Act Now! Sweeping Budget Cuts Proposed For Santa Cruz County Health Services!

At first glance this complicated document below seems to deal with mostly mental health cuts, which are important. However, it goes far beyond that, impacting all aspects of health care from HIV/AIDS prevention and care to elimination and reduction of Health care for poor and/ or homeless families, dental care, Planed Parenthood and much more, including job losses. There is little time to prepare. I suggest people voice their own experiences with the current county services at the June 20th meeting and demand this proposal be shelved until better solutions are found and the community has longer to analyze these complex issues.

A rally is planned by many impacted agencies and citizens. I do encourage people to go, if only to make contact with others concerned and to plan for more direct action at the June 20th meeting. Eliminating a flawed system with no plan for the backlash is ridicules. Emergency rooms will flood, jails will fill, and Ryan Coonerty will continue to say we have the best care for the poor than any City within 100 miles. His mileage changes speech to speech.

Although I support this rally in the sense that it brings together the community surrounding the issue. Email and phone call campaigns followed by a rally I fear will simply not be effective enough. I would much rather see combined direct action by dedicated concerned citizens. A possible "SIT IN" protest where we refuse to leave in mass numbers at the June 20th meeting, demanding more time to offer solutions to fix rather than eliminate and reduce an already seriously flawed system. If all the groups impacted and all concerned people joined together, we can demand change rather than have their proposed "solution" of elimination and reduction rammed down our throats. My idea of a "SIT IN" is simply that, an idea. This report was just released. I hope others will propose new ideas and offer new solutions.

When corporations are offered massive bail out programs reaching 50+ billion a month during times of economic crisis, it is simply wrong to cut services from the most poor and vulnerable in our society. I realize this is a County issue but I also believe we can do better than this by curtailing development plans and much more.

Without the ability and time to analyze the proposed cuts, job losses, the entire county budget and the limited time allowed to speak -- the time for direct action is now. I am more than willing to participate & help in organizing. The entire 13 page budget proposal is at the bottom of this post.

I hope the SEIU attends the meeting and rally in unison.

Rally info:

"NAMI Santa Cruz County and all mental health advocates are attending a rally for the
protection of Mental Health Services in our County. The rally will be held on Tuesday June
10 at 9:30 AM in front of the County Government Building on Ocean Street. Many people with
mental illness are losing their services or will receive reduced services."

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NOTICE OF PUBLIC HEARING JUNE 20, 2008, 1:30 P.M.
BOARD OF SUPERVISORS SANTA CRUZ COUNTY
701 OCEAN STREET, 5TH FLOOR
SANTA CRUZ, CALIFORNIA
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THE COUNTY OF SANTA CRUZ, HEALTH SERVICES AGENCY, IS RECOMMENDING THE FOLLOWING REDUCTIONS IN HEALTH CARE SERVICES BECAUSE OF REQUIRED REDUCTIONS IN THE AGENCY’S BUDGET. THE BOARD OF SUPERVISORS IS LEGALLY REQUIRED TO HOLD A PUBLIC HEARING TO CONSIDER THE RECOMMENDED REDUCTIONS

At the time, date and place stated above, the Board of Supervisors shall hear and consider all objections or protests, if any, to the proposed reductions in health care services. For questions related to these assessment/service charge reports, please contact the Health Services Agency at (831) 454-5405.

The County of Santa Cruz does not discriminate and no person shall, by reason of a disability, be denied the benefits of its services, programs or activities. The Board of Supervisors Chambers is located in an accessible facility. If you wish to attend this meeting and you require special assistance in order to participate, please contact the ADA Coordinator, at (831) 454-2348 (TDD number (831) 454-2123 at least 72 hours in advance of the meeting to make arrangements.

As a courtesy to those persons affected, please attend the meeting smoke and scent free.


SERVICE REDUCTIONS:

DESCRIPTION 1- MEDICRUZ: Changes to the MediCruz Indigent Healthcare Program are proposed for July 1, 2008 and including the following modifications to eligibility- Undocumented persons will no longer have inpatient and emergency care paid for through the MediCruz program. Hospitals can bill the federal government (Center for Medical Services-CMS) for these services. In addition MediCruz eligibility will be for local residents whose income level is from Zero to 100% of Federal Poverty. Service co-payments are modified to include the following: $45.00 per hospital emergency department visit unless admitted (new), $7 per medical visit including clinic visits, specialist visits, and physical therapy (increased from $5); $10 for retinal screening exam (new) and $3 per prescription (increased from $2). MediCruz will also be moving to a preferred provider system for specialist treatment, surgery, radiology, oncology, lab services, etc.

IMPACTS: The MediCruz program services an average of 2464 individuals per year. Primary care and Dental care services to the homeless are not reduced. Undocumented individuals who may use emergency inpatient care or emergency department services are 182 per year. Federal funding can be claimed for these services. Individuals affected by the reduction to 100% of federal poverty are 209 based on prior year actuals. All 2464 individuals in the program are impacted by the co-payments if they use these services. Sites impacted are 1080 Emeline Ave., Santa Cruz and 1430 Freedom/9 Crestview in Watsonville plus Dominican, Watsonville, and Sutter hospitals.

POSITION REDUCTIONS: NONE

FINANCIAL SAVINGS OR REVENUES EARNED: The change to undocumented inpatient and emergency department services saves $520,000. The reduction from 200 to 100% of federal poverty saves $375,000. The revenues earned through the co-payments are as follows: $9450 Emergency Department visits, $9630 pharmacy, $12,010 clinic, specialist, physical therapy visits, $560 retinal screening.
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DESCRIPTION 2 - CHILDREN’S MENTAL HEALTH: Mental Health Services are reduced or eliminated for children and their families in both County and Contract programs. These services include therapy, case management, assessment, rehabilitation, therapeutic behavioral services, and medication. Sites impacted include all schools, Juvenile Hall, Dominican and Watsonville Hospitals, County Clinics at 1400 Emeline Ave., Santa Cruz and 12 West Beach, Watsonville, Pajaro Valley Prevention and Student Assistance at 335 E. Lake Ave., 240 E. Lake Ave., and 294 Green Valley Rd. in Watsonville, Family Service Agency of the Central Coast at 104 Walnut Ave., Santa Cruz and 11-D Alexander St. in Watsonville, Parents Center at 530 Soquel Ave. in Santa Cruz and 255 E. Lake Ave. in Watsonville, Volunteer Center of Santa Cruz/Family Partnership/Child & Family Advocacy at 300 Harvey West Blvd., Santa Cruz County Community Counseling Centers at 241 E. Lake Ave., 9 Marea Ave., and 9-C Marea Ave. in Watsonville and 709 Mission St. in Santa Cruz, Santa Cruz Community Counseling Center, Court Ward at 241 E. Lake Ave. in Watsonville and 191 Harvey West Blvd. in Santa Cruz, Santa Cruz Community Counseling Center, Court Dependents at 191 Harvey West Blvd. and 290 Pioneer St. in Santa Cruz and 360 Whiskey Hill Dr. in Watsonville, and Unity Care, Inc. at 237 Race St., San Jose, CA.

IMPACTS: These reductions will eliminate services to approximately 500 children/youth and their families, a combination of ongoing intensive treatment as well as crisis-oriented services at local hospitals and juvenile hall. Additionally, 160 children/youth will not receive services from Children’s contract agencies.

POSITION REDUCTIONS: 20.5 County positions are reduced. Contractor reductions amount to 10% across the board in county funds, and approximately 10 FTE clinicians across multiple contractors.

FINANCIAL SAVINGS OR REVENUES EARNED: These reductions will result in approximately $1.9 million in cost avoidance, including local, state and federal revenues. In addition, approximately $600,000 in Contractor costs will be avoided, also including local, state and federal revenues. Expect County foster care costs and inpatient services to rise with reduced treatment options for Probation wards and Child Welfare dependents.
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DESCRIPTION 3 – ADULT MENTAL HEALTH: There are reductions to all programs as detailed below. County programs are listed first and then contract programs.

ACCESS AND ACUTE SERVICES:
Eliminate 2.5 FTE of Senior Mental Health Client Specialists from Access/Crisis services. The elimination of these positions significantly limits the ability to provide crisis and assessment services at the entry point of services to County Mental Health.
1.Positions impacted: County positions: 2.5 FTE of Senior Mental Health Client Specialists.
2.Impact on clients: There are currently 325 assessments conducted, 617 face-to-face crisis/walk-in services provided and 4,447 logged contacts annually in Access with 4.5 FTEs. With a reduction in staffing, wait times will likely increase and fewer people will be able to be seen.
3.Money saved or costs avoided: $280,720.
4.Sites impacted: North County Mental Health Services at 1400 Emeline Avenue and 12 West Beach in Watsonville.

DETENTION HEALTH SERVICES:
Eliminate 1.0 FTE of Senior Mental Health Client Specialist from Jail Crisis Services. The elimination of this position would have significant impact of the delivery of Jail Crisis Mental Health Services. The Jail Crisis Intervention Team (CIT) service provides mental health evaluations for individuals who appear at risk or suffer from a major psychiatric condition. The Jail CIT service had over 2,500 inmate contacts last year.
1.Positions impacted: County position: 1.0 FTE of Senior Mental Health Client Specialist.
2.Impact on clients: CIT services have an average of 134 cases open each month to mental health crisis services in the Water Street Jail facility. This position is the primary provider of these services. The ability to provide crisis assessments and services will be reduced by approximately 75%.
3.Money saved or costs avoided: $106,566.
4.Sites impacted: Water Street Jail.

Reduction in Jail Pharmacy expenditures based on new formulary. With the assistance of the new Forensic Psychiatrist, the formulary at the Jail for consumers with mental health conditions was updated to take into account current standards of care for Jail service.
1.Positions impacted: none
2.Impact on clients: Change of medication available in formulary.
3.Money saved or costs avoided: $50,000.
4.Sites impacted: Water Street Jail.

LOCKED SKILLED NURSING BED WITH SPECIALTY SUPPORTS:
Eliminate 1 specialty locked care bed at Telecare in Alameda County. This particular contract was to meet the needs of a specific individual with complex mental health and physical health care needs. This bed was discontinued when the individual passed away this past year.
1.Positions impacted: none
2.Impact on clients: none
3.Money saved or costs avoided: $90,908.
4.Sites impacted: Telecare Alameda County

LOCKED SKILLED NURSING BEDS FOR CONSERVATEES:
Reduce locked care beds by 3 at Creekside and 7th Avenue Center.
1.Positions impacted: none
2.Impact on clients: This will result in a loss of 3 locked care beds for consumers that are conserved and require intensive locked care services due to grave disability.
3.Money saved or costs avoided: $157,942.
4.Sites impacted: Creekside, Santa Rosa - 2 beds reduced & 7th Avenue Center, Santa Cruz (Front Street, Inc) – 1 bed reduced

HOSPITAL CARE:
Reduce Dominican Behavioral Health bed utilization by $100,000 of Medi-Cal expenditures and $20,000 of indigent utilization. These figures are based on the estimated actuals for BY 2007-2008.
1.Positions impacted: none
2.Impact on clients: none
3.Money saved or costs avoided: $120,000.
4.Sites impacted: Dominican Behavioral Health Unit, 1555 Soquel Dr., Santa Cruz

JANUS SOBERING BED:
Eliminate Janus Sobering bed contract, which served as a diversion site from Dominican Behavior Health. This helped to deflect costs from in-patient services.
1.Positions impacted: Contract: Unclear if Janus positions are affected.
2.Impact on clients: Rather than utilize an in-patient bed for individuals who are recovering from intoxication, individuals that could be safely diverted were allowed up to three days in the Sobering bed.
3.Money saved or costs avoided: $52,700.
4.Sites impacted: Janus, 200 – 7th Ave., Santa Cruz.

OUTPATIENT SUPPORT & SERVICES:
Eliminate Santa Cruz Community Counseling Center’s (SCCCC) Intensive Community Assertive Treatment Team.
1.Positions impacted: Contract: Santa Cruz Community Counseling Center - 6.5 FTE’s.
2.Impact on clients: This team has focused on serving 75 individuals with a serious psychiatric disability as well as a serious substance abuse problem; many of these individuals have criminal justice involvement and are homeless.
3.Money saved or costs avoided: $633,154.
4.Sites impacted: field based service

Eliminate 7.0 FTE County Mental Health Client Specialist positions on outpatient teams. We currently have 5 Adult and Older Adult Teams that provide case management services, 3 of these teams are Full Service Partnerships that provide intensive case management support services, 2 are general teams that serve all of North and South County.
1.Positions impacted: County: 7.0 FTE Mental Health Client Specialist positions.
2.Impact on clients: This reduction of staff will have significant impacts on our ability to continue providing person centered support to assist individuals in maintaining their housing, finding meaningful daily activities and preventing hospitalizations and locked care. Caseload size will potentially double to 60 clients to each FTE. Case management services will be provided to those individuals with high intensity needs.
3.Money saved or costs avoided: $808,812.
4.Sites impacted: North County at 1400 Emeline and South County Mental Health Clinics at 12 W. Beach St., Watsonville.

ON-CALL SERVICES:
Reduce the number of After Hour On-Call Staff Services by consolidating from 6 teams responding 7 days per week after hours and on weekends to 1 team.
1.Positions impacted: Loss of on-call pay to SEIU employees.
2.Impact on clients: This eliminates specialty services by teams who have long relationships with clients, know their history and have the ability to diffuse crisis situations, thus creating increased risk of in-patient admissions.
3.Money saved or costs avoided: $100,000.
4.Sites impacted: field based services

THERAPY SERVICES:
Significantly reduce use of Medi-Cal Managed Care panel contract providers.
1.Positions impacted: Currently 50 community providers in panel. Will reduce number of providers by an unknown number.
2.Impact on clients: Limited access to community providers for Medi-Cal managed care therapy services. Number of sessions will be limited and referral to internal therapy pool within County Mental Health to provide services to offset loss of services.
3.Money saved or costs avoided: $113,365.
4.Sites impacted: Countywide.

THERAPY SERVICES FOR MEDICARE PATIENTS:
Restructure Family Service Association’s Renaissance program that provides therapy services to Medicare recipients by utilizing Mental Health Service Act one-time funds to pilot revised program.
1.Positions impacted: none
2.Impact on clients: Medicare therapy services will be focused on supporting those individuals with a history or at risk of in-patient hospitalization.
3.Money saved or costs avoided: $40,000
4.Sites impacted: Family Services Offices in Watsonville and Santa Cruz

PATIENT TRANSPORTATION:
Reduce funding for consumer transportation and staff mileage.
1.Positions impacted: none
2.Impact on clients: 6-10 rides per week
3.Money saved or costs avoided: $20,000.
4.SITES IMPACTED: N/A

STORAGE OF CLIENT BELONGINGS:
Significantly reduce rental storage space for consumer belongings to be used while in locked care.
1.Positions impacted: none
2.Impact on clients: No place to store belongings when between housing or in locked care. 15-20 patients per month.
3.Money saved or costs avoided: $25,000.
4.Sites impacted: n/a

HOUSING LOAN FUNDS:
Reduce funding to consumer housing loan fund that provides first/last month and deposit funds for securing housing.
1.Positions impacted: none
2.Impact on clients: Less money to assist clients to access housing. 15 patients per year estimated impact.
3.Money saved or costs avoided: $11,000.
4.Sites impacted: n/a

Residential Treatment Programs:

DRAKE HOUSE CONTRACT FOR ADULTS AND OLDER ADULTS WITH MENTAL ILLNESS:
Eliminate Drake House 5-bed contract that provided specialty mental health care to seniors with complex medical conditions.
1.Positions impacted: Contract: Front Street Inc – 0 positions lost.
2.Impact on clients: Older adults with complex medical problems no longer have a Board and Care level facility for their specialty needs.
3.Money saved or costs avoided: $318,800.
4.Sites impacted: Drake Residential operated by Front Street, Inc at Drake St., in Monterey.
PALOMA HOUSE:
Eliminate Paloma 12-bed residential dual diagnosis treatment program in South County.
1.Positions impacted: Contract: Santa Cruz Community Counseling Center – 7.5 FTEs.
2.Impact on clients: 55 clients serviced annually. It is the only residential dual diagnosis treatment program in the county.
3.Money saved or costs avoided: $447,367.
4.Sites impacted: Located at 321 East Beach St. in Watsonville. This is the only residential treatment program in South County.

OPAL CLIFFS AND DARWIN HOUSE:
Eliminate Opal Cliffs and Darwin House Residential Social Rehabilitation programs that provided 30 treatment beds focused on learning independent living skills which would enable clients to move to permanent independent housing in the community.
1.Positions impacted: Contract: Front Street, Inc – 22 FTEs inclusive of both programs.
2.Impact on clients: There are 81 clients served by these programs annually. These programs are “step-down” programs from higher levels of care. The programs focus on teaching independent living skills in preparation for permanent housing. Individuals can stay in these programs for up to 18 months.
3.Money saved or costs avoided: $1,088,432.
4.Sites impacted: Front Street Inc., 126 Front St., Santa Cruz; Opal Cliffs, 4795 Opal Cliff Dr., Santa Cruz; Capitola & Darwin, 707 Darwin, Santa Cruz.

Convert the 16-bed El Dorado Residential program to a Board and Care facility. This program has been used as a “step down’ from DBHU and locked care.
1.Positions impacted: Contract: Santa Cruz Community Counseling Center – 6 FTEs.
2.Impact on clients: This conversion will significantly reduce staff and program services to consumers who are stepping down from acute levels of care. It also serves as an in-patient diversion placement for individuals that need additional support and structure. There are 325 clients served there annually. Conversion to a Board and Care will eliminate the ability to serve individuals that are sub-acute at this site.
3.Money saved or costs avoided: $73,000 County General Fund.
4.Sites impacted: El Dorado Center, 941 El Dorado Ave., Santa Cruz County.

Day Support Programs:
VOLUNTEER CENTER:
Drastically reduced pre-employment and education support services from contract with Volunteer Center.
1.Positions impacted: Contract: Volunteer Center – 5.5 FTEs.
2.Impact on clients: 400 individual consumers annually for Puentes Homeless program, Transition Age Youth, students at Cabrillo College and clients using pre-employment services to prepare for Department of Rehabilitation services and support.
3.Money saved or costs avoided: $485,124
4.Sites impacted: Community Connections operated by the Volunteer Center, 300 Harvey West Blvd., Santa Cruz

MENTAL HEALTH CLIENT ACTION NETWORK:
Cut $25,000 from Mental Health Client Action Network self-help advocacy program’s Friends Program.
1.Positions impacted: Contract: Mental Health Client Action Network - .5 FTE.
2.Impact on clients: The Friends Program serves 25 clients per year to match volunteers with mental health clients to assist them with developing natural supports.
3.Money saved or costs avoided: $25,000.
4.Sites impacted: MHCAN, 1051 Cayuga St., Santa Cruz.

PIONEER DUAL DIAGNOSIS DAY TREATMENT:
Reduce Santa Cruz Community Counseling Center’s Pioneer Treatment Program that serves 16 dually diagnosed homeless consumers in a day treatment program. This program will be partially refinanced by the Mentally Ill Offender grant.
1.Positions impacted: Contract: Santa Cruz Community Counseling Center – 2.4 FTEs.
2.Impact on clients: Previous program was able to serve 110 clients per year. New program will have reduced services and serve 70 clients per year.
3.Money saved or costs avoided: $142,000.
4.Sites impacted: Pioneer House, 290 Pioneer St., Santa Cruz Community Counseling Center, Santa Cruz.

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DESCRIPTION 4 - PUBLIC HEALTH: Reductions in public health services and administrative support are included in both the County Programs and contract agencies. These reductions will result in reduced access to care in terms of physical and occupational therapy for children, case management, nursing services, oral health, risk reduction counseling, follow-up for Sexually Transmitted Diseases, and emergency response, as well as reduced nutritional services at school sites and field-based services to families in the community. Sites impacted include reduced services for County programs at: 1080/1070/1060 Emeline, Santa Cruz; 12 West Beach, Watsonville; 1430 Freedom Blvd, Watsonville; 115A Coral Street, Santa Cruz; 4444 Scotts Valley Drive, Suite 5, Scotts Valley; 140 Herman Ave., Watsonville; and 18 East Lake Avenue, Suite G, Watsonville. Contract sites with reduced services are as follows: Salud Para La Gente, 204 E Beach, Watsonville; Dientes Community Dental Clinic, 1830 Commercial Way, Santa Cruz; Planned Parenthood, 1119 Pacific Ave., Santa Cruz; Santa Cruz Women’s Health Center, 250 Locust Street, Santa Cruz; Santa Cruz AIDS Project, 113 Cooper St., Santa Cruz; Santa Cruz AIDS Project Watsonville, 326 Main, Watsonville; Santa Cruz AIDS Project Drop-In Center, 412 Front St., Santa Cruz; Janus of Santa Cruz, 200-7th Avenue, Santa Cruz.

IMPACTS:

COMMUNICABLE DISEASE:
Significantly decreased Sexually Transmitted Diseases (specifically chlamydia) follow-up capacity because:
- 0.5 FTE of PHN time will be moved to the immunization Program.
Decreased emergency response capacity due to loss of 2.5 FTE.
Supervising PHN III (0.8 FTE) will have additional responsibilities/direct reports, as her supervisor will be assigned responsibility of Family Health Unit.
Diminished oversight capacity in unit due to additional responsibility of the Family Health Unit being assigned to the CD Manager.

HOMELESS PERSONS HEALTH PROJECT:
A 0.50 FTE PHN/Nurse Practitioner was deleted in Project Connect, which would have supported doubling of provider hours and clinic visits in Coral Street Clinic.
It will likely be necessary to reduce Nurse Practitioner hours dedicated to Project Connect, so that he/she can increase his/her provider hours for Coral Street Clinic.
This results in further reduction of staff time dedicated to Project Connect, and reduction in the number of individuals that can be outreached and enrolled in that project next year. Project Connect carries a point-in-time caseload of 70, and the intervention lasts 18 months per client, on average. The point-in-time caseload will need to be reduced by 10 to 20 clients.
A 1.0 FTE Senior Mental Health Client Specialist was deleted in the HRSA Health Care for the Homeless Program, Youth and Families Team. This position is a critical part of a very small interdisciplinary team (make-up is: 1 Supervising LCSW, 1 Public Health Nurse, 1 Mental Health Client Specialist and 1 MSW intern) that focus on homeless health outreach, care and care coordination services to homeless run-away youth, and families with young children.
The homeless youth (including transitional-aged young people 12-24 years old) targeted are outreached primarily in the downtown and surrounding areas of Santa Cruz. Many are young people who have blown out or aged out of the foster care system locally and in surrounding counties. The families targeted come primarily from the Rebele Family Shelter and the Pajaro Valley Shelter Services and Salvation Army Programs in Watsonville.
Eliminating this position means that we will be left with a two-person team to provide services to this population throughout the county. Services will be limited to medical triage and crisis response. Intensive case management focused on integrating housing, health, employment, and other needed services to support long-term change for this population will be discontinued.
An estimated 20 of 70 homeless and previously homeless adults will lose access to money management (representative payee) services and may be at risk to lose housing.

CHRONIC DISEASE PREVENTION – HEALTH EDUCATION:
HSA's involvement with the community-wide efforts to work towards reducing childhood obesity/overweight will be severely curtailed. With limited County resources, we will be providing fewer classrooms with oral health presentations which include how to brush and floss.
We will be unable to participate in Go For Health! and Diabetes Regional Collaborative unless it aligns with what we are obligated to do in our State grants, primarily as it relates to the OTS grant and bicycle/pedestrian safety. We will be unable to provide support to the Fitness Subcommittee, the Food Industry Subcommittee, the Youth and Environment subcommittee and the Steering Committee. We will be unable to sit on the Regional Diabetes Collaborative and participate on the Policy Subcommittee and Steering Committee.
HSA’s efforts to provide leadership on the obesity epidemic will be severely limited due to fewer staff available to work on this important public health issue.
We will be only be able to provide nutrition education to a few schools and a few grades and we won't be able to offer food tastings as part of the nutritional educational experience. A nutrition education contract with Pajaro Valley Unified School District will be eliminated. Impact on 300 kids.

HIV/AIDS SERVICES:
Programmatic oversight for HIV/AIDS Services will be reduced and consolidated.
Education & Prevention - We will no longer be able to work with a facilitated HIV prevention group for Spanish Speaking men who have sex with men. This group provides support to a high-risk group to help them stay HIV negative. Prevention counseling to those who are infected or at high risk of becoming infected will be limited. Fewer HIV tests will be administered due to reduced staffing availability.
CARE Team/Early Intervention Services - Nurse Case Management for persons living with HIV/AIDS will be reduced. Nurses and Social Workers will maintain higher caseloads and clients will receive less attention and support than in prior years.
The county-funded portions of the HIV/AIDS contract with Santa Cruz AIDS Project will be reduced by 10%.

FAMILY HEALTH:
Reduction from 3 FTE Nurse positions to1.5 FTE Nurse positions for the collaborative HSA/HSD effort for Families Together and Primeros Pasos. There are 120 cases alone in the Families Together program and these reductions will severely limit activities and both of the programs’ abilities to achieve the desired outcomes.

EMERGENCY PREPAREDNESS:
Total preparedness funding from federal sources decreased by $200,000 in federal CDC/Hospital Preparedness Programs and from the elimination of federal Pandemic Influenza funds. These cuts necessitate the elimination of 2.0 FTE and diminution of program activities. Plans for significant outreach to the healthcare sector and the public must be curtailed, hampering the county’s ability to coordinate medical surge activities. There will be only one functional exercise planned versus prior year averages of 3-5/year. Plans for establishing Alternate Care Centers must be significantly reduced.

POSITION REDUCTIONS: 38.20 County positions were reduced.

FINANCIAL SAVINGS OR REVENUES EARNED: $4.6 million savings in position reductions including 5% salary savings; $400,000 savings in contracted service reductions.


DESCRIPTION 5 – PRIMARY CARE CLINICS: Walk-in immunizations for both Children and Adults will only be available from 1:00-5:00 p.m. daily. Previously, these services were also available from 8:00 a.m. – 12:00 p.m. Behavioral counseling services to about 250 patients have been cut. The budget for MediCruz pharmaceuticals has been reduced, necessitating a reduced formulary. Education services for diabetic MediCruz patients will no longer be available; patients will be referred to the Diabetic Teaching Center. Fewer hours will be available for Patient Assistance for medications due to reduced staff. Sites impacted are the 9 Crestview facility in Watsonville and the 1080 Emeline Ave. Clinic in Santa Cruz.

IMPACTS: Reductions in staff and services will result in longer waits for appointments and for assistance in receiving free medications. Longer waits will impact approximately 7349 patients.

POSITION REDUCTIONS: 4.5 FTE total positions cut.

FINANCIAL SAVINGS OR REVENUES EARNED: Reduction in walk-in hours for immunizations will result in $64,000 in savings, but the number of patients affected is unknown. Cutting behavioral counseling services will result in $94,000 savings affecting 250 patients. Cuts to the pharmaceutical budget result in $106,090 with the number of patients affected unknown. Reducing diabetic teaching services results in $27,000 savings.


DESCRIPTION 6 – PUBLIC GUARDIAN: The changes to the Public Guardian’s Office are proposed for July 1, 2008 and include the elimination of one full time position. In addition, the office has moved to the basement of 1080 Emeline, Santa Cruz, CA.

IMPACTS: The Public Guardian’s office will continue to accept cases but will have less time to monitor each case.

POSITION REDUCTIONS: One Deputy Public Guardian

FINANCIAL SAVINGS OR REVENUES EARNED: None.


DESCRIPTION 7 – SUBSTANCE ABUSE: Cuts to services in the Alcohol and Drug Program will affect residential treatment programs, alternatives to incarceration for jail inmates whose alcohol and drug abuse is an underlying factor in criminal involvement, outpatient and day treatment services, Prevention Program, and the public information and referral line, which assists the public in how to access local treatment programs. Sites impacted are the Hermanas facility at 640 Rodriguez St. in Watsonville, the Mental Health Clinic at 1400 Emeline Ave., Santa Cruz, Jail Transition Counselor Program – Water Street Jail in Santa Cruz, Outpatient and Adult Drug Court Services – Water Street Jail and Outpatient services 1400 Emeline, Santa Cruz, Prevention Services – community public settings).

IMPACTS: Partial year funding will keep Hermanas, a 16-bed treatment program for women and children, open until December 31, 2008. Closure would affect 75 clients. Elimination of the Jail Transition Counselor Program will affect 180 jail inmates per year, who will likely spend more time in jail or prison without this alternative program. Reduction in Outpatient and Adult Drug Court services will impact 65 clients. Elimination of the Prevention Program will result in decreased availability of prevention services in schools and lost opportunities for collaboration with community partners to prevent alcohol and drug problems locally. Losses of positions in administration will reduce ability to staff the public information and referral line.

POSITION REDUCTIONS: A loss of 9.5 FTE positions in county and contract agencies.

FINANCIAL SAVINGS OR REVENUES EARNED: Closure of Hermanas will save approximately $180,000 in 2008-09 and $360,000/year in subsequent years. Elimination of the Jail Transition Counselor Program will save approximately $94,036 per year. Reduction in the Outpatient and Adult Drug Court services will result in $59,850 in savings. Decreasing the Prevention Program will save $94,414, and administrative staff cuts will save $37,527.