UM, PREFERRED TO HAVE VETS COME TO THE VA AND FOR, FOR US IN WASHINGTON COUNTY THAT'S IN MILWAUKEE, UM, TO RECEIVE SERVICES. 
          BUT THEY HAVE IN THE LAST SEVERAL YEARS, AND KURT CAN TALK MUCH MORE ELOQUENTLY ABOUT THIS, UM, IF NEED BE. 
          BUT, UM, THEY HAVE EXPANDED THEIR, UM, THEIR WILLINGNESS TO, UM, LET COMMUNITY MENTAL HEALTH FACILITIES, UM, PROVIDE THAT SERVICE MORE LOCALLY. 
          AND SO WE APPLIED FOR THIS, THIS FUNDING RECEIVED THIS $30,000 WITH THE INTENT OF BECOMING A, UM, PROVIDER, UM, OF THE VA COMMUNITY CARE SO THAT WE COULD BILL, UM, THAT INSURANCE. 
          AND WE ANTICIPATED THAT THAT WOULD TAKE A LOT LONGER THAN IT DID. 
          UM, AND SO WE WERE GONNA USE THE MONEY SO THAT PEOPLE COULD GET FREE THERAPY AND FREE, UM, UM, PSYCH PSYCHIATRY MEETINGS. 
          AND SO, BUT THAT DIDN'T TAKE VERY LONG. 
          UM, SO THAT WAS A, A BIG WIN FOR US. 
          UM, AND SO WE HAVE BEEN ABLE TO SERVICE INDIVIDUALS. 
          UM, SOME OF THEM, FOR WHATEVER REASON WE'RE, WE ARE PAYING FOR THROUGH THE GRANT, BUT MOST OF THEM WERE ABLE TO BILL THEIR INSURANCE AND PROVIDE THAT SERVICE TO THEM. 
          SO IT'S A HUGE SHIFT IN, UM, THE WAY THAT PEOPLE RECEIVE SERVICES AND WHERE THEY CAN RECEIVE THOSE SERVICES. 
          SO THAT WAS A BIG WIN INITIALLY FOR US. 
          UM, BUT THEN WHEN WE WERE SITTING THERE WITH ALL OF THIS MONEY, UM, AND MADE ABOUT SEVEN OR EIGHT CLIENTS WHO WE COULD BILL THEIR INSURANCE, UM, WE STARTED HAVING CONVERSATIONS ABOUT, WELL, HOW CAN WE GET THIS INFORMATION OUT TO OTHER VETS IN OUR COMMUNITY, UM, THAT DON'T NECESSARILY COME THROUGH THROUGH OUR DOORS? UM, SO WE STARTED A, UM, CONTRACT WITH EPIC CREATIVE, WHICH IS HERE IN WEST BEND. 
          UM, AND THEY'VE BEEN DOING SOME VERY SPECIFIC TARGETED ADS THROUGH SOCIAL MEDIA, UM, AND, AND OTHER, UM, PLACES. 
          UM, AND YOU CAN SEE SOME OF THOSE ADS THAT ARE IN THE PACKET. 
          AND SO WE JUST REALLY WANTED TO SHARE THAT WITH YOU. 
          UM, AND SO WE'RE REALLY EXCITED ABOUT THIS NEW INITIATIVE. 
          IT'S ONE OF THOSE THINGS THAT'S KIND OF LIKE, WHY, WHY WEREN'T WE ABLE TO DO THIS ALL ALONG, BUT GOTTA WAIT TILL THE, THE RIGHT PEOPLE CHANGE AND THE CHANGE HAPPENS. 
          SO, UH, WE'RE WORKING ON A COUPLE OF OTHER IDEAS. 
          ONE THAT EPIC IS WORKING ON WITH US, UM, IS CREATING COASTERS THAT WE WILL, UM, BE, UM, HAVING SOME PARTNERS DELIVER TO LOCAL BARS, RESTAURANTS, AND LIQUOR STORES, UM, THAT'LL HAVE A QR CODE SO THAT WHEN PEOPLE ARE SORT OF SITTING IN A PLACE, THEY, THEY GET THAT WITH THEIR, YOU KNOW, DRINK OR WATER OR WHATEVER. 
          UM, AND SO TO GET THAT INFORMATION OUT, WE THOUGHT THAT WAS A REALLY UNIQUE IDEA. 
          UM, WE'RE ALSO IN CONVERSATIONS WITH THE PARKS DEPARTMENT AROUND SOME PARK PASSES AND WHETHER WE COULD MAKE THAT HAPPEN FOR VETS, UM, AS WELL AS, UM, I GOTTA READ MY OWN NOTES HERE AND MY COMPUTER'S NOT, UM, SCROLLING DOWN, BUT YOU CAN SEE IN MY NOTES, UM, SOME OF THE OTHER INITIATIVES THAT WE'RE HAVING. 
          SO I JUST WANTED TO MAKE SURE THAT YOU GUYS WERE AWARE OF THIS, UM, BECAUSE THE WAY THAT I UNDERSTAND THAT IT WORKS, IF YOU'RE A VET, YOU'RE GETTING TARGETED THE, THE ADS, BUT IF YOU'RE NOT, MAYBE, MAYBE YOU AREN'T GETTING TARGETED. 
          SO, UM, AND WE'RE REALLY EXCITED ABOUT THIS. 
          UM, AND AGAIN, I THINK IT'S BEEN A REALLY NEAT COLLABORATIVE BETWEEN BEHAVIORAL HEALTH AND, AND OUR VETERAN SERVICES OFFICE. 
          UM, AND, AND EXCITING. 
          THIS CAME STRAIGHT FROM THE STAFF. 
          UM, AND, YOU KNOW, THEIR IDEA AND THEIR, THEY'RE WANTING TO DO SOMETHING MORE AND REACH, YOU KNOW, THIS POPULATION. 
          SO IT'S, IT'S JUST REALLY EXCITING 
          [01:15:01]
AND THAT IT MOVES SO QUICKLY. 
          THAT'S AWESOME. 
          RARE . 
          UH, ANY QUESTIONS? UH, YEAH. 
          UH, MS. RISCO, A COUPLE OF QUESTIONS AND, AND OR COMMENTS. 
          SO IT, I GUESS LET'S CALL IT LIKE SATELLITE SERVICING, RIGHT? UH, VERSUS GOING TO SOME, YOU KNOW, CENTRALIZED GEOGRAPHIC PLACE. 
          SO I, I APPLAUD THAT. 
          SO WHO, WHOEVER, UH, IF WE HELPED INFLUENCE THAT, GREAT. 
          UH, IF NOT, BUT WE'RE RECIPIENTS AND WE CAN SERVE OUR, OUR, UH, OUR, OUR CITIZENS EVEN BETTER. 
          UM, TO THAT END, THE EIGHT THAT YOU MENTIONED, JUST CURIOUS, ARE THOSE RESIDENTS OF WASHINGTON COUNTY AND DO YOU, OR, AND THE SECOND QUESTION IS, DO YOU HAVE TO BE A RESIDENT OF WASHINGTON COUNTY TO PARTAKE IN THE SERVICES THAT ARE BEING OFFERED THROUGH THE COUNTY? YES. 
          SO, UM, TO RECEIVE SERVICES FROM OUR COMMUNITY MENTAL HEALTH CENTER, YOU DO HAVE TO BE A RESIDENT OF WASHINGTON COUNTY. 
          UM, AND, UM, MOST OF THOSE REFERRALS HAVE COME STRAIGHT OUT OF OUR VETERAN SERVICE OFFICE. 
          UM, WE, SO THEN WE PROBABLY KNOW HOW MANY VETERANS WE DO HAVE IN A COUNTY. 
          MM-HMM. 
           AND MAYBE WITH SOME OF OUR INTEL ABOUT PTSD AND, AND HOW MANY ACTIVE AND HOW MANY RETURNEES AND HOW DO WE, YOU KNOW, GET THE WORD OUT. 
          UM, YOU KNOW, HAVE WE TAPPED INTO SOME OF THOSE? YOU TALK ABOUT MARKETING THROUGH EPIC. 
          UM, PRESUMABLY THERE'S SUPPORT GROUPS THAT, THAT I, I KNOW THERE ARE FORMAL AND INFORMAL. 
          UM, SO I'M, I'M ASSUMING THAT WE'RE TAPPING ALL THOSE AS PART OF THAT MARKETING. 
          BUT ONE THING THAT OCCURRED TO ME IS, SO RIGHT NOW WE'RE USING GRANT DOLLARS, RIGHT? GRANT, SO WHAT HAPPENS IF THOSE GRANT DOLLARS ARE EXHAUSTED? MM-HMM. 
          , HOW DO WE CONTINUE IF PEOPLE BECOME DEPENDENT, UM, NOT DEPENDENT ISN'T WHERE, BUT IF THEY BECOME COMFORTABLE WITH THOSE SERVICES PROVIDED HERE, AND THEN ALL OF A SUDDEN WE CAN'T PROVIDE 'EM, YOU KNOW, TWO YEARS OR A YEAR FROM NOW, YOU KNOW, IS, ARE WE THINKING ABOUT THAT? YEAH, SO THE WAY, UM, AGAIN, THE WAY THAT WE SET UP THIS PROGRAM WAS SO THAT WE COULD BECOME, UM, A BILLABLE PROVIDER FOR COMMUNITY CARE. 
          AND MOST, UM, VETS DO HAVE THAT INSURANCE, BUT THE WAY IN WHICH THE, OUR COMMUNITY MENTAL HEALTH CENTER IS SET UP IS IT IS SET UP TO SERVICE, UM, UNINSURED OR UNDERINSURED. 
          AND SO, UM, WE WOULD CONTINUE TO BE ABLE TO PROVIDE SERVICES FOR THOSE INDIVIDUALS, UM, AND WE WOULD LIKELY MOVE THEM INTO LIKE A SLIDING SCALE, UM, FEE TYPE OF SITUATION IF THEY DIDN'T HAVE AN INSURANCE THAT WE COULD BILL. 
          UM, I THINK DOUG ALLUDED TO THE CONVERSATION AROUND COMMERCIAL INSURANCE. 
          WE TYPICALLY DON'T, UH, MANAGE PEOPLE WHO HAVE COMMERCIAL INSURANCE, UM, BECAUSE WE'RE COMPETING THEN WITH THE PRIVATE SECTOR. 
          UM, AND THE NEED REALLY IS IN MEDICAID AND UNINSURED. 
          BUT THIS IS ONE OF THOSE EXAMPLES AROUND, UH, MAKING SURE THAT WE CAN, CAN THAT CONTINUITY OF CARE AND THAT WE CAN, UM, BILL INSURANCE SO SOMEBODY CAN STAY WITH US. 
          UM, AND SO THOSE ARE ALL THINGS THAT THEY'RE WORKING OUT IN THE CLINIC PROCESS AND IN THE, THE SORT OF THE, THE FLOW OF WORK AROUND WHEN SOMEBODY COMES INTO THE CLINIC AND HOW WE CONTINUE TO BE ABLE TO SERVICE THEM REGARDLESS OF THEIR INSURANCE STATUS. 
          UM, BUT INTERESTINGLY, THAT HAS BEEN, UM, EASIER THAN WE THOUGHT, AND NOT VERY, DIDN'T COST VERY MUCH MONEY. 
          UM, IT WAS JUST MORE, UH, YOU KNOW, THE LABOR OF THE STAFF THAT ALREADY ARE THERE. 
          AND SO THAT'S WHERE WE, WE WANNA MAKE SURE THAT WE'RE ACTUALLY JUST GETTING THIS INFORMATION OUT. 
          UM, YOU KNOW, BECAUSE WE HAVE, YOU KNOW, CERTAIN PERCENTAGE OF THE POPULATION THAT INTERACT VERY, UM, OFTEN WITH, YOU KNOW, THE VETERAN SERVICES, UM, OFFICE AND OTHER, YOU KNOW, GROUPS IN THE COMMUNITY. 
          UM, BUT WE ALSO WANNA REACH THOSE PEOPLE WHO DON'T CONNECT WITH THOSE, UM, YOU KNOW, REGULARLY WITH THOSE TYPE OF SUPPORT GROUPS AND THINGS LIKE THAT. 
          AND SORRY FOR MY LACK OF KNOWLEDGE ON THIS. 
          SO YOU, YOU MENTIONED THAT CLIENT BEING A VETERAN. 
          WHAT ABOUT IMMEDIATE FAMILY MEMBERS? I MEAN, THEY, THEY, YOU KNOW, WE TALKED EARLIER TODAY ABOUT FAMILIES, THE JUVENILES MM-HMM. 
           AND, AND THEIR FAMILY BEING PART OF A SOLUTION AND CARE. 
          SO DOES THE SERVICES YOU PROVIDE ALLOW FOR, YOU KNOW, FAMILY TO PARTICIPATE IN TREATMENT OR THERAPY OR DISCUSSION OR WHATEVER IT MAY BE? YES. 
          I'M GONNA SAY, UM, SO ALL THE THERAPY THAT WE PROVIDE IS INDIVIDUALIZED FOR THAT INDIVIDUAL. 
          AND SO IF THERE'S A FAMILY COMPONENT TO THAT, THE THERAPIST WOULD INVOLVE THEM IN IT AS A WAY THAT MAKES SENSE FOR THEIR TREATMENT. 
          AND ALSO IF THEIR FAMILY MEMBER NEEDED, UM, TREATMENT THEMSELVES OR SERVICES THEMSELVES, THEY COULD ALSO COME TO OUR CLINIC AND, AND BE A CLIENT WITH US. 
          THANK YOU. 
          YEP. 
          ANY OTHER QUESTIONS, COMMENTS? ALL, ALL RIGHT. 
          THANK YOU VERY MUCH. 
          GREAT UPDATE. 
          AND OUR LAST AGENDA ITEM IS THE, 
          [01:20:01]
UH, SIX MONTH FINANCIALS FOR THE OUT-OF-HOME CARE, EXCUSE ME, AND INPATIENT HOSPITALIZATION, JULIE. 
          YEP. 
          SO, UM, FOR THOSE WHO ARE MAYBE NEW TO THIS COMMITTEE, UM, THIS IS A, UM, REPORT THAT WE PROVIDE TWICE A YEAR, UM, TO JUST GIVE YOU 
          [f. 2024 6 Month Financials: Out of Home Care and Inpatient Hospitalization]
A SENSE OF WHERE WE'RE TRENDING AND WHERE WE'RE AT WITH WHAT ARE THE TWO, UH, BIGGEST DRIVERS OF COST AND OUR DEPARTMENT. 
          UM, AND, UM, AS YOU CAN SEE, OUR BUDGET AND OUR COSTS CONTINUE TO INCREASE, UM, YEAR OVER YEAR. 
          UM, EVERY YEAR WE, WE TRY TO INCREASE WHAT WE BUDGET TO BE MORE ALIGNED WITH, UM, WHAT WE'RE ACTUALLY SEEING OR WHAT WE'RE SPENDING. 
          UM, BUT WE'RE ALSO IMPLEMENTING STRATEGIES TO DECREASE THAT DEEP END, YOU KNOW, SERVICES, UM, WHICH ARE HOSPITALIZATIONS AND OUT HOME CARE. 
          AS YOU HEARD ABOUT FCT TODAY IS ONE OF THOSE INTERVENTIONS THAT WE'VE IMPLEMENTED. 
          OUR COS RESPONDER UNIT IS ANOTHER, UM, BIG INITIATIVE THAT WE'RE, WE'VE IMPLEMENTED. 
          UM, WE HAVE OUR OWN, UM, RESIDENTIAL CARE FACILITY HERE IN WASHINGTON COUNTY, AND WE'RE WORKING WITH THEM RIGHT NOW IN A PRELIMINARY CONVERSATION ABOUT A REDESIGN, UM, TO REALLY SEE IF WE CAN MAKE SURE WE'RE MEETING THE NEEDS OF THE COMMUNITY AND THE KIDS, UM, IN THE RIGHT WAY. 
          I WANNA PREFACE THE CONVERSATION ABOUT THIS, UM, THIS REPORT ON THAT, ALTHOUGH EVERY YEAR WE ARE OVERSPENT IN OUR LINE ITEM FOR BOTH OUT-OF-HOME CARE AND INPATIENT HOSPITALIZATION, OUR BUDGET ALWAYS COMES IN UNDER BUDGET, AT LEAST IN THE LAST, UM, SEVEN YEARS. 
          UM, AND WE ARE PROJECTED TO COME IN UNDER BUDGET THIS YEAR AS WELL. 
          UM, I WILL SAY WHAT I KNOW ABOUT MANY, MANY OTHER COUNTIES IS THAT IS NOT NECESSARILY THE CASE. 
          SO I'M PRETTY PROUD OF OUR TEAM, UM, FOR ALL ALL THIS WORK THAT WE'VE BEEN TALKING ABOUT WITH YOU TODAY AROUND, YOU KNOW, REALLY MAKING OUR BUDGET AND OUR FINANCES A, A, A FOCAL POINT, UM, TO MAKE SURE THAT WE CAN PROVIDE THE RIGHT SERVICE, BUT THAT WE'RE ALSO DOING IT IN A RESPONSIBLE WAY. 
          UM, AS YOU CAN SEE, OUR OUT-OF-HOME CARE COST, RESIDENTIAL CARE IS THE HIGHEST DRIVER OF COST. 
          UM, AND ONE OF THOSE, ONE OF THE REASONS, OR ONE DATA POINT FOR THAT IS, UM, OUTTA STATE PLACEMENTS. 
          WE HAVE A COUPLE OF KIDS WHO HAVE SOME NEEDS THAT COULD NOT BE MET HERE IN WISCONSIN, AND WE'VE HAD THEM PLACED, UM, OUT OF STATE. 
          UM, AND THAT IS, YOU KNOW, A, A SIGNIFICANT MORE COST THAN IT IS IF THEY'RE IN STATE. 
          ALSO, AS CORAL DISCUSSED EARLIER, IT'S THE LENGTH OF STAY. 
          YOU KNOW, SOME FOLKS CAN BE 12, 16, 18 MONTHS IN A RESIDENTIAL CARE FACILITY. 
          UM, UH, WE'VE BEEN WORKING ON ANOTHER, A NUMBER OF INITIATIVES. 
          UH, I THINK LAST YEAR OUR RESIDENTIAL CARE BUDGET LINE ITEM WAS PROBABLY THE WORST IT'S EVER BEEN, AND IT WAS QUITE ALARMING. 
          UM, AND SO, UM, WHEN WE RECOGNIZED THAT ABOUT A YEAR AGO, PROBABLY SIX MONTHS INTO 2023, WE STARTED, UM, REALLY FOCUSING ON A NUMBER OF INITIATIVES AROUND WORK PROCESS AND SUPERVISORY, UM, YOU KNOW, REVIEW OF CASES TO, TO MAKE SURE THAT KIDS WEREN'T LANGUISHING IN A PLACEMENT IN AN INAPPROPRIATE WAY. 
          AND TO REALLY, UM, PUSH FAMILIES AND, AND THEIR CARE TEAM TO, UM, ATTEMPT COMMUNITY-BASED INTERVENTIONS, UM, BEFORE WE PLACE KIDS. 
          WE'RE NEVER GOING TO BE ABLE TO NOT PLACE KIDS IN RESIDENTIAL CARE. 
          WE'RE ALWAYS GONNA HAVE A NEED FOR THAT. 
          UM, BUT, YOU KNOW, MAKING SURE THAT IT IS THE MOST APPROPRIATE LEVEL OF CARE FOR INDIVIDUALS. 
          AND I THINK THE WORK THAT THAT TEAM HAS DONE IS EVIDENT IN WHAT WE'RE, WE'RE TRENDING IN IN 2024. 
          SO I'M, I'M REALLY VERY PLEASED. 
          UM, AND I THINK SOME OF THESE OTHER THINGS LIKE FCT AND THE WORK THAT WE'RE DOING WITH RIVERBEND PLACE WILL FURTHER THAT. 
          UM, AND REALLY, YOU KNOW, WE SPEND A LOT OF TIME TALKING ABOUT THE DOLLARS AND CENTS OF ALL THIS, BUT I MEAN, REALLY IT'S ABOUT IMPROVED OUTCOMES AND WE THINK THAT, AND WE KNOW THAT, YOU KNOW, KIDS WHO ARE STAYING IN THEIR COMMUNITY AND CAN STAY WITH THEIR FAMILY AND RECEIVE SERVICES, AND THAT THEY'RE REALLY GONNA HAVE A BETTER OUTCOME, UM, THAN IF THEY'RE PLACED ELSEWHERE. 
          SPECIFICALLY WITH, IF YOU MOVE TO OUR INPATIENT HOSPITALIZATION, YOU SEE TWO LINE ITEMS THERE. 
          ONE IS INPATIENT HOSPITAL, THAT'S HOSPITALIZATIONS, THAT'S TYPICALLY WINNEBAGO. 
          IT COULD BE OTHER, UM, PLACES LIKE WAUKESHA HAS A, HAS A, A HOSPITAL NUMBER OF DIFFERENT HOSPITALS, UM, BUT IT'S PRIMARILY WINNEBAGO. 
          AND THEN THE IMD IS TREO. 
          UM, AND FOR THOSE OF YOU WHO ARE NOT ON THE COMMITTEE, UM, IN THE LAST COUPLE OF YEARS, YOU, WE'VE DONE A NUMBER OF SIGNIFICANT INITIATIVES TO REDUCE OUR TREMOLO PLACEMENTS. 
          UM, DOUG'S TEAM DID A LOT OF WORK TO, UM, FIND APPROPRIATE COMMUNITY-BASED, UM, PLACEMENTS FOR THOSE INDIVIDUALS BECAUSE THEY, AGAIN, WERE LANGUISHING IN TREMOLO, UM, IN A PLACEMENT THAT REALLY WASN'T APPROPRIATE. 
          THE GOAL IS ALWAYS TO HAVE THE LOWEST LEVEL OF CARE, UM, THAT'S APPROPRIATE FOR AN INDIVIDUAL. 
          AND INSTITUTIONALIZATION IS 
          [01:25:01]
ONLY APPROPRIATE IN VERY RARE PLACES FOR A LONG RARE, IN INSTANCES FOR A LONG PERIOD OF TIME. 
          SO YOU'LL SEE THE IMD, UM, BUDGET LAST YEAR. 
          UM, WHAT WE HAD HAD BEEN TYPICALLY BUDGETING AND WHAT WE ACTUALLY SPENT WAS ALMOST NOTHING. 
          AND SO WE DID REDUCE THAT BUDGET, UM, IN 2024, AND I BELIEVE WE HAVE ONE PLACEMENT THERE RIGHT NOW. 
          SO WE'LL HAVE SOME COST, UM, BUT NOT WHAT WE WERE SEEING IN THE PAST. 
          UM, THE OTHER THING THAT'S INTERESTING TO KNOW ABOUT INPATIENT PLACEMENT, ESPECIALLY AT WINNEBAGO, IS IF PEOPLE HAVE INSURANCE, THEY DO, UM, RECEIVE REIMBURSEMENT FOR THEIR STAY, WINNEBAGO DOES, AND THEN THEY REIMBURSE US. 
          BUT IT'S ALWAYS, UM, IT'S ALWAYS ANYWHERE FROM THREE TO SIX TO NINE MONTH LAG. 
          UM, AND THEN IT JUST SHOWS UP ON OUR INVOICE. 
          SO AS AN EXAMPLE, IF WE HAVE $10,000 WORTH OF COST IN THE MONTH OF AUGUST, BUT THEY RECEIVED A PAYMENT FROM INSURANCE IN THE AMOUNT OF 8,000, WE WOULD ONLY HAVE A $2,000 PAYMENT DUE THAT MONTH, EVEN THOUGH THAT WASN'T OUR COST AND THE PAYMENTS ARE FROM CLIENTS WHO WERE THERE MONTHS PRIOR. 
          SO IT'S SUPER COMPLICATED . 
          AND SO THAT'S WHERE, WHILE YOU, WE CAN LOOK AT THE NUMBER OF PLACEMENTS WE MAKE EVERY YEAR, UM, AND LOOK AT, YOU KNOW, IS THAT GOING UP OR IS THAT GOING DOWN? UM, BUT WE CAN'T ALWAYS CONTROL THE DOLLAR AMOUNT THAT'S SPENT OR NOT SPENT BECAUSE THE REIMBURSEMENT IS COMING IN, IN, IN A STRANGE WAY. 
          BUT I THINK THE TAKEAWAY, UM, AGAIN, FOR INPATIENT IS, YOU KNOW, WE'RE WITHIN TARGET. 
          WE'RE NOT, UM, EXTREMELY PROJECTING TO BE OVERSPENT. 
          SO I'M, I'M PLEASED WITH WHAT I'M SEEING, UM, SO FAR THIS YEAR. 
          AND I KNOW THE TEAM IS DOING A LOT OF WORK AROUND REALLY TRYING TO, UH, MEET THE NEEDS OF INDIVIDUALS IN THE RIGHT WAY, BUT ALSO, YOU KNOW, NOT, UM, NOT HOSPITALIZING OR INSTITUTIONALIZING PEOPLE WHEN IT'S, WHEN IT'S NOT APPROPRIATE. 
          EXCELLENT. 
          ANY QUESTIONS? UM, ACTUALLY YOU MIGHT HAVE, UH, ANSWERED PART OF MY, MY QUESTION. 
          SO GOING BACK TO THE, UM, RESIDENTIAL CARE, UM, CARE CENTERS MM-HMM. 
          , TO YOUR POINT ABOUT ACTUALS BEING GREATER, YOU KNOW, WITH THE EXCEPTION OF 2019, YOU KNOW, WAS APPROXIMATELY 50% MORE ACTUAL VERSUS BUDGET, AND I LOOK AT 2024, WE'RE ESTIMATING THAT IT WILL BE PRETTY MUCH ON BUDGET. 
          SO WHAT YOU ALLUDED TO SOME CHANGES THAT YOU WERE MAKING, UM, BASED UPON LAST YEAR, YOU KNOW, ALMOST DOUBLE, RIGHT? MM-HMM,  900 TO 200 SOMETHING, WHATEVER. 
          SO, OR OVER A HUNDRED PERCENT INCREASE. 
          SO YOU HAVE A DEGREE OF CONFIDENCE THAT THE ACTUALS IN 2024 WILL BE CLOSE TO BUDGET AND NOT 50% MORE LIKE WE'VE SEEN HISTORICALLY. 
          YES, THAT'S CORRECT. 
          AND I THINK, UM, TO JUST, UM, DESCRIBE IT A LITTLE BIT MORE CLEAR, UM, SO WE DO HAVE A NEW SUPERVISOR, UM, AND WE'VE SET SOME, UM, VERY SPECIFIC EXPECTATIONS WITH THAT SUPERVISOR AROUND, UM, REGULAR MEETINGS WITH STAFF AROUND KIDS WHO ARE BOTH PLACED IN RCC, SO THE RESIDENTIAL CARE CENTER, AND THEN KIDS WHO ARE POTENTIALLY GOING TO BE PLACED. 
          SO THEY'RE WANTING TO BE PLACED. 
          UM, SOMETIMES RESIDENTIAL CARE CENTERS CAN BE AN EASY ANSWER FOR SOCIAL WORKERS AND FAMILIES. 
          UM, YOU HAVE A CHILD WITH VERY SIGNIFICANT BEHAVIORS AS THEY DIS, YOU KNOW, DISCUSSED IN THE FCT PRESENTATION AND, UM, EVERYBODY'S AT THEIR WITS END. 
          UM, AND PARENTS DON'T, YOU KNOW, THEY DON'T WANT THE KID IN THEIR CARE. 
          UM, AND THESE KIDS NEED TREATMENT. 
          AND SO, YOU KNOW, THE RESIDENTIAL CARE FACILITY OR CENTER IS APPROPRIATE, UM, WHEN THE TREATMENT NEEDS CANNOT BE MET IN THE COMMUNITY AND THE CHILD'S BEHAVIORS, UM, REALLY NEED THAT INTENSIVE, MORE SORT OF INSTITUTIONAL LEVEL OF SERVICE. 
          UM, BUT THE OUTCOMES AREN'T ALWAYS WHAT WE EXPECT BECAUSE THE KID IS GETTING ALL OF THAT TREATMENT AND THE FAMILY IS DOING, NOTHING'S CHANGING IN THE FAMILY, SO THEY GO HOME AND THE, THE FAMILY STILL REMEMBERS ALL THE THINGS THAT HAVE BEEN HAPPENING AND THEY HAVEN'T DONE ANY WORK ON THEMSELVES, RIGHT? I MEAN, KIDS DON'T JUST, UM, MIRACULOUSLY SHOW UP AND HAVE POOR BEHAVIOR. 
          UM, THEY USUALLY A PRODUCT OF THEIR ENVIRONMENT. 
          SO, UM, AND SO THAT'S WHERE YOU'RE SORT OF SEEING THE DISCONNECT. 
          AND SO I THINK IT'S BEEN A, I THINK IT'S BEEN A MIND SHIFT, A CULTURE SHIFT WITH THE STAFF AND, AND THE CONVERSATIONS, HOW THEY HAVE CONVERSATIONS WITH FAMILIES, UM, AROUND TRYING OTHER COMMUNITY BASED INTERVENTIONS BEFORE WE GO TO THE LEVEL OF PLACEMENT. 
          AND I THINK THAT SHIFT, UM, AND REALLY, UM, YOU KNOW, SORT OF SETTING THAT REALLY HARD EXPECTATION WITH THAT THE SUPERVISOR AND THAT TEAM HAS, UH, YOU, I THINK THAT HAS BEEN THE, THE BIGGEST IMPACT. 
          YEAH, THAT'S, THAT'S GREAT. 
          WHICH BENEFITS EVERYBODY THAT YOU TALKED ABOUT EARLIER, 
          [01:30:01]
RIGHT? RIGHT. 
          THE CHILD, THE FAMILY. 
          OKAY. 
          THANK YOU. 
          YEAH, YOU'RE WELCOME. 
          ANYTHING ELSE? ALL RIGHT, WELL THANK YOU VERY MUCH. 
          GREAT, UH, PRESENTATIONS TODAY. 
          UM, OUR NEXT MEETING DATE WILL BE WEDNESDAY, SEPTEMBER 25TH AT FOUR O'CLOCK. 
          THIS MEETING IS ADJOURNED.
* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.